Social Determinants and Risk Factors Associated with Multi-Drug Resistant Tuberculosis Among Tuberculosis Patients in Tamilnadu – A Case-Control Study

Authors

  • S Suganathan Soundararajan PSG Medical College and Research institute, Coimbatore, Tamil Nadu
  • Pavithra GB Saveetha Medical College, Saveetha Institute of technical sciences, Thandalam, Tamil Nadu
  • Preeti P Saveetha Medical College, Saveetha Institute of technical sciences, Thandalam, Tamil Nadu
  • Nisha B Saveetha Medical College, Saveetha Institute of Technical Sciences, Thandalam, Tamil Nadu, India
  • Srinivasan Vengadassalapathy Saveetha Medical College, Saveetha Institute of technical sciences, Thandalam, Tamil Nadu
  • Ruma Dutta Saveetha Medical College, Saveetha Institute of technical sciences, Thandalam, Tamil Nadu
  • Gomathy Parasuraman Saveetha Medical College, Saveetha Institute of technical sciences, Thandalam, Tamil Nadu

DOI:

https://doi.org/10.55489/njcm.131120222346

Keywords:

Social Determinants, Tuberculosis, Multidrug –resistance, Risk factors

Abstract

Introduction: The emergence of Multi-drug Resistant Tuberculosis (MDR- TB) is a challenge for global control and prevention mainly in developing countries. Socio-economic conditions, social vulnerability, and behavioral factors to be considered as risk factors in identifying MDR-TB. The objective of the study was to identify independent risk factors of MDR-TB among Tuberculosis patients.

Methods: An unmatched Case-control study was conducted from January 2021 to June 2021 among tuberculosis (TB) patients registered under RNTCP in Kanchipuram district during the study period. ‘Cases’ were consecutive MDR TB patients aged 15 and older, diagnosed with MDR-TB. ‘Controls’ were patients aged 15 and older, diagnosed with drug susceptible TB. Data was collected using pretested semi-structured questionnaire with face-to- face interview. Univariate and multi-variate analysis were used to identify associated determinants of MDR-TB.

Results: A total of 80 subjects, 20 cases and 60 controls (1:3) were recruited. Mean age of ‘cases’ was 32±9.3 years, and for controls was 31± 8.3 years. Multiple logistic regression analysis identified five significant risk factors for the occurrence of MDR TB as follows: passive smoking [OR = 8.449, 95% CI (6.791–30.27)], overcrowding [OR= 2.062,95% CI (1.004-4.005)], low socio-economic status [OR=11.362,95% CI (10.312-35.174)] and previous TB treatment [OR =13.72 with 95% CI (8.599-35.118)]. Inadequate ventilation [OR=4.6434(.217-13.906)]

Conclusion: To reduce the burden of drug-resistance, these risk factors can be used as screening tool in identifying individuals with MDR-TB in resource limited settings.

References

Al Ammari M, Al Turaiki A, Al Essa M, Kashkary AM, Eltigani SA, Ahmed AE. Drug resistant tuberculosis in Saudi Arabia: an analysis of surveillance data 2014-2015. Antimicrobial Resistance & Infection Control. 2018 Dec;7(1):1-6. Doi: https://doi.org/10.1186/s13756-018-0306-4 PMid:29387346 PMCid:PMC5778613

India M. Guidelines for Programmatic Management of Drug Resistant Tuberculosis in India-2021: Ministry of Health and Family Welfare [Internet]. Tbcindia.gov.in. 2021 [cited 18 October 2021]. Available from: https://www.tbcindia.gov.in/showfile.php?lid=3590

MacNeil A, Glaziou P, Sismanidis C, Date A, Maloney S, Floyd K. Global epidemiology of tuberculosis and progress toward meeting global targets-worldwide, 2018. Morbidity and Mortality Weekly Report. 2020 Mar 20;69(11):281. Doi: https://doi.org/10.15585/mmwr.mm6911a2 PMid:32191687 PMCid:PMC7739980

Seung KJ, Keshavjee S, Rich ML. Multidrug-resistant tuberculosis and extensively drug-resistant tuberculosis. Cold Spring Harbor perspectives in medicine. 2015 Sep 1;5(9): a017863. Doi: https://doi.org/10.1101/cshperspect.a017863 PMid:25918181 PMCid:PMC4561400

