Determinants of Multidrug-Resistant Mycobacterium tuberculosis Infection: A Multicenter Study from Southern Ethiopia

Abstract

Background: Multidrug-resistant tuberculosis (MDR-TB) continues to be a public health problem. Globally in 2019, a total of 465,000 people developed rifampicin-resistant TB (RR-TB), of which 78% had MDR-TB. There is a paucity of evidence on the determinants of MDR-TB in southern Ethiopia. Hence, this study aimed to assess the determinants of MDR-TB in southern Ethiopia. Methods: A hospital-based case–control study was conducted in southern Ethiopia. The cases were all MDR-TB patients attending TB clinics, and controls were all patients who were declared as cured or treatment completed. The cases were selected by consecutive sampling, and a simple random sampling technique was used for controls. Multivariable logistic regression analysis was done to identify determinants of MDR-TB. Adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were computed, and statistical significance was declared at a P-value less than 5%. Results: A total of 191 participants, 67 cases, and 124 controls were included. TB patients facing social stigma (AOR = 8.9, 95% CI: 2.3–34.6), living in a household with one room (AOR = 12.3, 95% CI: 2.3–63.5), and two rooms (AOR = 9.7, 95% CI: 1.7–54.8), having the previous history of TB treatment (AOR = 11.8, 95% CI: 2.9–47), having baseline body mass index (BMI) less than 18.5Kg/ m2(AOR = 4.5, 95% CI: 1.2–16.8), and having pulmonary TB (AOR = 5.1, 95% CI: 1.33–19.8) were determinants of MDR-TB. Conclusion: In this study, TB patients facing social stigma, living in one-and two-roomed houses, having a previous history of TB treatment, having low baseline BMI and pulmonary type of TB had higher odds of MDR-TB. Therefore, health workers in TB control programs should include mental health services in the TB care protocol, and priority should be given to malnutrition screening as a first-line diagnosis, nutritional supplements, and health education about proper housing.