Characteristics of multidrug-resistant tuberculosis in Namibia

Abstract

BackgroundTo describe the epidemiology and possible risk factors for the development of multidrug-resistant tuberculosis (MDR-TB) in Namibia.MethodsUsing medical records and patient questionnaires, we conducted a case-control study among patients diagnosed with TB between January 2007 and March 2009. Cases were defined as patients with laboratory-confirmed MDR-TB; controls had laboratory-confirmed drug-susceptible TB or were being treated with WHO Category I or Category II treatment regimens.ResultsWe enrolled 117 MDR-TB cases and 251 TB controls, of which 100% and 2% were laboratory-confirmed, respectively. Among cases, 97% (113/117) had been treated for TB before the current episode compared with 46% (115/251) of controls (odds ratio [OR] 28.7, 95% confidence interval [CI] 10.3–80.5). Cases were significantly more likely to have been previously hospitalized (OR 1.9, 95% CI 1.1–3.5) and to have had a household member with MDR-TB (OR 5.1, 95% CI 2.1–12.5). These associations remained significant when separately controlled for being currently hospitalized or HIV-infection.ConclusionsMDR-TB was associated with previous treatment for TB, previous hospitalization, and having had a household member with MDR-TB, suggesting that TB control practices have been inadequate. Strengthening basic TB control practices, including expanding laboratory confirmation, directly observed therapy, and infection control, are critical to the prevention of MDR-TB.

Risk factors for multidrug resistant tuberculosis patients in Amhara National Regional State.

“…History of TB treatment failure was one of the strongest predictors for having MDR-TB. This conforms to other studies conducted in different parts of the world 14,[17][18][19][20][21] . Similarly, a nationwide anti-TB drug resistance survey conducted Key: ANRS (Amhara National Regional State), COR (Crude odds ratio), AOR (Adjusted odds ratio)…”

“…An association between history of close contact with MDR-TB patients and subsequent MDR-TB cases in this study conforms to other studies 18,19,25 . The association between history of close contact with MDR-TB patients and MDR-TB strain would be attributable to acquiring of primary drug resistant bacteria from the patient.…”

“…The association between TB treatment failure and MDR-TB might be related to unsatisfactory compliance by patients or clinicians, lack of supervision of treatment, improper drug regimens and inadequate or irregular drug supply that may potentiate drug resistance 14,[17][18][19][20][21] . Furthermore, those TB patients who had history of > 2 times anti TB treatment were 1.9 times more likely to be at risk of developing MDR-TB.…”

Barriers to access to antiretroviral treatment for HIV-positive tuberculosis patients in Windhoek, Namibia

“…Inconsistent recordkeeping was already observed in Namibian TB services [27]. It is acknowledged as a barrier to ART [9] and implies underreporting of national data.…”

“…This obstacle to adequate staffing in TB units should be actively addressed by imparting knowledge on the actual risk of TB infection to all clinical staff. Also, national TB infection control guidelines must be updated in order to reflect the latest WHO policy [25,26], and implementation of the guidelines must be improved [27].…”