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IJBAF, April, 2019, 7(4)
RISK FACTORS FOR MULTI DRUG
TUBERCULOSIS PATIENTS OF NEKEMTE REFERRAL HOSPITAL, OROMIA
REGIONAL STATE, WESTERN ETHIOPIA, 2017
ZALALEM KABA BABURE
ASSEFA3, TESFAYE
DAGNE WELDEMARIUM
1
Quality officer at East Wollega Zonal Health Office, Nekemte
2
Program Officer at USAID/JSI Transform: Primary HealthCare Project, East
3
High Quality Clinical Care Technical Advisor
4
Department of health economics, management and policy, College of Health Sciences, Jimma
5
Program Officer at USAID/JSI Transform: Primary HealthCare Project, East Wollega Zone,
*Corresponding author:
Zalalem
Multidrug-
Resistance Tuberculosis (MDR
line drugs; both
isoniazid and rifampicin. Globally in 2015, there were an estimated 480, 000
new cases of multidrug-
resistant TB.
conducted nationwide in Ethiopia in 2012 among 804 newly diagnosed TB cases 1.6 % w
found to be infected with MDR
management of Multidrug-
Resistant Tuberculosis (MDR
Nekemte Referral hospital in particular prompted this study which seeks
factors for MDR-TB. U
nmatched case control study design was conducted to identify the risk
factors for multi-
drug resistant tuberculosis among tuberculosis patients of Nekemte Referral
Received 6
th
May 2018; Revised 20
IJBAF, April, 2019, 7(4): 63-77
RISK FACTORS FOR MULTI DRUG
-
RESISTANT TUBERCULOSIS AMONG
TUBERCULOSIS PATIENTS OF NEKEMTE REFERRAL HOSPITAL, OROMIA
REGIONAL STATE, WESTERN ETHIOPIA, 2017
ZALALEM KABA BABURE
1*, KASSAHUN TEGEGNE BIDU2
, JIRU
DAGNE WELDEMARIUM
4,
AND AKLILU FIKADU TUFA
Quality officer at East Wollega Zonal Health Office, Nekemte
, Oromia, Western Ethiopia,
Program Officer at USAID/JSI Transform: Primary HealthCare Project, East
Nekemte, Western Ethiopia
High Quality Clinical Care Technical Advisor
at
Oromia Regional Health Bureau
Ethiopia
Department of health economics, management and policy, College of Health Sciences, Jimma
University, Ethiopia
Program Officer at USAID/JSI Transform: Primary HealthCare Project, East Wollega Zone,
Nekemte, Western Ethiopia
Zalalem
Kaba Babure (ZK): E Mail:
kabazalalem@gmail.com
+251921192448
ABSTRACT
Resistance Tuberculosis (MDR
-
TB) is tuberculosis (TB) that is res
isoniazid and rifampicin. Globally in 2015, there were an estimated 480, 000
resistant TB.
