PATTERN OF FIRST-LINE ANTI-TUBERCULOSIS DRUG RESISTANCE AND ASSOCIATED FACTORS IN PATIENTS ATTENDING NATIONAL TUBERCULOSIS AND LEPROSY TRAINING CENTRE AND REFERRAL HOSPITAL ZARIA

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Department of Medicine

ABSTRACT
Tuberculosis (TB) is an infectious disease caused by the bacillus Mycobacterium tuberculosis. Despite the availability of Short-course regimens of first-line drugs that can cure around 90% of cases, TB remains a major global health problem causing ill-health among millions of people each year. It ranks as the second leading cause of death from an infectious disease worldwide. In 2012, nearly 8.6 million people developed TB and 1.3 million died from the disease worldwide. Among these deaths, there was an estimated 450,000 who developed multidrug resistant TB (MDR-TB) with an estimated 170,000 deaths. The African Region has 24% of the world’s cases and the highest rates of cases and deaths per capita. This study was therefore carried out to determine the pattern of first-line anti-Tb drug resistance and associated factors in patients attending National Tuberculosis and Leprosy Training Centre/Referral Hospital Zaria. Sputum samples were collected from 200 DR-TB suspects median age 32 years (range 15 – 75 years) of which 138 (69%) were males. Among these, 156 (78%) and 44(22%) were new and retreatment cases respectively. Also, 59.5 % of the patients were in the age group 21-40 years and 90.6% of them were either unemployed or self employed, and 68.9% either have no formal education or terminated at secondary school level. The sputum samples were first screened for M. Tuberculosis complex and rifampicin resistance using GeneXpert(MTB/Rif) and confirmed with Hain line probe aassay(LPA). Of the 200 samples, 81(40.5%) were positive for Mycobacterium tuberculosis, out of which 55(67.9%) were rifampicin (RIF) resistant. More males (74.1%) were positive for MTBC and for MDR-TB (76.2%) than females. The highest resistance to any one drug alone and in combination with other drugs was found in rifampicin (67.9%). However, rifampicin mono resistance was 13.6%, Isoniazid mono resistance was 1.2% while mono resistance to streptomycin and ethambutol were not seen. Furthermore, 6 (7.4%) were resistant to all the 4 first line drugs while MDR-TB was (51.8%). On bivariate analysis, six factors were found to be associated with development of MDR-TB, 4 of which are patient related while 2 are health care related. Among these, being a retreatment case was the only statistically significant factor (OR=8.2, P-value <0.01). The study concluded that there was a high rate of rifampicin resistance and MDR-TB among patients attending NTBLTC/Referral Hospital Zaria and recommends that health care providers should adequately educate TB patients on the need for treatment adherence in order to prevent development of anti-TB drug resistance. The TB-DOTS strategy should also be reinforced to ensure patient compliance. Availability of drugs should also be ensured at all times and nonfixed drug combinations should be discouraged. Key words: MDR-TB, Drug resistance pattern, Drug sensitivity testing, Rifampicin resistance,LPA.