PREDICTORS FOR MULTIDRUG-RESISTANT TUBERCULOSIS AMONG TUBERCULOSIS PATIENTS, BRONG AHAFO REGION, GHANA, 2019

ABSTRACT Background: Multidrug resistant tuberculosis (MDR-TB) has not been given the necessary attention in Africa and particularly Ghana where incidence of TB and risk factors are high. Nearly 600,000 new MDR/RR-TB clients with 240 000 deaths reported worldwide. Regionally, Africa accounted for 25% of the reported clients. However, Ghana reported a total of 528 MDR-TB with 63 (10.3%) deaths from 2012 to 2018. Of these cases, 44 (13.6%) were reported in Brong Ahafo Region over the same period. Possible resistance to the second line drugs is eminent. This can lead to increased new infections and mortalities. This study seeks to primarily identify the factors that independently could predict MDR among TB clients. Method: We conducted an unmatched case-control study (1:3 ratio) to assess the sociodemographic, behavioral, health facility factors associated with MDR-TB using a structured questionnaire. Seven districts in BAR were selected for the study with approval from the KHRIRC. Cases were selected purposively whilst a simple random sampling to select their controls. A total of 36 cases and 108 controls were selected from smear positive TB clients (with cured/MDR outcome) between 2016 to 2018 were used for the study for the period of March to June, 2019. GIS was also employed to determine spatial patterns of MDR-TB. The data were entered into Epi Info 7.2.0 and analysed using STATA 15.0 versions. Descriptive statistics was performed to generate summary values for the variables and those that showed statistical significance in the bivariate level were entered into multivariate analysis to identify independent factors. Statistical significance was pegged at p-value less or equal to 0.05. Results: In all, 36 cases and 108 controls were enrolled unto the study with a mean age of 42.7 (SD±11.6). Ages of participants ranged from 21years to 70 years. The mean age of cases was 44.4 (+-9.9) years, and controls 42.3 (+-12.1) years with majority within the age group of 20 to 40 years. xiv Females constituted 25 (69%) of cases and 53 (49%) of controls. Presence of HIV infection [AOR=12.3, 95% CI (2.49 – 60.77)] and taking more than one month of onset of first symptom to report at health facility [AOR=13.2, 95% CI (2.95 – 59.47)], treatment supporters [AOR=0.1, 95% CI (0.0 – 0.34)], living within a family [AOR=0.10, 95% CI (0.03 – 0.34)] and timely follow ups [AOR=0.2, 95% CI (0.76 – 0.79)] were discovered to independently predict the development of MDR-TB among TB clients. Conclusion: Presence of HIV/AIDS infection and late capture of clients by the health system were found to have strong association with the occurrence of MDR-TB. Based on these findings, we concluded that strategies in combating multidrug resistant should be emphasize on clients with presence of HIV/TB co-infection, strengthening TB surveillance for early case detection, motivate treatment supporters and frequent follow-up of clients during first line treatment Keywords: MDR-TB, predictors, case-control study, Brong Ahafo region, Ghana