Predictors of Multidrug-Resistant Tuberculosis (MDR-TB) in Sudan

Abstract

Multidrug-resistant tuberculosis (MDR-TB) is a global public health threat and burden on the health system. This is especially the case in high tuberculosis (TB) prevalence countries, such as Sudan. Consequently, this study aimed to ascertain the predictors of MDR-TB in Sudan to provide future guidance. An unmatched case-control study to assess the predictors of MDR-TB infections among the Sudanese population was conducted from August 2017 to January 2018 at Abu-Anga referral hospital. Patients’ data was gathered from patients’ cards and via interviews. A structured pre-validated questionnaire was used to gather pertinent information, which included sociodemographic characteristics and other relevant clinical data. Univariate and multivariate logistic regression analysis was employed to determine the predictors of MDR-TB infection. 76 of the 183 patients interviewed (41.5%) had MDR-TB cases. The independent predictors for MDR-TB were living in rural areas [adjusted odds ratio (aOR) = 3.1 (95% confidence interval (CI): 1.2–8.2)], treatment failure [aOR = 56.9 (10.2–319.2)], and smoking [(aOR = 4 (1.2–13.2)], whereas other sociodemographic factors did not predict MDR-TB. In conclusion, the study showed that a history of smoking, living in rural areas, and a previous treatment failure were the predictors of MDR-TB in Sudan. The latter factors are most likely due to issues that are related to access and adherence to treatment and lifestyle. The existence of any of these factors among newly diagnosed TB patients should alert clinicians for the screening of MDR-TB. The implementation of directly observed treatment (DOT) and health education are crucial in stopping the spread of MDR-TB in Sudan.

Incidence Density and Predictors of Multidrug-Resistant Tuberculosis Among Individuals With Previous Tuberculosis History: A 15-Year Retrospective Cohort Study

“…Continuous monitoring indicates that some MDR-TB patients have a previous history of tuberculosis (PTBH) (e.g., a case after completing TB treatment happens MDR-TB) (4,5). The most recent MDR-TB epidemic revealed an increased risk of morbidity in individuals with PTBH (6,7).…”

“…Our literature review concluded that a clear understanding of how previous TB cases contributed to future MDR-TB onset was still lacking. Previous reports focused primarily on the prevalence and predictors of MDR-TB in TB patients (5,(8)(9)(10). Few researchers have studied the incidence and risk factors of MDR-TB among individuals with PTBH (10)(11)(12).…”

Prevalence of Antibiotic-Resistant Pulmonary Tuberculosis in Bangladesh: A Systematic Review and Meta-Analysis

“…Some of the major underlying risk factors for DRs in patients with TB include treatment failure, relapse, acquired DR, lack of drug susceptibility testing (DST), limited drug supply, and indiscriminate use of anti-TB drugs as well as the cost of DST. Unfortunately, due to the high cost of DST, many newly diagnosed patients are treated with anti-TB drugs without implementing DST in low and middle-income countries [ 6 , 7 , 8 ].…”

The Impact of Alcohol Drinking And Tobacco Smoking On The Drug-Resistance of Newly Diagnosed Tuberculosis

“…In addition, alcohol drinking contributed to a 35% higher risk of TB infection (relative risk(RR)=1.35, 95% con dence interval(CI):1.09-1.68), accompanied by a lower rate of sputum culture conversion and a worse treatment outcome [9,10]. Current years, some studies found that smoking (adjusted odds ratio (aOR)=4, 95%CI:1.2-13.2) and alcohol drinking habits (aOR=5.1, 95% CI:1.4-18.7) might be independent predictors for MDR-TB [11]. However, most of these studies had a small sample size, more confounding factors such as retreated TB cases, and few discussed the joint impact of alcohol uses and tobacco smoking on DR-TB [4,[9][10][11].…”

“…Current years, some studies found that smoking (adjusted odds ratio (aOR)=4, 95%CI:1.2-13.2) and alcohol drinking habits (aOR=5.1, 95% CI:1.4-18.7) might be independent predictors for MDR-TB [11]. However, most of these studies had a small sample size, more confounding factors such as retreated TB cases, and few discussed the joint impact of alcohol uses and tobacco smoking on DR-TB [4,[9][10][11]. It also remains unclear the impact of tobacco smoking and alcohol drinking on various drug-resistant sub-types such as mono-resistant (MR)-TB, MDR-TB, polydrug resistant (PDR)-TB.…”