Khat Chewing and Clinical Conditions Determine the Epidemiology of Primary Drug Resistance Tuberculosis in Amhara Region of Ethiopia: A Multicenter Study

Abstract

Getahun Molla Kassa, Mehari Woldemariam Merid, Atalay Goshu Muluneh Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences and Specialized Comprehensive Hospitals, University of Gondar, Gondar, EthiopiaCorrespondence: Atalay Goshu Muluneh Email [email protected]: Rifampicin and/or multidrug-resistant tuberculosis (RR/MDR-TB) remains an uncontrolled public health emergency that has been synergized by the recently increased person-to-person transmission in the community as primary RR/MDR-TB, which is defined as RR/MDR-TB in new TB patients with no prior exposure to anti-TB treatment for more than one month. This study aimed to measure the prevalence and associated factors of primary drug-resistance among drug-resistant tuberculosis patients, as evidenced by the Amhara region treatment initiating centers.Methods: An institutional-based multicenter cross-sectional study was conducted from September 2010 to December 2017, among 580 RR/MDR-TB patients on the second-line anti-TB drug in the Amhara regional state. Data were collected from patient charts and registration books using a standardized data abstraction sheet. The data were entered using Epi-data 4.2.0.0 and transferred to Stata 14 software for further data management and analysis. A bivariable and multivariable binary logistic model was run subsequently, and finally, a p-value of less than 0.05 with a 95% confidence interval (CI) was used to declare the significance of the explanatory variable.Results: The magnitude of primary drug resistance among drug-resistant tuberculosis patients was 15.69% (95% CI: 12.94, 18.89). Alcohol drinking (adjusted odds ratio [AOR] = 0.31, 95% CI: 0.12– 0.82), khat chewing (AOR = 4.43; 95% CI: 1.67– 11.76), ambulatory and bedridden functional status (AOR = 0.43; 95% CI: 0.24– 0.76) and (AOR = 0.41; 95% CI: 0.19– 0.91), respectively, positive sputum smear result (AOR = 0.48; 95% CI: 0.26– 0.90), and HIV coinfection (AOR= 2.31; 95% CI: 1.31– 4.06) remained statistically significant associated factors of primary RR/MDR-TB.Conclusion: Primary drug resistance is a public health problem in the study setting. Different behavioral and clinical conditions were significant factors of primary drug-resistant development. Mitigation strategies targeted on the patient’s clinical condition, substance-related behaviors, and universal DST coverage might be very important for early detection and treatment of RR/MDR-TB to prevent community-level transmission.Keywords: clinical conditions, epidemiology of primary RR/MDR-TB, Ethiopia

Keywords

• clinical conditions
• epidemiology of primary rr/mdr-tb
• ethiopia