According to the anti-tuberculosis
drug resistance survey
conducted nationwide in Ethiopia in 2012 among 804 newly diagnosed TB cases 1.6 % w
found to be infected with MDR
-TB. The
continuous challenge in the occurrence and
Resistant Tuberculosis (MDR
-
TB) in the country in general and
Nekemte Referral hospital in particular prompted this study which seeks
-
nmatched case control study design was conducted to identify the risk
drug resistant tuberculosis among tuberculosis patients of Nekemte Referral
May 2018; Revised 20
th
June 2018; Accepted 25
th
July 2018; Available online 1
ISSN: 2320 – 0774
63
RESISTANT TUBERCULOSIS AMONG
TUBERCULOSIS PATIENTS OF NEKEMTE REFERRAL HOSPITAL, OROMIA
REGIONAL STATE, WESTERN ETHIOPIA, 2017
, JIRU
FEKADU
AND AKLILU FIKADU TUFA
5
, Oromia, Western Ethiopia,
Program Officer at USAID/JSI Transform: Primary HealthCare Project, East
Wollega Zone,
Oromia Regional Health Bureau
, Addis Ababa,
Department of health economics, management and policy, College of Health Sciences, Jimma
Program Officer at USAID/JSI Transform: Primary HealthCare Project, East Wollega Zone,
kabazalalem@gmail.com
; Tel:
TB) is tuberculosis (TB) that is res
istant to two first-
isoniazid and rifampicin. Globally in 2015, there were an estimated 480, 000
drug resistance survey
conducted nationwide in Ethiopia in 2012 among 804 newly diagnosed TB cases 1.6 % w
ere
continuous challenge in the occurrence and
TB) in the country in general and
-
to investigate the risk
nmatched case control study design was conducted to identify the risk
drug resistant tuberculosis among tuberculosis patients of Nekemte Referral
July 2018; Available online 1
st
April 2019
Zalalem Kaba Babure et al Research Article
64
IJBAF, April, 2019, 7(4)
Hospital. All MDR-TB (21 cases) and Non-MDR-TB (44 controls) patients’ registered from
September 1st 2016 to August 30th 2017 in this hospital were included in the study. A Face-to-
face interview and Patient medical records review were used to collect the data. In bivariate
analysis; variables which had P value <=0.25 were entered into multivariate logistic regression
model value <0.05 taken as statistically significant. A total of 65 tuberculosis patients (21 cases
and 44 controls) included in this study; response rate 100 %. Previous tuberculosis treatment
(AOR = 0.975, 95 % CI = 0.957 – 0.994), history of defaulter (AOR=0.055, 95 % CI=0.008-
0.391), history of Smoking (AOR=74.833, 95 % CI=1.563-36.248), number of rooms in the
house (AOR=5.410,95 % CI=1.579-18.536) and presence of HIV/infection (AOR=0.232,95 %
CI=0.065-0.823) were statistically significant predictors of having multidrug-resistance
tuberculosis. History of:- previous tuberculosis treatment; defaulter and smoking, number of
rooms in the house, and presence of human immune virus infection were significant predictors in
this study. Health education on adherence to anti-tuberculosis drugs and risky behavior should be
given a special attention.
Key words: Multidrug-resistant, Tuberculosis, Nekemte, Risk factor, Case-control
INTRODUCTION
Tuberculosis (TB) is an infectious disease
caused by the bacillus mycobacterium
tuberculosis [1]. Multidrug resistance
Tuberculosis (MDR-TB) is TB that is
resistant to two first-line drugs both isoniazid
and rifampicin [2]. It results from either
primary infection with resistant bacteria or
may develop in the course of a patient’s
treatment [3]. The main reason for the
emergence of MDR-TB is improper
treatment. This may be caused by non-
compliance, poor treatment regimes, and
poor quality of drugs or concomitant medical
diseases [4].
Ethiopia is one of among the 22 high burden
countries (HBCs). According to the anti-TB
drug resistance survey conducted nationwide
in Ethiopia in 2012 among 804 newly
diagnosed TB cases 1.6 % were found to be
infected with MDR-TB [5].Treatment for
drug-resistant TB is much more expensive,
toxic and takes much longer than treatments
for ‘normal’ TB [6].
Globally in 2015 there were an estimated
480,000 new cases of MDR-TB and an
additional 100,000 people with rifampicin-
resistant tuberculosis (RR-TB) who were also
newly eligible for MDR-TB treatment [7]. In
2014 an estimated 190,000 people died of
Zalalem Kaba Babure et al Research Article
65
IJBAF, April, 2019, 7(4)
MDR-TB globally. Only 50 % of MDR-TB
patients were successfully treated globally
[8]. As identified by World Health
Organization (WHO) in its 2007-2008 global
response plan Ethiopia is one of the top 25
priority MDR-TB and XDR-TB countries
[9].
