Original Articles

Determinants of Multi-Drug Resistant Tuberculosis among Tuberculosis Patients in Southern Ethiopia: A Case Control Study


Background: Multi-drug resistance tuberculosis (MDR) have been a hazardous concern both in developed and developing countries. Little information is available regarding the determinants of MDR-TB in Ethiopia, and hence, We assessed the probable determinants of MDR-TB in Southern Ethiopia. Methods: A case-control study was conducted. Cases were TB patients with simultaneous resistance to at least rifampicin (RMP) and isoniazid (INH) and controls were TB patients who were susceptible to first line TB drugs and registered as cure or treatment completed from March 2016 to March 2018. We used simple random sampling method to select cases and controls. Data were collected using semi-structured questionnaire with face to face interview and patients’ clinical record review. Bivariate and multivariate logistic regression analysis was done to determine determinants of MDR-TB. Significance level was adjusted at p-value <0.05.  Results: A total 102 cases together with 102 controls participated in the study. The mean age for cases and controls were 35.6 years (SD± 13.6) and 31.2 years (SD ±15.4) respectively. Factors that independently predicted MDR-TB were: time to reach health facility taking more than three hours (AOR 2, 95%CI=0.10-0.45), history of contact with known MDR-TB patients (AOR 6, 95%CI=1.8-19.7), patients with no formal education (AOR 4.40, 95%CI=1.7-13.3), patients who didn’t get counseling (AOR 5, 95% CI=1.8-14) and patients who didn’t hear about MDR-TB (AOR 6.8, 95% CI=2.99-15.3). Conclusion: Multiple factors predicted MDR-TB. Patients: at distant location, with known contact history of MDR-TB patients, with low level of literacy, who lack information on MDR-TB and who didn’t get counseling deserve special attention.

World Health Organization. Global tuberculosis report Geneva.2015

World Health Organization. Global tuberculosis report, Geneva, WHO 2017

WHO Definitions and Reporting Frame work for Tuberculosis 2013 revision, Geneva.

Chiang CY, Centis R R, Mig lire GB. Drug resistant tuberculosis: past, present, future. Respirology. 201015:413–432.

FMOH Guideline on programmatic Management of Drug Resistant Tuberculosis in Ethiopia December Addis Ababa 2013

Federal Ministry of Health of Ethiopia. Guidelines for Clinical and Programmatic management of TB, TB/HIV and leprosy in Ethiopia 5th ed. Addis Ababa 2013.

, Mahratta SB. Multidrug resistant tuberculosis burden and risk factors: An update. Kathmandu University Med J; 2010 8:116 -125.

Zetola NM, Morongo C, Kip EC, Gross R, Bison GP, Colman RG. Alcohol use and abuse among patients with multidrug-resistant tuberculosis in Botswana. Int J Tuberc Lung Dis. 2012;16: 1529–34.

, Casal M, Vaquerom H. Rinder H. A Case-Control study for multidrug-resistant tuberculosis: Risk factors in four European Countries. Microb Drug Resist 2005; 11: 62 - 67.

, Range, N., Friis, H., Mfaume, S., Magnussen, P., Chanualucha, J., Kilale, A., Mugomela, A. and Andersen, A.B. (2012) Anti-Tuberculosis Drug Resistance Pattern among Pulmonary Tuberculosis Patients with or without HIV infection in Mwanza, Tanzania. Tanzania Journal of Health Research, 1-6.

Bang, D.) The Management of Tuberculosis: Epidemiology, Resistance and Monitoring. Dansh M edicalBulletin, (2010).

Mahratta, S. (2010) Multi-Drug Resistant Tuberculosis Burden and Risk Factors: An Update. Kathmandu UniversityMedicalJournal,8, 116-125.

WHO. Global tuberculosis report. Geneva, Switzerland: WHO press; 2015

, Wryer K, Brand J, Lancaster Levin J, vanderwalt M. Determinants of multidrug-resistant tuberculosis in South Africa: results from a national survey. Safer Med J 2007; 97:1120-1128.

