Development of multidrug resistant tuberculosis in Bangladesh: a case-control study on risk factors

Mahfuza Rifat; Abul Hasnat Milton; John Hall; Christopher Oldmeadow; Md Akramul Islam; Ashaque Husain; Md Wahiduzzaman Akhanda; Bodrun Naher Siddiquea

doi:10.1371/journal.pone.0105214

Development of multidrug resistant tuberculosis in Bangladesh: a case-control study on risk factors

PLoS One. 2014 Aug 19;9(8):e105214. doi: 10.1371/journal.pone.0105214. eCollection 2014.

Authors

Mahfuza Rifat¹, Abul Hasnat Milton², John Hall², Christopher Oldmeadow², Md Akramul Islam³, Ashaque Husain⁴, Md Wahiduzzaman Akhanda⁵, Bodrun Naher Siddiquea³

Affiliations

¹ The University of Newcastle, Newcastle, New South Wales, Australia; BRAC, Dhaka, Bangladesh.
² The University of Newcastle, Newcastle, New South Wales, Australia.
³ BRAC, Dhaka, Bangladesh.
⁴ National Tuberculosis Control Programme, Directorate General of Health Services, Dhaka, Bangladesh.
⁵ National Institute of Diseases of the Chest and Hospital, Dhaka, Bangladesh.

Abstract

Objective: To determine the risk factors for developing multidrug resistant tuberculosis in Bangladesh.

Methods: This case-control study was set in central, district and sub-district level hospitals of rural and urban Bangladesh. Included were 250 multidrug resistant tuberculosis (MDR-TB) patients as cases and 750 drug susceptible tuberculosis patients as controls. We recruited cases from all three government hospitals treating MDR-TB in Bangladesh during the study period. Controls were selected randomly from those local treatment units that had referred the cases. Information was collected through face-to-face interviews and record reviews. Unadjusted and multivariable logistic regression were used to analyse the data.

Results: Previous treatment history was shown to be the major contributing factor to MDR-TB in univariate analysis. After adjusting for other factors in multivariable analysis, age group "18-25" (OR 1.77, CI 1.07-2.93) and "26-45" (OR 1.72, CI 1.12-2.66), some level of education (OR 1.94, CI 1.32-2.85), service and business as occupation (OR 2.88, CI 1.29-6.44; OR 3.71, CI 1.59-8.66, respectively), smoking history (OR 1.58, CI 0.99-2.5), and type 2 diabetes (OR 2.56 CI 1.51-4.34) were associated with MDR-TB. Previous treatment was not included in the multivariable analysis as it was correlated with multiple predictors.

Conclusion: Previous tuberculosis treatment was found to be the major risk factor for MDR-TB. This study also identified age 18 to 45 years, some education up to secondary level, service and business as occupation, past smoking status, and type 2 diabetes as comorbid illness as risk factors. National Tuberculosis programme should address these risk factors in MDR-TB control strategy. The integration of MDR-TB control activities with diabetes and tobacco control programmes is needed in Bangladesh.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Bangladesh / epidemiology
Case-Control Studies
Female
Humans
Logistic Models
Male
Middle Aged
Risk Factors
Tuberculosis, Multidrug-Resistant / epidemiology*
Young Adult

Grants and funding

This research was supported by the Australian Respiratory Council, the University of Newcastle, Australia, and BRAC Bangladesh. The funders had no role in study design, data collection and analysis or decision to publish or preparation of manuscript.