Multidrug-resistant tuberculosis (MDR TB)
Tuberculosis (TB) is an infectious airborne disease and a major health problem worldwide. Globally, TB is the second most life-threatening disease, next only to AIDS.A growing concern is the development of multi drug-resistant form of TB, which have developed due to partial or incomplete treatments. Multidrug-resistant tuberculosis (MDR TB) is caused by bacteria Mycobacterium tuberculosis which is resistant to both Isoniazid and Rifampicin and usually associated with high morbidity and mortality. It is among the most alarming pandemic problem. Multi-drug resistance tuberculosis has become a global public health burden and a health security threat to tuberculosis treatment. (Marahatta, Kaewkungwal, Ramasoota, & Singhasivanon, 2010)
Research question: What are the factor influencing MDR-TB and their possible solution?
Data source: I searched different web data base paper and articles for information about MDR-TB. The data bases articles I searched were (Midline, PubMed, SINHAL, HINARI and google scholar) with limitations to English language, full article, peer reviewed, and the date is within the last 5 years of publication.
Search key words: MDR-TB, Knowledge, Poverty Rifampicin, Isoniazid.
Inclusion/Exclusion criteria: I included the articles that are most relevant to my research with no limitation on ethnicity, colors and country. The aim of my research review is to generalize the result even though there is limitation to English language which could be considered as partiality those articles which are not relevant to my research topic and abstract were eliminated. I excluded some articles because they were repeated in several occasions. I have included different type of study paper without any restrictions on populations, culture etc. The study material I included was done in several countries where research were done as MDR-TB as the main area of the study.
According to global data, 490,000 cases of multidrug-resistant TB (MDR-TB) in 2016 and an additional 110,000 cases were susceptible to isoniazid but resistant to rifampicin (RR-TB), the most effective first-line anti-TB drug (World Health Organization, 2017). Around 47% of the total prevalence of MDR-TB cases is increasing in Asian countries like China, India and the Russian Federation (World Health Organization, 2017).
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In 2008, an estimated 440,000 cases of MDR tuberculosis came out globally whereas India and China carry the greatest estimated burden, together with reporting for almost 50% of the world’s total cases.(Eva Nathanson, 2014).History of prior tuberculosis, smoking habit, social stigma, lack of knowledge on multi-drug resistance tuberculosis and on DOTS Plus with multi-drug resistance tuberculosis are some of the factors contributing for multi-drug resistance tuberculosis (Marahatta et.al, 2010).In Nepal, patients think the disease is caused by sins, witchcraft, hard work, they take medicines irregularly, feel shy to talk about anti-tubercular medications.
Tuberculosis patients are the most vulnerable group for developing Multi-Drug Resistance Tuberculosis. The burden of MDR-TB is overwhelming in resource developing countries. Multi-Drug-resistant Tuberculosis is a persistent threat to the successful tuberculosis control program.
According to WHO, The latest anti-TB drug resistance surveillance data globally shows that 4.1% of new and 19% of previously treated TB cases in the world are estimated to have rifampicin- or multidrug-resistant tuberculosis (MDR/RR-TB) (World Health Organization, 2017).
According to Australian data found that MDR-TB accounted for up to 2.2% of all TB notifications between 1998 and 2007. The rate of TB in the Australian born non Indigenous population continues to remain relatively stable whereas, the rate of TB in the overseas born population has ranged from 16.2 per 100,000 to 20.2 per 100,000 respectively. (Cindy Toms, 2014)
A case-controlled study done in China, in between June 2012 and December 2013 revealed that one of the determinants of multidrug-resistant tuberculosis is also a poor knowledge regarding MDR-TB (Chunxiao Zhang, 2016)
A research carried out in Hyderabad, India showed that maximum number of patients was unsure about the severe complication of TB whereas patients did not adhere to the treatment and discontinued, this becomes the prime reasons for the gap between treatment and control, thereby non-adherent treatment could have severe consequences of diseases and might lead to death (Fazlu Rehman, 2017)
A descriptive study was done on “Knowledge, attitude and practice (KAP) of tuberculosis patients enrolled on treatment in Juba City, South Sudan 2010: a pilot study” among 120 patients showed that 80.4% had no knowledge on cause of TB, 52% did not know correct signs and symptoms of TB likewise, 39.2% did not know overall treatment duration whereas, 54.9% did not know the importance of treatment (Lou Joseph Kenyia, 2014)
Likewise, another study conducted on “Knowledge and Attitude about Multidrug-Resistant Tuberculosis among Healthcare Workers in Public Health Centres ”in Bandung, Indonesia among nurses and laboratory staff revealed that Regarding the knowledge of MDR-TB, 38.1% of study participants had good knowledge. Additionally, participants provided incorrect answers about the definition of MDR-TB, how it is diagnosed, and duration of treatment. In terms of attitude, 53.3% of study participants had a positive attitude towards MDR-TB (Lestari & Soeroto, 2016)
A research carried out by Joshua R Francis on MDR-TB in Western Australia in the year 1998-2012 showed that a total of 16 cases were notified as MDR-TB. During the research, it was found that the patients with MDR-TB were predominantly female of age group 28 years and most of the patients were born outside Australia (South Asia, East Asia, Sub Sahara Africa, and North Africa). (Joshua R Francis, 1998-2012).
