HIV Insight: Determinants of Multidrug-Resistant Tuberculosis in Henan Province in China

Background

Multi-drug resistance (MDR) has been a cause of concern for tuberculosis (TB) control in both developed and developing countries. This study described the characteristics and risk factors associated with MDR-TB among 287 cases and 291 controls in Henan province, China.

Methods

A hospital-based case-control study was conducted between June 2012 and December 2013. The study subjects were selected using multistage probability sampling. Multivariate conditional logistic regression models were used to determine the risk factors associated with MDR-TB.

Results

The following risk factors for MDR-TB were identified: previous TB treatment (AOR = 4.51, 95 % CI: 3.55–5.56), male sex (AOR = 1.09, 95 % CI: 0.24–1.88), high school or lower education degree (AOR = 1.87, 95 % CI: 1.27–2.69), unemployment (AOR = 1.30, 95 % CI: 0.78–2.52), long distance of residence from the health facility (AOR = 6.66,95 % CI: 5.92–7.72), smoking (AOR = 2.07, 95 % CI: 1.66–3.19), poor knowledge regarding MDR-TB (AOR = 2.06, 95 % CI: 1.66–2.92), traveling by foot to reach the health facility (AOR = 1.85, 95 % CI: 1.12–3.09), estimated amount of time to reach the health facility was greater than 3 h (AOR = 1.42, 95 % CI: 0.51–2.35), social stigma (AOR = 1.17, 95 % CI: 0.27–2.03), having an opportunistic infection (AOR = 1.45, 95 % CI: 0.58–2.4), more than 3 TB foci in the lungs (AOR = 1.98, 95 % CI: 1.49–3.25), total time of first treatment was more than 8 months (AOR = 1.39, 95 % CI: 0.65–2.54), adverse effects of anti-TB medication (AOR = 2.39, 95 % CI: 1.40–3.26), and more than 3 prior episodes of anti-TB treatment (AOR = 1.83, 95 % CI: 1.26–2.80).

Conclusion

The identified risk factors should be given priority in TB control programs. Additionally, there is a compelling need for better management and control of MDR-TB, particularly through increasing laboratory capacity, regular screening, enhancing drug sensitivity testing, novel MDR-TB drug regimens, and adherence to medication.

Socio-demographic distribution of cases and controls, Henan province, 2013

Variables		Case (287)		Control (291)		Total (578)
Variables		n	%	n	%	n	%
Sex
	Female	58	20.21	89	30.58	147	25.43
	Male	229	79.79	202	69.42	431	74.57
Age (years)
	≤29	39	13.59	29	9.96	68	11.76
	30–59	64	22.3	68	23.37	132	22.84
	≥60	184	64.11	194	66.67	378	65.4
Nationality
	Han Nationality	251	87.34	241	82.75	492	85.12
	Other Nationality	36	12.66	50	17.25	86	14.88
Religion
	Christian	20	7.12	15	5.32	35	6.05
	Muslim	7	2.42	9	2.96	16	2.77
	No religion	260	90.46	267	91.72	527	91.18
Occupation
	Unemployed	182	63.41	151	51.89	333	57.61
	Employed	105	36.59	140	48.11	245	42.39
Education degree
	High school or lower	211	73.52	157	53.95	368	63.67
	University or higher	76	26.48	134	46.05	210	36.33
Marital status
	Married	185	64.57	179	61.39	364	62.98
	Single	76	26.48	72	24.83	148	25.61
	Divorced	20	6.84	31	10.52	51	8.82
	Widowed	6	2.11	9	3.26	15	2.59
Monthly income of the Family (RMB)
	≤3000	231	80.44	228	78.35	459	79.41
	3000–5000	45	15.57	40	13.89	85	14.71
	≥5000	11	3.99	23	7.76	34	5.88
Patient residence
	Rural	197	68.49	175	60.18	372	64.36
	Urban	90	31.51	116	39.82	206	35.64
Family size
	≤3	142	49.32	156	53.74	298	51.56
	≥4	145	50.68	135	46.26	280	48.44

Full article at: http://goo.gl/pkTWDC

By: Zhang C1, Wang Y2, Shi G3, Han W4, Zhao H5, Zhang H6, Xi X7.

1Department of Tuberculosis, the First Hospital Affiliated to the Xinxiang Medical College (http://www.xxmu.edu.cn/english/), No. 88 Jiankang Road, Weihui, 453100, Henan, China. 76406865@qq.com.
2Department of Tuberculosis, the First Hospital Affiliated to the Xinxiang Medical College, No. 88 Jiankang Road, Weihui, 453100, Henan, China. hope_liang@163.com.
3Department of Tuberculosis, the First Hospital Affiliated to the Xinxiang Medical College, No. 88 Jiankang Road, Weihui, 453100, Henan, China. lq13079587230@163.com.
4Department of Tuberculosis, the First Hospital Affiliated to the Xinxiang Medical College, No. 88 Jiankang Road, Weihui, 453100, Henan, China. renyong196847@163.com.
5Department of Tuberculosis, the First Hospital Affiliated to the Xinxiang Medical College, No. 88 Jiankang Road, Weihui, 453100, Henan, China. liangqing123@gmail.com.
6Department of Tuberculosis, the First Hospital Affiliated to the Xinxiang Medical College, No. 88 Jiankang Road, Weihui, 453100, Henan, China. 2236470894@qq.com.
7Department of Tuberculosis, the First Hospital Affiliated to the Xinxiang Medical College, No. 88 Jiankang Road, Weihui, 453100, Henan, China. xixiue@outlook.com.
BMC Public Health. 2016 Jan 16;16(1):42. doi: 10.1186/s12889-016-2711-z.