A study of MDR-TB patient costs in March
2013 indicated that the average total out-of-
pocket cost for an MDR-TB patient to get
diagnosis and treatment was US$ 1,341 and
each patient lost on average US$ 293 of
income due to time spent seeking and
receiving care [10]. Multidrug-resistant
tuberculosis (MDR-TB) caused 250,000
deaths in 2015[11]. Risk factors for MDR-
TB as revealed by different studies includes:
-history of previous anti-TB treatment, TB
treatment outcome, lack of TB treatment
adherence, having a larger size of family,
smoking habit, contact with MDR-TB
patients, gender, age, history of
imprisonment, level of education,
occupation, industrial work, low socio-
economic status, social behavior like alcohol
addiction, and co-morbidities like HIV-AIDS
were significantly associated with MDR-TB
[12-18]. However, in Nekemte Referral
Hospital there is lack of information with
regard to possible associated risk factors for
the occurrence of MDR-TB. Thus, the aim of
this study is to identify the possible risk
factors for MDR-TB which in turn is vital in
order to prevent and treat TB and MDR-TB.
MATERIALS AND METHODS
Study area and Period
This study was conducted in Nekemte
referral hospital which is found at a distance
of 331 kilometers west of nation’s capital,
Addis Ababa. It gives different health service
for more than 2.5million populations. This
hospital has 8 wards (Obstetrics,
Gynecology, Surgical, Medical, Pediatrics,
Orthopedic and Emergency), one TIC
(treatment initiative center) which was
established at 2013 and served as the only
treatment center for MDR-TB patients’ in the
western part of the country. This study was
conducted from September 1st 2016 to
August 30th2017.
Study design
Unmatched case-control study design was
carried.
Population
All 65 TB patients (21 case and 44 controls)
confirmed to be MDR-TB and non-MDR-TB
registered from September 1, 2016 to August
30th2017 in this hospital were taken as source
population, and those who had willing to
give informed consent were taken as the
study population.
Zalalem Kaba Babure et al Research Article
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IJBAF, April, 2019, 7(4)
Inclusion and exclusion criteria
TB patients whose registries were not found
in the hospital or information on the register
were incomplete for the variables of interest
were excluded from the study. Since the
sample size was manageable; all TB patients’
who fulfills the inclusion criteria were
included in the study.
Data collection techniques and
instruments
Face-to-face interview was carried out using
a structured and pre-tested questionnaire to
collect primary data whereas secondary data
were collected by reviewing patient medical
charts. The questionnaire was first prepared
in English from different literatures [19-33]
and translated into Afaan Oromo and then
back to English. Three diploma nurses to
collect the data and two BSc nurse graduate
to supervise the data collection process were
selected and assigned from outside of this
hospital to minimize bias related to the
interviewer. Data collectors were used the N-
95 respiratory mask (covers both the mouth
and nose and filters more than 95% of
particles) during data collection. Study
subjects wore a surgical mask to reduce the
risk of TB transmission.
Study variables
Dependent variable
Risk factors for MDR-TB
Independent variables
Socio-demographic characteristics (age, sex,
educational level, Religion, Ethnicity,
Marital status, Monthly family income, Place
of residence and occupation)
TB Patients’ related factors: -Being in prison,
History of (previous TB treatment, TB
contact, traditional treatment, and defaulter),
Alcohol use, Illicit drug use, Chat chewing,
Habit of smoking, Number of times of
previous treatment and Previous treatment
outcome.
Environmental related factors: -Had or had
not have house to live in, Number of rooms,
Family size and Presence of television (TV).
Clinical related factors: - Mental illness,
Contract by diabetes mellitus and Having
HIV infection.
Operational definitions
Cases (MDR- TB patients): -were all culture-
proven to be resistant to both isoniazid and
rifampicin with or without resistance to other
anti-TB drugs.
Controls (non-MDR-TB patients): - were all
TB patients who were either not resistant to
anti-TB drugs or resistant to isoniazid or
rifampicin.
