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ORIGINAL RESEARCH
Year : 2019  |  Volume : 10  |  Issue : 1  |  Page : 67

Factors associated with the development of secondary multidrug-resistant tuberculosis


1 Department of TB and Chest, Gandhi Medical College, Bhopal, Madhya Pradesh, India
2 Department of Microbiology, Gandhi Medical College, Bhopal, Madhya Pradesh, India
3 Jhpiego (formerly Johns Hopkins Program for International Education in Gynecology and Obstetrics), India
4 Department of Forensic Medicine and Toxicology, Gandhi Medical College, Bhopal, Madhya Pradesh, India

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Pavan Pandey
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijpvm.IJPVM_298_17

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Background: Spread of multidrug-resistant tuberculosis (TB) is a threat to India's TB control program. We conducted this study with the objective to determine the risk factors for the development of secondary multidrug-resistant TB. Methods: We conducted an unmatched case–control study involving 247 multidrug-resistant TB patients as “cases” and 494 individuals who were declared as “cured” after category I DOTS treatment as “controls.” Data were collected through face-to-face interviews and review of treatment records. Multivariable logistic regressions were used to analyze the collected data. Results: The mean duration for which cases took first-line anti-TB drug was 19.7 months. The mean duration between initial diagnosis of TB and diagnosis of multi-drug resistant TB (MDR-TB) was 28.3 months. In our study, 26.7%, 50.2%, and 23.1% of MDR-TB cases had one, two, or more previous episodes of TB before being diagnosed as MDR-TB. In multivariable analysis, low or no formal education (album-oriented rock [AOR] =1.63 [confidence interval (CI) = 1.03–3.11]), labor occupation (AOR = 2.15 [CI = 1.18–3.90]), smoking (AOR = 2.56 [CI = 1.19–3.26]), having HIV (AOR = 9.45 [CI = 6.80–15.9]), migration for job (AOR = 3.70 [CI = 1.96–5.67]), stopping TB treatment due to comorbid conditions (AOR = 8.86 [CI = 5.45–11.2]), and having type 2 diabetes (AOR = 3.4 [CI = 1.96–5.16]) were associated with MDR-TB. Conclusions: Government of India should devise strategy to prevent interruption of treatment to stop the emergence and spread of MDR-TB. We need to better integrate TB control activities with diabetes and tobacco control programs for better health outcome among patients.


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