PREVALANCE OF TUBERCULOSIS AND RISK FACTORS ASSOICATED WITH MULTIDRUG RESISTANT TUBERCULOSIS IN CENTRAL NEPAL
Limited epidemiological information is available on tuberculosis and the risk factors of multidrug-resistant tuberculosis (MDR-TB) in Nepal. The objectives were to determine the prevalance and distribution of tuberculosis in central Nepal and to assess determinants of MDR tuberculosis in Central Nepal.
METHODS:
A retrospective study was done by assembling secondary information on tuberculosis cases reported in Central Nepal. To explore the determinants of MDR-TB, a matched case-control study was conducted.
RESULTS:
The case notification, incidence, and prevalence rates in Central Nepal were found to be 151/100,000; 182/100,000, and 245/100,000, respectively. As evidenced by the routine reports, MDR-TB is increasing in Central Nepal. The development of drug resistance in Nepal is the result of a complex combination of biomedical, sociocultural, and behavioral interactions, while the reporting of individual risk factors is over-simplified. However, injecting drug users (IDU) have a 5.13 times higher risk of MDR-TB and are more likely to suffer from cirrhosis/liver infection, (p<0.001), diabetes (p=0.002), heart disease (p=0.044), gastritis (p=0.015), and seizure (p=0.045) in unvariate analysis. Of the MDR-TB cases, 179 (96.4%) had a history of TB compared with 0 patients in the control group (p<0.001). The findings suggest that previous smoking habit as independent risk factors to MDR-TB, with OR = 4.5 (95% CI =1.24-16.20). Likewise, social discrimination, with OR=5.83 (95% CI = 1.77-19.71), remained an independent predictor of MDR-TB.
CONCLUSIONS:
This study clearly illustrates that an approach encompassing the proper treatment of all TB cases would enhance the national TB control programs, i.e., to identify and effectively treat more TB patients. Providing drug therapy in treatment centres alone cannot successfully address the MDR-TB problem. It is crucial that Nepal takes steps to strengthen the DOTS program of the WHO Global Plan, and ensure that patients complete a full treatment regimen to avoid further development of MDR-TB.