Defaulter: all patients whose treatment was
interrupted for two or more consecutive
months.
Zalalem Kaba Babure et al Research Article
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IJBAF, April, 2019, 7(4)
DR-TB patients: -All forms of TB resistant to
one or more drugs different from isoniazid
and rifampicin together Sensitive TB cases: -
All forms of TB which is sensitive to first
line TB drugs.
Data quality management
A week before the actual data collection; a
pre-test was done on 5 % of the sample at
JimmaArjo district hospital and then a
necessary adjustment was made. Training
was given for one day for data collectors and
supervisors on the objectives of the study and
data collection process.
Data Analysis and Presentation
Collected data were coded and entered into
EPI-DATA version 3.1 and then exported to
SPSS windows version 20.0. Bivariate
analysis was performed and all variables
having a p-value <=0.25 were entered into
multivariate logistic analysis in order to
assess the independent predictors of MDR-
TB. A crude and adjusted odd ratio with their
95% confidence was computed to show the
association between dependent and
independent variables. Statistical significance
was determined using p<0.05 as a cut-off
point.
RESULT
Socio-demographic characteristics of the
respondents
A total of 65 patients (21 cases and 44
controls) were included in this study of
which 21 were MDR-TB and the remaining
were non-MDR-TB patients with the
response rate of 100 %. Of these 8(38 %) and
26 (59.1 %) were males in cases and controls
respectively. Sex, residence, marital status,
educational status, occupation and monthly
family income were candidate variables for
multivariate logistic regression (detail
characteristics of study participants presented
on table 1).
Tuberculosis disease related factors
TB Patients’ related characteristics
From the total of 21 MDR-TB cases fifteen
(71.4 %) of them had history of previous TB
treatment while only three (6.8 %) of
controls (non-MDR-TB) had this history.
Imprison history, previous anti-TB treatment,
history of TB contact, history of smoking,
history of defaulter, history of chat chewing
and TB treatment outcome were candidate
variables for multivariate logistic regression
(for more detail see table 2).
Environmental related characteristics
Only number of rooms in the house become
the candidate variable for multivariate
Zalalem Kaba Babure et al Research Article
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IJBAF, April, 2019, 7(4)
logistic regression analysis (for more detail
see table 3).
Clinical related characteristics
As indicated in the table 4 eleven (52.4 %) of
cases and eight (18.2 %) of controls are HIV
infected patients. Presence of HIV co-
infection and having history of mental illness
were variables which had p-value of <= 0.25
at bivariate analysis among clinical related
characteristics (for more detail see table 4).
Multivariate logistic regression analysis
The Final Predictors of developing MDR-
TB
All candidate variables explained above
under result part of bivariate analysis were
entered into multivariate logistic regression
analysis. After adjusting for possible
confounding factors MDR-TB was
significantly associated with history of
previous TB treatment (AOR = 0.975, 95 %
CI = 0.957 – 0.994), history of defaulter
(AOR=0.055, 95 % CI=0.008-0.391), history
of Smoking (AOR=74.833, 95 % CI=1.563-
36.248), number of rooms in the house
(AOR=5.410,95 % CI=1.579-18.536) and
presence of HIV infection (AOR=0.232,95 %
CI=0.065-0.823). The study participants’
who had had previous history of TB
treatment had 97.5 % increased risk of
having MDR-TB when compared to TB
patients who had not has history of previous
TB treatment. TB patients who had no
history of defaulter had decreased risk of
developing MDR-TB when compared with
those TB patients’ who had such history. The
study participants who had history of
smoking had 75 % higher risk of developing
MDR-TB compared to those who did not had
history of smoking. Moreover, those TB
patients who had live in one room were 5.41
times more likely to develop MDR-TB
compared to those who had live in two and
above rooms. The study participants with
TB/HIV co-infection had 77 % increased risk
of getting MDR-TB compared to those TB
patients without TB/HIV co-infection (see
table 5).
