Multi-drug Resistant Tuberculosis: Experience in Bogra

Abstract

This descriptive study was carried out from February 1995 to December 2004. Sputum positive tuberculosis patients who were not cured by re-treatment with Category-2 regimen under DOTS were included in this study. Information were collected from the patients, treatment cards and treatment registers.

Among 13633 sputum positive TB patients registered during study period, 12511 were new smear positive (NSP) TB patients and1122 were re-treatment smear positive (RSP) TB patients. RSPTB patients were found significantly (p<.001) decreased in respect to NSP TB in subsequent years. Percentage of Chronic TB patients in respect to total smear positive TB patients registered, in first three years, was higher (1.25%, 1.3% &1.5% respectively) and the percentage sharply decreased in the subsequent years and it remained near base line in last five years. There was no significant sex differences in Chronic TB cases. Age of Chronic TB patients was 37±12 years and 59%(23) were literate. All the Chronic TB patients were residing in their home and 44% from sador upazilla including Bogra town. 62% of Chronic TB patients were from economically in average group and 25% were poor. 85% Chronic TB patients had no associated diseases. Associated diseases of Chronic TB patients were diabetes, bronchiectasis and bronchitis. 56% Chronic TB patients were smoker but none of them had habit of drug abuse. 62% of them had history of incomplete Rifampicin containing anti TB treatment from general practitioners. About the reasons of discontinuation of treatment 50%(12) stated that they felt better and discontinued, 29%(7) stated that they could not afford treatment and 21%(5) stated that they did not get result from the treatment and discontinued. 23% of Chronic TB patients had history of Cat -I regimen relapse or failure under DOTS. During the study period 26%(10) died and duration of death from onset of declared MDR-TB was 22.4±17.5 months. Nearly half (57%) of Chronic TB patients had no information, 15% remain negative with treatment and 13% remain smear positive.

Age, sex, literacy, homelessness, associated diseases, poor economical condition, availability of treatment facility had less impact on irregular/ incomplete treatment. Unsupervised anti TB treatment with inadequate information and motivation prior to treatment starting is important cause of incomplete treatment. DOTS treatment for all TB patients with adequate motivation can check RSP-TB patients and thereby Chronic TB patients. Once MDR-TB is identified the patients should be isolated from the community and adequate treatment should be arranged for them.  

doi: 10.3329/taj.v18i1.3302

TAJ 2005; 18(1): 30-36