Skrahina A, Hurevich H, Zalutskaya A, Sahalchyk E, Astrauko A, van Gemert W, Hoffner S, Rusovich V, Zignol M. Alarming levels of drug-resistant tuberculosis in Belarus: results of a survey in Minsk. European Respiratory Journal. 2012 Jun 1;39(6):1425-31. Doi: https://doi.org/10.1183/09031936.00145411 PMid:22005924 PMCid:PMC3393766

Stosic M, Vukovic D, Babic D, Antonijevic G, Foley KL, Vujcic I, Grujicic SS. Risk factors for multidrug-resistant tuberculosis among tuberculosis patients in Serbia: a case-control study. BMC Public Health. 2018 Dec;18(1):1-8. Doi: https://doi.org/10.1186/s12889-018-6021-5 PMid:30208864 PMCid:PMC6134722

Companion Handbook to the WHO Guidelines for the Programmatic Management of Drug-Resistant Tuberculosis [Internet]. Pub-Med. 2021 [cited 18 October 2021]. Available from: https://pubmed.ncbi.nlm.nih.gov/25320836/

Ahmad AM, Akhtar S, Hasan R, Khan JA, Hussain SF, Rizvi N. Risk factors for multidrug-resistant tuberculosis in urban Pakistan: A multicenter case-control study. International journal of mycobacteriology. 2012 Sep 1;1(3):137-42. Doi: https://doi.org/10.1016/j.ijmyco.2012.07.007 PMid:26787209

WHO guidelines on tuberculosis infection prevention and control 2019 updat [Internet]. Apps.who.int.2021[cited18October2021].Availablefrom:https://apps.who.int/iris/bitstream/handle/10665/311259/9789241550512-eng.pdf?ua=1

Treatment of tuberculosis Guidelines [Internet]. Apps.who.int. 2021 [cited 18 October 2021]. Available-from:https://apps.who.int/iris/bitstream/handle/10665/44165/9789241547833_eng.pdf;sequence=1

Revised National Tuberculosis Control Programme | National Health Portal Of India [Inter-net].Nhp.gov.in.2021[cited18October2021].Availablefrom:https://www.nhp.gov.in/revised-national-tuberculosis-control-programme_pg

Mukati S, Julka A, Varudkar HG, Singapurwala M, Agrawat JC, Bhandari D, Jain A. A study of clinical profile of cases of MDR-TB and evaluation of challenges faced in initiation of second line Anti tuberculosis treatment for MDR-TB cases admitted in drug resistance tuberculosis center. Indian Journal of Tuberculosis. 2019 Jul 1;66(3):358-63. Doi: https://doi.org/10.1016/j.ijtb.2016.11.031 PMid:31439180

Munje R, Deshmukh R, Tumane K. Multidrug-resistant TB among previously treated TB cases: a retrospective study in Nagpur, In-dia. Indian Journal of Tuberculosis. 2015 Oct 1;62(4):207-10. Doi: https://doi.org/10.1016/j.ijtb.2015.11.002 PMid:26970460

Giri OP, Giri VP, Nikhil N. Socio-demographic Profile of MDR-TB and XDR-TB Patients Admitted in DR-TB Centre, North India. The Journal of the Association of Physicians of India. 2019 Oct 1;67(10):61-4.1

Okethwangu D, Birungi D, Biribawa C, Kwesiga B, Turyahabwe S, Ario AR, Zhu BP. Multidrug-resistant tuberculosis outbreak asso-ciated with poor treatment adherence and delayed treatment: Arua District, Uganda, 2013-2017. BMC infectious diseases. 2019 Dec;19(1):1-0. Doi: https://doi.org/10.1186/s12879-019-4014-3 PMid:31064332 PMCid:PMC6503550

