Drug resistant tuberculosis in Karamoja region: prevalence, patterns and associated factors

Abstract

Introduction: Tuberculosis (TB) remains a major public health problem in Uganda especially in Karamoja. Drug-resistance has been a major setback in fighting this infectious disease. The prevalence of MDR among new cases is 0-4.5% in Uganda, and among recurrent cases it is 12.1% - 17.7%. Karamoja is the region with the highest incidence of TB in Uganda; with some 3,500 new cases identified and treated annually including increasing cases of MDR. This study aimed at determining the prevalence, the patterns and factors associated with drug resistant Tuberculosis among TB patients in Karamoja region in the period from January 2015 to April 2018. Methods: We conducted a cross sectional study to determine the prevalence and patterns of DR-TB in Karamoja region during the months of January 2015 to April 2018. To determine the factors associated, we conducted a matched case control study with 41 cases and usedrandom by sampled 164 controls. Three Focus group discussions (FGD), ten in-depth interviews and Key informant interviews were used to collect qualitative data. Adjusted Conditional logistic regression was used to determine associated factors. Ethical approval for this study was obtained from School of Medicine Research Ethics Committee and the Uganda National Council for Science and Technology. Results: The prevalence of DR-TB in Karamoja was found to be 0.1% and 0.6% among the new and previously treated TB patients respectively. The patterns found in the region were Rifampicin Resistance and Multi Drug Resistant Tuberculosis. The major factors associated with Drug resistant Tuberculosis were Type of patient (P=0.004) and Drug stock out (P=0.001. The community was aware of high burden of TB and had positive perception of the values of TB treatment but nomadic lifestyle, use of substances, congested homesteads and poor attitudes of the health workers were a great challenge to effective treatment of TB. Conclusion: Karamoja is still a low DR-TB prevalence region but with the highest TB incidence, the numbers are likely to increase if not handled early. History of TB treatment, and Drug stock out use were associated with DR-TB. Treatment adherence interventions targeting susceptible TB patients and infection control for their close contacts with poor socioeconomic status is recommended with more emphasis on improving the Directs Observed Therapy (DOTs).