Prevalence and clinical predictors of drug-resistant tuberculosis in three clinical settings in Calabar, Nigeria
Authorship and contributorship
Akaninyene Otu conceived the study; Akaninyene Otu, Victor Umoh, Victor Ansa and Abdulrazak Habib designed the study protocol; Akaninyene Otu and Victor Umoh carried out the clinical assessment; Akaninyene Otu, Victor Umoh, Abdulrazak Habib and Victor Ansa carried out the analysis and interpretation of the data. Akaninyene Otu drafted the paper. Abdulrazak Habib and Victor Ansa critically revised the paper for intellectual content. All authors read and approved the final paper. Akaninyene Otu is the guarantor of the paper.
This study was reviewed and approved by the Health Research Ethics Committee of the Cross River State Ministry of Health, Nigeria. All proceedings were in accordance with the ethical standards laid down in the 2000 Declaration of Helsinki. All participants gave their informed consent prior to their inclusion in the study. The clinical trials number issued by the above committee is (CRS/MH/CR-HREC/018/Vol.1/18).
Conflict of interest
The authors have stated explicitly that there are no conflicts of interest in connection with this article.
Background and Aims
Drug-resistant tuberculosis (TB) poses a serious challenge to global control of TB. This multicentre study was to identify risk factors for drug resistance to the first line anti-TB drugs among TB patients presenting for care in three health facilities in Calabar, Nigeria.
Materials and Methods
A cohort of 100 consecutive TB patients were recruited. Demographic information such as age, sex, weight, height, occupation, previous TB diagnosis and treatment, smoking, alcohol dependence and substance abuse were obtained. Sputum samples were collected from participants and cultured on Lowenstein – Jensen (LJ) slopes. Drug susceptibility testing was then carried out for the isolates identified as Mycobacterium tuberculosis, using isoniazid, rifampicin, ethambutol and streptomycin.
Forty-two of the 100 participants evaluated were found to be resistant to at least one drug. Multi-drug-resistant TB was seen in four persons. Statistically significant differences were found with respect to three variables: younger age, abandonment of TB treatment and presence of cavitary lesions on chest radiograph. The variables sex, alcohol dependence, tobacco use and previous imprisonment were not significantly associated with TB drug resistance. Four variables were significant following the multivariate analysis with the following adjusted odds ratios: abandonment of TB treatment (9.34), cavitary lesions on chest radiograph (5.88), younger age (6.25) and male sex (3.25).
Thus, risk stratification of TB patients is advocated in clinical settings where diagnostic facilities for drug-resistant TB are scarce using the identified predictors. This group will benefit from close monitoring and early drug susceptibility testing.