The Targeted Maximum Likelihood estimation to estimate the causal effects of the previous tuberculosis treatment in Multidrug-resistant tuberculosis in Sudan

Abstract

Introduction This study used Targeted Maximum Likelihood Estimation (TMLE) as a double robust method to estimate the causal effect of previous tuberculosis treatment history on the occurrence of multidrug-resistant tuberculosis (MDR-TB). TMLE is a method to estimate the marginal statistical parameters in case-control study design. The aim of this study was to estimate the causal effect of the previous tuberculosis treatment on the occurrence of MDR-TB using TMLE in Sudan. Method A case-control study design combined with TMLE was used to estimate parameters. Cases were MDR-TB patients and controls were and patients who cured from tuberculosis. The history of previous TB treatment was considered the main exposure, and MDR-TB as an outcome. A designed questionnaire was used to collect a set of covariates including age, time to reach a health facility, number of times stopping treatment, gender, education level, and contact with MDR-TB cases. TMLE method was used to estimate the causal association of parameters. Statistical analysis was carried out with ltmle package in R-software. Result presented in graph and tables. Results A total number of 430 cases and 860 controls were included in this study. The estimated risk difference of the previous tuberculosis treatment was (0.189, 95% CI; 0.161, 0.218) with SE 0.014, and p-value (<0.001). In addition, the estimated risk ratio was (16.1, 95% CI; 12.932, 20.001) with SE = 0.014 and p-value (<0.001). Conclusion Our findings indicated that previous tuberculosis treatment history was determine as a risk factor for MDR-TB in Sudan. Also, TMLE method can be used to estimate the risk difference and the risk ratio in a case-control study design.

Protocol for a systematic review of long-term physical sequelae and financial burden of multidrug-resistant and extensively drug-resistant tuberculosis

“…Tuberculosis (TB) is a major cause of death and disability worldwide [ 1 ]. According to the recent World Health Organization (WHO) report, about 10.6 million people were ill and 1.6 million people died due to TB in 2021 [ 1 ].…”

“…Tuberculosis (TB) is a major cause of death and disability worldwide [ 1 ]. According to the recent World Health Organization (WHO) report, about 10.6 million people were ill and 1.6 million people died due to TB in 2021 [ 1 ]. South-East Asia (45%), Africa (23%), and Western Pacific regions (18%) were the most affected regions by TB [ 1 ].…”

“…According to the recent World Health Organization (WHO) report, about 10.6 million people were ill and 1.6 million people died due to TB in 2021 [ 1 ]. South-East Asia (45%), Africa (23%), and Western Pacific regions (18%) were the most affected regions by TB [ 1 ]. More recently, the emergence of multidrug-resistant tuberculosis (MDR-TB), resistant to at least isoniazid and rifampicin, and extensively drug-resistant tuberculosis (XDR-TB), MDR-TB plus resistance to any fluoroquinolone and to injectable second-line drugs [ 1 , 2 ], continue to be a major challenge to achieving the global End-TB Strategy targets [ 3 , 4 ].…”