Table 1: Bivariate Analysis of the Socio-demographic characteristics of study participants with MDR-TB at Nekemte
referral hospital, Oromia regional state, Western Ethiopia, September 1st 2016 to August 30th 2017
Variables Category Case-21(N, %) Control-44(N, %) COR(95 % CI) P-value
Age
<=25 years 5(23.8) 12(27.3) 0.595(0.144-2.467) 0.474
26
-
45 years
9(42.9)
22(50.0)
0.584(0.169
-
2.017)
0.395
>=46 years 7(33.3) 10(22.7) 1
Total 21(100) 44(100)
Sex
Male 8(38.1) 26(59.1) 0.426(0.147-1.237) 0.117*
Female 13(61.9) 18(40.9) 1
Total
21(100)
44(100)
Residence Rural 7(33.3) 6(13.6) 3.167(0.907-11.06) 0.071*
Urban 14(66.7) 38(86.4) 1
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IJBAF, April, 2019, 7(4)
Total 21(100) 44(100)
Religion
Orthodox
9(42.9)
13(29.5)
1.780(0.526
-
6.020)
0.354
Protestant 7(33.3) 18(40.9) 0.989(0.256-3.820) 0.87
Muslim 5(23.8) 13(29.5) 1
Total 21(100) 44(100)
Ethnicity Oromo 17(81) 36(81.8) 1
Amhara
4(19)
8(18.2)
1.059(0.280
-
4.010)
0.933
Marital status Married 14(66.7) 22(50.0) 2(0.677-5.906) 0.210*
Single 7(33.3) 22(50.0) 1
Total 21(100) 44(100)
Education
al status
Unable to read and write 8(38.1) 5(11.4) 3.520(0.756-16.3) 0.109*
Primary school
2(9.5)
9(20.5)
0.489(0.076
-
3.1)
0.451
Secondary school 6(28.6) 19(43.2) 0.695(0.171-2.8) 0.610
College and above 5(23.8) 11(25) 1
Total 21(100) 44(100)
Occupation
House wife 5(23.8) 5(11.4) 3.500(0.662-18.4) 0.140*
Government employed 6(28.6) 15(34.1) 1.400(0.325-6.0) 0.651
Private employed 6(28.6) 10(22.7) 2.100(0.467-9.4) 0.333
Farmer
4(19.0)
14(31.8)
1
Total 21(100) 44(100)
Monthly
family
income
<=500 ETB 5(23.8) 11(25.0) 0.758(0.211-2.71) 0.670
501-1500ETB 2(9.5) 9(20.5) 0.370(0.068-2.00) 0.250*
1501-2000ETB 2(9.5) 4(9.1) 0.833(0.132-5.25) 0.846
>=2001ETB
12(57.1)
20(45.5)
1
Total 21(100) 44(100)
Key *Variables that showed significant association during bivariate analysis at P-value <=0.25, **P-Value<=0.05, COR.
