Risk Factors for Drug-Resistant Tuberculosis: An Unmatched Case-Control Study, Nigeria-2018

  • Anti-microbial resistance
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Background: In Nigeria, drug-resistant tuberculosis (DR-TB) is a growing threat to tuberculosis (TB) control and a major public health problem. In 2017, Nigeria accounted for the highest incidence of multidrug-resistant or rifampicin-resistant tuberculosis (MDR/RR-TB) in Africa with an estimated 24,000 new cases. Understanding the risk factors for DR-TB is key to developing appropriate control strategies. We therefore investigated the risk factors for DR-TB in Nigeria.
Methods: We conducted an unmatched 1:2 case-control study from April 24 to July 12, 2018 using 180 cases and 360 controls selected randomly from DR-TB treatment centers across the country. Cases were bacteriologically diagnosed pulmonary TB patients ≥18 years old with TB resistant to either rifampicin or rifampicin and isoniazid, while controls were bacteriologically diagnosed pulmonary TB patients ≥18 years old with TB sensitive to rifampicin. We collected data using a structured questionnaire and reviewed medical records. We calculated adjusted odds ratios (aOR) with their corresponding 95% confidence intervals (CI) to identify independent risk factors for DR-TB.
Results: The mean age was 36.1±12.6 years for cases and 36.6±13.6 years for controls. Males constituted 110 (61.1%) and 223 (61.9%) of cases and controls respectively. A higher proportion of cases (50.6%) as compared to controls (12.8%) were previously treated for TB (p<0.001). However, there was no significant difference in proportion of cases (16.7%) and controls (20.0%) with HIV co-infection (p=0.351). Independent risk factors for DR-TB were: previous TB treatment (aOR=6.22; 95% CI:3.89-9.92), poor anti-TB drug adherence (aOR=1.64; 95% CI:1.03-2.61) and poor socio-economic status (aOR=1.82; 95% CI:1.16-2.87). HIV co-infection was not a risk factor (aOR=1.16; 95% CI:0.67-2.02).
Conclusions: Risk factors for DR-TB in Nigeria were previous TB treatment, poor drug adherence and poor socio-economic status. We shared the findings with the National TB control Program and recommended to the program to prioritize these factors during screening for DR-TB.

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