Correlates of multi-drug resistant tuberculosis: a case control study from a hilly district of North India

Abstract

Background: Drug resistance has emerged as a major threat to global TB control efforts in recent years. India, with the highest burden of Tuberculosis worldwide, faces a looming epidemic of drug resistant TB due to initial irrational, irregular and incomplete treatment outside the purview of the robust national programme. Himachal Pradesh, a north Indian hilly state with a population of about 7 million has a considerable burden of Tuberculosis with geographical challenges. The present study envisaged to identify the potential risk factors to the emergence of drug resistance TB in the settings of district Shimla.Methods: A pilot case control study, all patients (n=11) enrolled for MDR-TB in Tuberculosis Unit Shimla during the period (2013-14) were included. 3 of who died were excluded. Thrice the number of controls (n=24) were selected after matching for age, sex and approximate geographical location.Results: The univariate analysis showed that, compared with controls, risk factors significantly associated with primary MDR-TB were Socioeconomic status lower than class 3 (OR=13.8; p=0.02), poor ventilation (OR=5; p=0.05), absent BCG scar (OR=23; p=0.002), history of default (p=0.002) and initial treatment from a private practitioner (OR=6.60; p=0.04). The Multivariate analysis showed that the risk factors independently associated with primary MDR-TB were absent BCG scar (OR=28.15; 95% CI=1.51524.38) and initial irrational and incomplete treatment from a private practitioner (OR=16.77; 95% CI =1.12-319.26).Conclusions: In our stud, poor ventilation, lower socioeconomic condition and initial default have been found to be significantly associated with the disease whereas absent BCG scar and initial irrational treatment from private practitioners have emerged as independent risk factors for the emergence of drug resistant Tuberculosis further reiterating the need for strengthening Immunization and early diagnosis and treatment aspect of the disease involving private practitioners. Larger and extensive studies on these aspects are further warranted.