The last was taken as reference group
Table 2: Bivariate analysis of TB Patients’ related factors with MDR-TB at Nekemte referral hospital, Oromia regional
state, Western Ethiopia, September 1st 2016 to August 30th 2017
Variables Category Case-21(N, %) Control-44(N, %) COR(95 % CI) P-value
History of being in prison Yes 2(9.5) 1(2.3) 4.526(0.387-53.002) 0.229*
No 19(90.5) 43(97.3) 1
History of previous TB Treatment Yes 15(71.4) 3(6.8) 34.167(7.572-154.173) 0.001**
No 6(28.6) 41(93.2) 1
History of TB contact
Yes
11(52.4)
35(79.5)
0.283(0.092
-
0.87)
0.001**
No 10(47.6) 9(20.5) 1
Number of times of previous
treatment
1time 15(71.4) 10(22.7) 1
>=2times 6(28.6) 34(77.3) 0.118(0.036-0.383) 0.001**
History of defaulter Yes 15(71.4) 19(43.2) 3.289(1.074-10.072) 0.037**
No
6(28.6)
25(56.8)
1
History of traditional treatment Yes 7(33.3) 15(34.1) 0.967(0.322-2.906) 0.952
No 14(66.7) 29(65.9) 1
History of illicit drug use
Yes 7(33.3) 11(25.0) 1.500(0.482-4.668) 0.484
No 14(66.7) 33(75.0) 1
History of Smoking
Yes
2(9.5)
20(45.5)
0.126(0.026
-
0.609)
0.010**
No 19(90.5) 24(54.5) 1
History of alcohol use
Yes 4(19.0) 14(31.8) 0.504(0.143-1.778) 0.287
No
17(81.0)
30(68.2)
1
History of chat chewing
Yes 2(9.5) 10(22.7) 0.358(0.071-1.806) 0.213*
No
19(90.5)
34(77.3)
1
Chronic Antacid use
Yes 2(9.5) 5(11.4) 0.821(0.146-4.627) 0.823
No 19(90.5) 39(88.6) 1
Previous TB treatment outcome
Cured
5(23.8)
5(11.4)
1
Completed 8(38.1) 6(13.6) 3.600(0.736-17.599) 0.114*
Failure
3(14.3)
15(34.1)
4.800(1.126
-
20.460)
0.034**
Key *Variables that showed significant association during bivariate analysis at P-value <=0.25, **P-Value<=0.05, COR.
The last was taken as reference group
Zalalem Kaba Babure et al Research Article
70
IJBAF, April, 2019, 7(4)
Table 3: Bivariate analysis of Environmental related factors with MDR-TB at Nekemte referral hospital, Oromia regional
state, Western Ethiopia, September 1st 2016 to August 30th 2017.
Variables Category Case-21(N, %) Control-44(N, %) COR(95 % CI) P-value
Have a house to live in Yes 15(71.4) 35(79.5) 0.643(0.194-2.128) 0.469
No 6(28.6) 9(20.5) 1
Number of rooms in the
house
One
14(67)
6(14)
1
>=two 7(33) 38(86) 6.800(2.155-21.455) 0.001**
Total number of family size <=5 2(9.5) 6(13.6) 1
>5 19(90.5) 38(86.4) 1.500(0.276-8.149) 0.639
Have a TV Yes 12(57.1) 25(56.8) 1
No
9(42.9)
19(43.2)
0.987(0.345
-
2.820)
0.980
Key *Variables that showed significant association during bivariate analysis at P-value <=0.25, **P-Value<=0.05, COR.
The last was taken as reference group
Table 4: Bivariate analysis of Clinical related factors with MDR-TB at Nekemte referral hospital, Oromia regional state,
Western Ethiopia, September 1st 2016 to August 30th 2017.
Variables Category Case-n=21(%) Control-n=44(%) COR(95%CI) P-value
Contract diabetes mellitus
Yes 5(23.8) 13(29.5) 0.745(0.226-2.462) 0.630
No
16(76.2)
31(70.5)
1
Presence of HIV/infection
Yes 11(52.4) 8(18.2) 4.950(1.569-15.618) 0.006**
No
10(47.6)
36(81.8)
1
History of mental illness Yes 6(28.6) 5(11.4) 3.120(0.827-11.771) 0.093*
No 15(71.4) 39(88.6) 1
Key *Variables that showed significant association during bivariate analysis at P-value <=0.25, **P-Value<=0.05, COR.
