https://imcjms.com Ibrahim Medical College Journal of Medical Science https://imcjms.com/registration/journal_full_text/54 Tue, 02 Aug 2016 11:11:46 +0000 This case control study was conducted between January to June 2010 to determine the relationship between substance abuse and multidrug- resistant tuberculosis. A total of 73 cases were selected purposively, from culture- positive multidrug- resistant tuberculosis patients admitted in the National Institute of Diseases of the Chest and Hospital, Dhaka and compared with 81 un-matched controls, recruited from the cured patients of pulmonary tuberculosis who attended several DOTS centers of ‘Nagar Shastho Kendra’ under Urban Primary Health Care Project in Dhaka city. Data were collected by face to face interview and documents’ review, using a pre- tested structured questionnaire and a checklist. Multidrug- resistance was found to be associated with smoking status (χ2 = 11.76; p = 0.01) and panmasala use (χ2 = 8.28; p = 0.004). The study also revealed that alcohol consumption and other substance abuse such as jarda, sadapata, gul, snuff, heroine, cannabis, injectable drugs was not associated with the development of multidrug- resistant tuberculosis. Relationship between substance abuse and multidrug- resistant tuberculosis are more or less similar in the developing countries. Bangladesh is not out of this trend. The present study revealed the same fact, which warrants actions targeting specific factors. Further study is recommended to assess the magnitude and these factors related to the development of multidrug- resistant tuberculosis in different settings in our country. Introduction Estimates suggest that daily about 880 new TB cases and 176 TB deaths occur in the country.4 In Bangladesh the number of MDR-TB cases is increasing gradually despite the government’s success in TB treatment by 92% and the detection rate of 72% in 2007. From July 2007 to Feb 2008, 165 cases of MDR-TB were detected in the National Institute of Diseases of Chest and Hospital (NIDCH).5 According to the WHO report 2008, the MDR-TB rate in Bangladesh is estimated at 3.6% and 19% among new and previously treated TB cases, respectively.4 In such a situation, the emerging drug resistance in Bangladesh needs further exploration.6 Those factors are required to be assessed, evaluated and weighted in terms of their role in increasing the risk of MDR-TB in our perspective. In order to adopt and implement the strategies and changes that may be necessary at present or in future, to combat this deadly form of TB, accurate and comprehensive information regarding its development, is a prime requirement.   Material and Methods   Results The respondents were asked about their habits of smoking and other smokeless tobacco. Among the cases 24.7% were past smokers which was higher than the controls (19.8%; p = 0.01). Cases and controls were further stratified by their gender to find the smoking data precisely. Among the male cases 54.8% were past smokers whereas it was 39% among the controls (p = 0.02). There was no difference in number of cigarettes smoked per day or proportion of heavy/moderate smokers, even when it stratified by gender. Odds ratio showed that the past smokers were 1.02 times more likely to develop MDR- TB in reference to those who never smoked. Table-1: Smoking status of the cases and controls   The respondents were asked about their history of other smokeless tobacco use. Some of them answered ‘no’ and some of them answered either regular or occasional history of tobacco use. The regular/ occasional users were recorded as ‘yes’. Other substance abuse     Discussion Statistically smoking status was found to be significant for the development of MDR- TB (p = 0.02). A study in Russia reveals that for isoniazid and rifampicin resistance male sex, smoking is the significant risk factor.15 In a Pakistani study smoking shows an association with MDR- TB.9 Among the smokeless tobaccos only panmasala found to be statistically significant (p =0.004) in this study. Alcohol consumption was not associated with the development of MDR-TB although a number of studies showed association.9,17,18 This study did not found any association of MDR- TB with drug abuse as heroine, cannabis. Overall substance abuse was less common in this study sample. A similar study in Iran showed no significant difference incase of MDR-TB groups in terms of drug abuse (p = 0.63).11   The study revealed that, smoking status and panmasala use of the TB patients were significantly associated with the development of multidrug- resistance. Alcoholism and other drug abuse had no association to develop MDR- TB. Relationship between substance abuse and multidrug- resistant tuberculosis are more or less similar in the developing countries. Bangladesh is not out of this trend. The present study supports the same fact, which warrants actions targeting specific factors.   This study was supported by a grant from National Tuberculosis Control Programme (NTP).   1.   Lee SW, Jeon K, Min KH. Multidrug-resistant Pulmonary Tuberculosis Among Young Korean Soldiers in a Communal Setting. Journal of Korean Medical Science 2009; 24; 592-5. 3.   Zager EM, McNerney R. Multidrug-resistant tuberculosis. BMC Infectious Diseases 2008; doi: 10.1186/1471-2334/8/10. 5.   Amin MN, Rahman MA, Flora MS, Azad MAK. Factors associated with multidrug-resistant tuberculosis. Ibrahim Medical College Journal 2009; 3(1): 29-33. 7.   Parvaneh Baghaei, Payam Tabarsi, Ehsan Chitsaz et al. Risk Factors Associated with Multidrug- Resistant Tuberculosis. National Research Institute of Tuberculosis and Lung Disease, Iran. Tanaffos (2009); 8(3): 17- 21. 9.   Franke MF, Appleton SC, Bayona J, Arteaga F, Palacios E, Liaro K. et al. Risk Factors and Mortality Associated with Default from Multidrug- Resistant Tuberculosis Treatment. Clinical Infectious Diseases 2008; 15: 1844-1851. 11.Suarez GI, Rosriquez BA, Vidal- Perez JL Garcia-Viejo MA, Jaras- Hernandez MJ, Lopez O et al. Risk factors for multidrug – resistant tuberculosis in a tuberculosis unit in Madrid, Spain. European Journal of Clinical Microbial Infectious Diseases 2009; 28(4): 325-30. 13.Piryani Rano Mal, Rizvi Nadeem. Presentation of Pulmonary Tuberculosis in Cannabis or/ and Opiates Drugs Abusers. SAARC Journal of Tuberculosis, Lung Diseases and HIV/ AIDS 2006; 3(1): 26-55. 15.Ruddy M, Balabanova Y, Graham C, Fedorin I, Malomanova N, Elisarova E. et al. Rates of drug resistance and risk factor analysis in civilian and prison patients with tuberculosis in Samara Region, Russia.; 60: 130- 135. doi: 10.1136/ thx. 2004. 026922. 17.Espinal MA, Laserson K, Camacho M, Fusheng Z, Kim SJ, Tlali E. et al. determinants of drug- resistant tuberculosis: analysis of 11 countries. International Journal of Tuberculosis and Lung Diseases 2001; 5(10): 887-893. 18.  Anunnatsir S, Chetchotisakd P, Wanke C. Factors Associated with Treatment outcomes in Pulmonary Tuberculosis in Northeastern Thailand. South East Asian Journal of Tropical Medicine and Public Health 2005; 36(2): 324-330. 2026 Ibrahim Medical College. All rights reserved.