Li XX, Lu W, Zu RQ, Zhu LM, Yang HT, Chen C, Shen T, Zeng G, Jiang SW, Zhang H, Wang LX. Comparing risk factors for primary multi-drug-resistant tuberculosis and primary drug-susceptible tuberculosis in Jiangsu province, China: a matched-pairs case-control study. The American journal of tropical medicine and hygiene. 2015 Feb 4;92(2):280. Doi: https://doi.org/10.4269/ajtmh.13-0717 PMid:25535310 PMCid:PMC4347330

Djibuti M, Mirvelashvili E, Makharashvili N, Magee MJ. Household income and poor treatment outcome among patients with tuber-culosis in Georgia: a cohort study. BMC Public Health. 2014 Dec;14(1):1-7. Doi: https://doi.org/10.1186/1471-2458-14-88 PMid:24476154 PMCid:PMC3908381

Atre SR, D'Souza DT, Vira TS, Chatterjee A, Mistry NF. Risk factors associated with MDR-TB at the onset of therapy among new cases registered with the RNTCP in Mumbai, India. Indian journal of public health. 2011 Jan;55(1):14. Doi: https://doi.org/10.4103/0019-557X.82536 PMid:21727675 PMCid:PMC4132633

Venkatesh U, Srivastava DK, Srivastava AK, Tiwari HC. Epidemiological profile of multidrug-resistant tuberculosis patients in Go-rakhpur Division, Uttar Pradesh, India. Journal of family medicine and primary care. 2018 May;7(3):589. Doi: https://doi.org/10.4103/jfmpc.jfmpc_99_17 PMid:30112315 PMCid:PMC6069649

Leung CC, Yew WW, Chan CK, Chang KC, Law WS, Lee SN, Tai LB, Leung EC, Au RK, Huang SS, Tam CM. Smoking adversely affects treatment response, outcome and relapse in tuberculosis. European respiratory journal. 2015 Mar 1;45(3):738-45. Doi: https://doi.org/10.1183/09031936.00114214 PMid:25359352

Lomtadze N, Aspindzelashvili R, Janjgava M, Mirtskhulava V, Wright A, Blumberg HM, Salakaia A. Prevalence, and risk factors for multidrug-resistant tuberculosis in the Republic of Georgia: a population-based study. The International journal of tuberculosis and lung disease. 2009 Jan 1;13(1):68-73.

Hasker E, Khodjikhanov M, Usarova S, Asamidinov U, Yuldashova U, van der Werf MJ, Uzakova G, Veen J. Default from tuberculosis treatment in Tashkent, Uzbekistan; Who are these defaulters and why do they default? BMC Infectious Diseases. 2008 Dec;8(1):1-7. Doi: https://doi.org/10.1186/1471-2334-8-97 PMid:18647400 PMCid:PMC2492865

Mesfin YM, Hailemariam D, Biadglign S, Kibret KT. Association between HIV/AIDS and multi-drug resistance tuberculosis: a sys-tematic review and meta-analysis. PloS one. 2014 Jan 8;9(1): e82235. Doi: https://doi.org/10.1371/journal.pone.0082235 PMid:24416139 PMCid:PMC3885391

Suchindran S, Brouwer ES, Van Rie A. Is HIV infection a risk factor for multi-drug resistant tuberculosis? A systematic review. PloS one. 2009 May 15;4(5): e5561. Doi: https://doi.org/10.1371/journal.pone.0005561 PMid:19440304 PMCid:PMC2680616

https://www.health.govt.nz/our-work/preventative-health-wellness/tobacco-control/tobacco-control-information-practitioners/definitions-smoking-status, last accessed on 07/09/2022

https://www.cdc.gov/alcohol/faqs.htm, last accessed on 07/09/2022

https://www.yalemedicine.org/conditions/stress-disorder, last accessed on 07/09/2022

Downloads

Published

2022-11-30

How to Cite

1.
Soundararajan SS, GB P, P P, B N, Vengadassalapathy S, Dutta R, Parasuraman G. Social Determinants and Risk Factors Associated with Multi-Drug Resistant Tuberculosis Among Tuberculosis Patients in Tamilnadu – A Case-Control Study. Natl J Community Med [Internet]. 2022 Nov. 30 [cited 2024 Mar. 29];13(11):771-6. Available from: https://njcmindia.com/index.php/file/article/view/2346

Issue

Section

Original Research Articles