The last was taken as reference group
Table 5: Multiple logistic regression analysis for risk factors of multidrug-resistant tuberculosis among tuberculosis
patients at Nekemte referral hospital, Oromia regional state, western Ethiopia, September 1st 2016 to August 30th 2017
Variables Category COR(95 %CI) AOR(95 %CI) P-value
History of previous TB Treatment
Yes
34.167(7.572
-
154.173)
0.975(0.957
-
0.994)
0.011
No 1 1
History of defaulter Yes 3.289(1.074-10.072) 0.055(0.008-0.391) 0.004
No
1
1
History of Smoking Yes 0.126(0.026-0.609) 74.833(1.563-36.248) 0.029
No
1
1
Number of rooms in the house One 6.800(2.155-21.455) 5.410(1.579-18.536) 0.007
>=two
1
1
Presence of HIV/infection
Yes
4.950(1.569
-
15.618)
0.232(0.065
-
0.823)
0.024
No 1 1
DISCUSSION
This study has provided relevant information
about the predictors associated with MDR-
TB infection which can support activities
being implemented to decrease the burden of
TB in the study area specifically and Oromia
regional state broadly.
The study conducted in Belarus indicated
that the majority of TB patients who have
had previous treatment for the disease have
MDR-TB [16]. In line with this, the current
study revealed that the chance of having
MDR-TB was higher in TB patients who had
history of previous TB treatment. Another
study conducted at St. Peter’s TB Specialized
Hospital in Addis Ababa of Ethiopia
indicated that patients who had previous
history of treatment for TB had 21 times
higher risk of developing MDR-TB than
patients who did not have [27]. Similar study
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IJBAF, April, 2019, 7(4)
conducted in Portugal by Marta G. et al
showed that previous TB treatment was a
well-known risk factor for drug-resistant TB
[31]. In line with the current study, a study
conducted in central Nepal revealed that
previous treatment of tuberculosis was
strongly associated with MDR-TB [30].
Study conducted in Oromia region showed
that previous TB treatment outcome were
predictors of MDR-TB [29]. Our finding
infers that the association between history of
defaulter and having MDR TB is significant
(AOR=0.055, 95 % CI 0.008-
0.391(p=0.004).
In the present study TB patients who had
history of smoking showed significantly
increased risks of developing MDR-TB. This
is similar to the corresponding values
previously reported in Belarus [16]. Similar
finding from another study conducted in
Northern Tanzania indicated that the odds of
developing MDR-TB among smokers were
2.3 times higher compared with non-smokers
[13]. In contrary to the current study finding,
the study conducted in Oromia region
revealed that personal behaviors like
smoking were not predictors of MDR-TB
[29]. In line with the current study finding
the study conducted in central Nepal showed
that having a history of smoking and MDR-
TB was significant [30].
This study revealed that patients living in the
house with only one room were five times
more likely to develop MDR-TB than those
living in a house with greater than and equal
to two rooms. The possible description may
be due to the crowded places which favor
high risk of acquiring resistant strains from
infected hosts. A finding from the study
conducted at St. Peter’s TB Specialized
Hospital in Addis Ababa of Ethiopia
similarly indicated that patients living in a
household with only one room were five
times at higher risk of having MDR-TB than
those living in a household with more than
one room [27].
It is revealed by this study: - TB patients with
HIV co-infection were high risk to develop
MDR-TB when compared with those without
HIV co-infection. Similar study conducted in
Belarus showed that HIV-positive TB cases
were found to have a significantly higher risk
of MDR-TB than their HIV-negative
counterparts [16]. Another similar study
conducted in Addis Ababa at St. Peter’s TB
Specialized Hospital showed that study
participants who had HIV infection were
three times at higher risk than those who had
no HIV infection to develop MDR-TB [27].
The study conducted in Oromia Region by
Girma M. et al also showed that HIV
infection was significantly associated with
Zalalem Kaba Babure et al Research Article
72
IJBAF, April, 2019, 7(4)
the occurrence of MDR-TB [29]. In contrary
to this the study conducted by Selamawit H.
et al in Addis Ababa revealed that HIV status
was not significantly associated with MDR-
TB among individuals who had been
previously treated with first-line anti-TB
drugs [33]. Similarly, the study conducted in
Northern Tanzania indicated: - being HIV
infection was not independently associated
with MDR-TB [13]. The study conducted at
St. Peter Hospital Addis Ababa by Muluken
D et al also showed that there is no a
significant association between HIV/AIDS
co-infection and MDR-TB [28]. Another
study conducted in Portugal also indicated
that there was no a significant association
between HIV co-infection and drug-
resistance [31].
