https://imcjms.com/public Ibrahim Medical College Journal of Medical Science https://imcjms.com/public/registration/journal_full_text/135 Sun, 06 Nov 2016 14:08:56 +0000 This case control study was conducted in selected centers of Dhaka City from March to July 2008 to determine the association of multidrug-resistant tuberculosis with the attributes related to treatment and socio-economic condition of tuberculosis patients. Sixty seven culture-proven multidrug-resistant tuberculosis cases and similar number of age and sex matched controls were selected purposively. 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 occupation (p=0.001) and residential status (p=0.001) of the tuberculosis patients. Tuberculosis patients who did not remain under directly observed treatment were 3 times more likely to develop multidrug-resistant tuberculosis (OR 3.21, 95%CI=1.59-6.52). Multidrug-resistance was associated with inadequacy of treatment (OR 2.56, 95%CI=2.03-3.23). Failure of sputum conversion at the end of 2 months of treatment was detected to be the best predictor of multidrug-resistant tuberculosis (OR 11.82, 95% CI=4.61-30.33), followed by treatment with non Directly Observed Treatment Short course regimen and high labor intensive occupations like agriculture, production and transport. The risk factors of multidrug-resistant tuberculosis warrant much improvement in the effective implementation of control programs. Introduction 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).6 WHO estimated 14% MDR-TB rate among previously treated cases and 1.8% among new cases.7   Sixty seven cases were selected, as defined by WHO5 ‘resistant to the two main first line drugs, Isoniazid andRifampicin’,fromculture-provedMDR-TBpatients admitted in National Institute of Disease of Chest and Hospital (NIDCH). Equal number of age and sex matched controls, the cured patients of TB, as defined by NTP,9 who had been smear-positive initially but became smear negative in the last month of treatment and on at least one previous occasion, were selected from NIDCH and other DOTS centers in Mohakhali, North Badda, Adorsha Nagar and Rampura in Dhaka City. The sample size of 134 was estimated following WHO guideline.10 Data were collected by face to face interview and documents’ review, using a pre tested structured questionnaire and a checklist on background characteristics of the samples, socio-economic data and data related to anti tuberculosis treatment. Ethical clearance was obtained from the Ethical Committee of NIPSOM before data collection. Data were processed and analyzed by SPSS version 12.0. Results Cases and controls were matched for age and sex. No significant difference was observed in marital status, religion, house-type and income level between cases and controls (Table–1). Although initially showed, after Bonferroni correction no significant difference was observed in educational status between cases and controls. Cases and controls significantly differed by their places of residence (p=0.001) and occupational categories (p=0.001). TB patients with high labor intensive occupations like agriculture, production and transport were five times more likely and those who lived in rural areas were fourteen times more likely to develop MDR TB than their counterparts. Table-1: Distribution of the respondents by socio-demographic characteristics       Entering all independent variables together, a logistic regression model was constructed with overall 84% correct prediction. Failure of sputum conversion at the end of 2 months of treatment was detected as the best predictor of MDR TB, followed by treatment with non-DOTS regimen, high labor intensive occupations and lastly non-observation of treatment (Table-3). Table-3: Factors of MDR TB after adjusting for other variables   This study was designed to determine the association of multidrug- resistant tuberculosis with the socio-economic and treatment related factors of TB-patients. In the present study, highest proportion of the MDR TB cases (61.2%) were found to be involved in occupations like agriculture, production and transport. Occupation might have an association with MDR TB (p<0.01). This might be because, these are the occupations where maintenance of a strict, meticulous and long course like TB-treatment seems to be difficult without special motivation.  The study revealed that, failure of sputum conversion at the end of 2 months of treatment was the best predictor of MDR TB. In a study in India in 2000, researchers found that more than half of the patients receiving category II treatment who remained sputum positive after 3 or 4 months of treatment, had MDR TB.17   This study was supported by a grant from Bangladesh Medical Research Council (BMRC). References 2.   Onorato IM, Kent JH and Gastro KG. Epidemiology of tuberculosis. In Tuberculosis. Lutwic kLI (ed). Chapman and Hall Medical. 1st(edin)1995; 3: 20-53. 4.   Biswas MS. Acknowledgement. In: NTP, DGHS. Tuberculosis Control in Bangladesh, TB Annual Report 2007. Dhaka 6.   Arju A.Number of MDR-TB patients on the rise.The Daily New Age 2008; VI(5):19s (col.2-4). 8.   Khalequzzaman M, Younus M, Rahim J, Arifeen SE, Baqui AH, Hossain S, et al. Epidemiology and surveillance of multidrug- resistant tuberculosis in urban and rural areas of Bangladesh.[cited 2008 Mar24]. Http://www.icddrb.org/pub 10.        Lwanga Sk,Lemeshow S. Sample size determination in health studies, A practical Manual. WHO, Geneva 1991; p 9 and 45. 12.Yang BF, Xu B, Jiang WL, Jhou PY, Jiang QW. Study on the epidemiology and determinants of drug resistant tuberculosis in northern rural area of Jiangsu province. Zhonghua Liu Xing Bing Xue Za Zhi 2004; 25(7): 582-5.      Pandey RM, Jain NK, et al. Clinical and genetic risk factors for the development of multidrug-resistant tuberculosis in non-HIV infected patients at a tertiary care center in India: a case control study. Infect Genet Evol 2003; 3(3):183-8. 15.Wells CD, Cegielsky JP, Nelson LJ, Laserson KF, Holtz TH, Finlay A, et al. HIV infection and multidrug-resistant tuberculosis: the perfect storm. J Infect Dis 2007; 196 Suppl 1: S86-107. 17.Santha T, Garg R, Freiden TR, Chandrasekaran V, Subramani R, Gopi PG, et al. Risk factors associated with default, failure and death among tuberculosis patients treated in a DOTS programme in Tiruvallur District, South India, 2000. Int J Tubercle Lung Dis 2003; 7(2): 200-1. 2026 Ibrahim Medical College. All rights reserved.