Risk factors of multidrug resistant tuberculosis in Institute of Respiratory Medicine, Kuala Lumpur

Abstract

Background: Globally, the issue of Multidrug Resistant Tuberculosis (MDR-TB) was acknowledged to being a threat to the successful prevention and treatment of TB. In Malaysia, TB remains a major health issue and incidence has been rising slowly for the past decade indicating poor success rate in Malaysia's current TB control programme. Currently, very little epidemiological data can be found regarding the situation of TB and MDR-TB in Malaysia. Therefore, the objective of this retrospective study is to identify the independent risk factors associated with MDR-TB in Malaysia. Methods & Materials: 477 systematically randomized TB patients from the Institute of Respiratory Medicine (IPR) were sampled based on the records of patients in 2010. Data were divided based on four categories, sociodemographics, lifestyle and habits, co-morbidities and TB case management. Results: Among 477 patients sampled, 67.9% were male with mean age 37.2 (SD 14.9). 30% of patients were foreign born with the majority were from Myanmar (14.9%), Indonesia (9.4%) and Bangladesh (2.7%). In multivariate logistic analysis, BCG Status (AOR = 0.292, 95%CI 0.13-0.67) was found to be a protective risk factor while history of previous TB (AOR = 4.36, 95%CI 1.80-10.56) was a risk factor for MDR-TB. Conclusion: Whilst history of previous TB is a commonly acknowledged risk factor, the evidence of BCG as a protective factor for MDR-TB indicates that BCG vaccination is still a viable preventive measure. Therefore, this study recommends the continuation of of neonatal BCG vaccination and further research should also be carried out in order to allow the possiblity of reintroducing the booster shot which was administered several years after the initial vaccination. Research should not only focus on the cost effectiveness of the practise but also on the long-term viability of booster shot in protecting against TB and MDR-TB.