CONCLUSION AND
RECOMMENDATION
In this survey history of (previous TB
treatment, defaulter, smoking), number of
rooms in the house, and presence of HIV
infection were found to be the major
predictors for having MDR–TB. Nekemte
referral hospital management bodies should
give emphasis on TB patient’s adherence to
anti-TB drugs and special attention should be
given to health education and promotion
activities to decrease risky behaviors like
smoking habit. Besides, they should give due
attention to strength the collaboration
between TB and HIV control programs.
ABBREVIATIONS/ ACRONOMY
AOR: -Adjusted Odds Ratio
COR: -Crude Odds Ratio
FMOH: -Federal Ministry of Health
HBCs: -High Burden Countries
HIV: -Human Immune Virus
MDR-TB: -Multi-drug resistant
Tuberculosis
TIC: -Treatment Initiative Center
WHO: -World Health Organization
AUTHORS’ CONTRIBUTIONS
ZK conceived and designed the study,
drafting the article, analyzed the data
critically for intellectual content and wrote
the manuscript. KT, JF, TD and AF were
participated in the design of the study,
statistical analysis and interpretation of data.
All authors read and approved the final
manuscript.
AUTHORS’ INFORMATION
ZK is currently working at East Wollega
Zonal Health Office as Quality Officer. KT
and AF are currently working at USAID/JSI
Transform: Primary Health Care Project as
Zonal Program officer. JF is currently
working as high Quality Clinical Care
Technical Advisor at Oromia Regional
Health Bureau, Addis Ababa. TD is currently
a Lecturer at Jimma University department of
Zalalem Kaba Babure et al Research Article
73
IJBAF, April, 2019, 7(4)
health economics, management and policy,
College of Health Sciences.
ACKNOWLEDGMENTS
The authors would like to express their
sincere gratitude to Nekemte referral hospital
administrative bodies for giving us an
opportunity to conduct this study in this
hospital. The warmest thanks go to the study
participants for their genuine response and
Nekemte referral hospital TB unit staff for
facilitating data collection during the study
period.
AUTHORS’ DETAILS
1Zonal level healthcare service quality unit
head, East Wollega Zonal Health Office,
Oromia Regional State, Western Ethiopia
2,5Zonal Program Officer, USAID/JSI
Transform: Primary Health Care Project,
East Wollega Zone, Oromia Regional State,
Western Ethiopia
3Technical advisor of high quality clinical
care at Oromia Regional Health Bureau,
Addis Ababa, Ethiopia
4Lecturer at Jimma University department of
health economics, management and policy,
College of Health Sciences.
CONFLICT OF INTERESTS
“The authors have not declared any conflict
of interests.”
FUNDING
This research did not receive any specific
grant from funding agencies in the public,
commercial, or not-for-profit sectors.
ETHICAL APPROVAL
Permission was obtained to undertake the
study from Nekemte referral hospital
administrative bodies. All the study
participants were informed about the
objective and importance of the study and
their verbal consent was obtained before
conducting data collection and they were also
being informed about their right of not
participating in the study and terminating at
any time. Confidentiality of study
participants was assured by using
questionnaire identification number and
privacy by removing names and other
identifiers during the interview.
ARTICLE CAN BE CITED AS
BABURE ZK, BIDU KT, ASSEFA JF,
WELDEMARIUM TD4, AND TUFA AF.
2019. Risk Factors For Multi Drug-Resistant
Tuberculosis Among Tuberculosis Patients
of Nekemte Referral Hospital, Oromia
Regional State, Western Ethiopia, 2017. Int.
J. Biotechnol. Allied Fields. 7(3): 63-77.
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