, peter –olupot et.al Multi-drug resistant tuberculosis (MDR-TB) in emerging economies in sub-Saharan Africa April 2017

, World Health Organization. Drug-resistant tuberculosis now at record levels. Geneva: WHO press; 2010

, World Health Organization. Anti-tuberculosis drug resistance in the world: fourth global report. Geneva: WHO press; 2008.

, Hirpa S, Medhin G, Girma B, Melese M, Mekonen A, Suarez P, et al. Determinants of multidrug-resistant tuberculosis in patients who underwent first-line treatment in Addis Ababa: a case control study. BMC Public Health. 2013; 13 (1):1–9.

Biadglegne F, Sack U, Rodloff AC. Multidrug-resistant tuberculosis in Ethiopia: efforts to expand diagnostic services, treatment and care. Antimicrob Resist Infect Control.2014;3(1):1-10.

Migliori GB, Dheda K, Centis R, Mwaba P, Bates M, O’Grady J, et al. Review of multidrug-resistant and extensively drug-resistant TB: global perspectives with a focus on sub-Saharan Africa. Tropical Med Int Health. 2010; 15(9):1052–66.

World Health Organization. Global tuberculosis report. Geneva. WHO 2017.

National comprehensive tuberculosis leprosy and TB/HIV training manual for health worker Addis Ababa November 2016

FMOH Guideline on Programmatic Management of Drug Resistance in Ethiopia December 2013 Addis Ababa.

, Demelash Assefa et.al.Determinants of multi drug resistant TB Addis Ababa July 2017

Caminero, J.A. (2010) Multidrug-Resistant Tuberculosis: Epidemiology, Risk Factors and Case Finding. International Journal of Tuberculosis and Lung Disease, 14, 382-390.

, Farazi, A., Sofian, M., Zarrinfan, N., Katebi, F., Hoseini, S. and Keshavarz, R. (2013) Drug Resistance Patterns and Associated Risk Factors of Tuberculosis in the Central Province of Iran. Caspian Journal of Internal Medicine, 4, 785-789.

Hirpa et al. BMC Public Health, determinants of Multi-drug resistance tuberculosis 2013, 13:782]

Caminero JA. Multidrug-resistant tuberculosis: epidemiology, risk factors and case finding. Int J Tuberc Lung Dis 14 (4): 382 – 390.

, Risk Factors for Drug-Resistant Tuberculosis. Journal of Tuberculosis Research, 2, 111-118.

Risk Factors forMultidrug-Resistant Tuberculosis among Patients with Pulmonary Tuberculosis at the Central Chest Institute of Thailand. PLoS ONE 10(10): e0139986.doi: 10.1371/journal.pone.0139986]

MulatYimeret.al.Risk factors for multidrug resistant tuberculosis patients in Amhara National Regional State, 2014.

Assefa et al, Infection and Drug Resistance 2017:10 209–213

Demelash Assefa et al. Determinants of multi-drug resistance tuberculosis Addis Ababa Ethiopia; 2017: 10209-213

The pan African Medical Journal. 2016; 25(Sup 2): 5.doi: 10.11604/pamj.supp. 2016. 25.2.9203]d

G. Mulisa et al. International Journal of Infectious Diseases 39 (2015) 57–61]

Sharma SK, Turaga KK, Balamurugan A, Saha PK, Pandey RM, Jain NK, et al. Clinical and genetic risk factors for the development of multidrug-resistant tuberculosis in non-HIV infected at a tertiary care center in India: a case-control study. Infect Genet E vol 2003; 3: 183-8.

Sushil c Baral et.al. The importance of counseling and financial support to patients receiving treatment for multi-drug resistance tuberculosis mixed qualitative and pilot interventional study 2014 (4:46)

International journal of microbiology a cross sectional study knowledge attitude toward MDR and XDR drug resistance June 2016: 128-134

IssueVol 8 No 1-2 (2019) QRcode
SectionOriginal Articles
Determinants MDR-TB Southern Ethiopia.

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How to Cite
Fikre A, Tewelde T, Shaweno T. Determinants of Multi-Drug Resistant Tuberculosis among Tuberculosis Patients in Southern Ethiopia: A Case Control Study. J Med Bacteriol. 8(1-2):1-12.