Multidrug‐resistant TB in Zambia: review of national data from 2000 to 2011

Abstract

Abstractbackground Multidrug-resistant tuberculosis (MDR-TB) is posing a great threat to global TB control. The burden in Zambia is not well defined because routine surveillance data are scarce. We reviewed national MDR-TB data for the last decade to inform future public health policy with respect to MDR-TB in Zambia.method Retrospective review of national surveillance of MDR-TB data, TB programme and laboratory reports between 2000 and 2011.results The total number of DSTs performed during this 11-year period was 2 038 and accounted for 2.6% (2 038/78 639) of all the retreatment cases notified. The total number of diagnosed MDR-TB cases for this period was 446, of which 56.3% (251/446) were male and 41.7% (186/446) female. Only one child was found to have MDR-TB. Poly-drug resistance accounted for 18.9% (172/ 911) of the DR-TB cases and 8.4% of the total DSTs. 8.8% (80/911) of the DR-TB cases showed either rifampicin mono-or poly-resistance other than MDR-TB. No XDR-TB was reported. There were no data available on DR-TB and HIV co-infection. Only 65 MDR-TB patients were notified and put on second-line treatment according to WHO guidelines.conclusions Multidrug-resistant tuberculosis may be an emerging challenge in Zambia. There is a need to invest in improving the capacity of the TB programme to detect and manage MDR-TB.

Rifampicin resistance in mycobacterium tuberculosis patients using GeneXpert at Livingstone Central Hospital for the year 2015: a cross sectional explorative study

“…In this study we showed that GeneXpert identified 9 (5.9%) cases of rifampicin resistant TB out of the total (152) cases of TB in the year 2015 at Livingstone Central Hospital (LCH). The prevalence of rifampicin resistance in the current study is consistent with other published studies [ 12 , 13 ]. However, a much lower and higher proportion was found in a study which was conducted in India [ 14 ] and in Ghana [ 3 ], respectively.…”

“…The case of MDR-TB and co-infection with HIV may need further investigation as the cases of HIV negative participants were very few (2) in the sample population under our study. A study conducted in Zambia [ 13 ] that reviewed records from 2000 to 2011 found no data available on MDR-TB / HIV co-infections and this was attributed to inadequate reporting and recording.…”

“…In this study, no information was available on drug resistance testing for the patients that tested rifampicin resistance positive on GeneXpert MTB/RIF to ascertain whether they were MDR-TB cases or rifampicin mono-resistant cases. This lack of information is very common in Zambian laboratories with few exceptions, such as the reference laboratories at the University Teaching Hospital, Tropical Disease Research Centre and the Chest Diseases Laboratory (National TB Reference Laboratory) [ 13 ]. Thus, it is possible that previous studies from this country under-estimated the prevalence of MDR-TB [ 13 ] and indicate that further investigations are warranted and illustrate the importance of improving the documentation of MDR-TB in Zambia.…”

The Second Zambian National Tuberculosis Drug Resistance survey – a comparison of conventional and molecular methods

“…In 2001, a national survey of drug resistance was carried out following the WHO recommended methodology of clustered sampling and culture on Löwenstein Jensen (LJ) medium . Prevalence of multidrug resistance TB was estimated to be 1.8% (95% CI 0.8–3.5) in a nationally representative sample of smear‐positive tuberculosis patients including both new and retreatment cases in 2001 .…”

Outcomes of multidrug-resistant tuberculosis in Zambia: a cohort analysis

“…The region also has high rates of HIV prevalence and consequently high TB/HIV co-infection rates (WHO 2015; Kapata et al 2011). In 2015, WHO estimated that 480,000 people developed MDR-TB but only 26% of these were notified, even fewer were started on treatment and the treatment outcomes were poor with less than half of these Research Centre in Ndola (Kapata et al 2013). However, only a few patients were started on second line treatment at two hospital facilities in the country.…”