Similarly, another cross-sectional study was conducted on “Multidrug-resistant tuberculosis” in Queensland, Australia in the year 2018 which showed that 61.4% females were diagnosed with MDR-TB and 97.9% of the people who had an MDR-TB were born outside of Australia. This study also revealed that although Australia has a low incidence of MDR-TB, numbers are increasing day by day. It also demonstrated that, compared with other Australian states, Queensland had a high burden of MDR-TB. (T. Baird, 2018)
Environmental and economic factors
Another study conducted on KwaZulu-Natal, South Africa on the topic “Multidrug-resistant tuberculosis: An overview of patients” reported that there may be an associated morbidity of MDR TB with HIV infection, and in KwaZulu-Natal, HIV transmission rates from men to women has increased and poverty, the low status of women and gender-based violence has been cited as reasons for the disparity in HIV prevalence between men and women.(Jayneetha Maharaj1 Andrew Ross2 Niren R. Maharaj3 Laura, 2015)
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According to the study conducted on China on the topic “Determinants of multidrug-resistant tuberculosis in Henan province in China: a case control study” revealed that though there isn’t an identifiable biological relationship between marital status and TB but single people are more likely to lack social support or be involved in high-risk behaviours, such as alcohol consumption or smoking, which potentially leaves them exposed of infection of MDR-TB than those with other marital statuses. Additionally, a study also revealed that income levels of people are also interrelated with disease and health. Low socioeconomic status was associated with MDR-TB as people with low economic cannot afford a high medical services and there is a lack of cheap and good medical services (Chunxiao Zhang, 2016)
Factors influencing MDR-TB
A cross-sectional study was carried on “Concerns about the knowledge and attitude of multidrug-resistant tuberculosis among health care workers and patients “in Delta State, Nigeria which revealed that 80% of age group 15-34 years have poor knowledge and only 20% have good knowledge on MDR-TB. Likewise, 88.9% were from 35-54 years age group have poor knowledge, 70.8%from ≥55 years age group have poor knowledge of MDR-TB (Ar Isara, 2015)
A study done on “Knowledge about Tuberculosis and its Complication among the Patients in a Teaching Hospital” showed that male is better informed of the causes, transmission of TB, its
Complication and control than female.(Fazlu, Raoof, Srinivasa, Ashfaq, & Qurram, 2017)
The study revealed that the level of knowledge regarding MDR-TB was positively associated with the educational status of the HCWs but not with that of the TB patients. Participation in the MDR-TB training program was not associated with greater knowledge among either the HCWs or the patients.
Similarly, a cross-sectional study was carried on “Concerns about the knowledge and attitude of multidrug-resistant tuberculosis among health care workers and patients “in Delta State, Nigeria which revealed that knowledge of MDR‑TB was poor among the TB patients studied as well as among HCWs with low educational status (Ar Isara, 2015)
A cross-sectional study was done on “Tuberculosis knowledge, attitudes, and practices among northern Ethiopian prisoners: Implications for TB control efforts” resulted that Government employees had a significantly higher level of knowledge compared to farmers. Students were found to have a higher level of favourable attitude compared to farmers (Adane K, 2017)
Tuberculosis is one of the major public health concern and the leading cause of the disease worldwide. The Latest World Health Organization report shows that there were 9.0 million new TB cases and 1.5 Million tuberculosis deaths. Despite the implementation of the Stop TB Strategy, the emergence of multidrug-resistant TB poses a formidable threat to TB control with 480,000 cases estimated worldwide in 2015 (T. Baird, 2018). Patient with previous TB treatment, male, low education, unemployment, poor knowledge of MDR TB, social stigma, being far from the health facility, etc. were shown to be in increased risk for MDR-TB (Chunxiao Zhang, 2016). From all this study, it can be concluded that the identified risk factors should be given more priority in an effective TB control program to control MDR-TB.
Evaluating the scenario, further research and investigation is important. Active public awareness program, effective new anti-TB drug regimens and better diagnostic tests, enhancing drug sensitivity tests and better management and control of MDR-TB to control the disease is a field of importance, which is becoming life-threatening day by day.
- Adane K, S. M. (2017). Tuberculosis knowledge, attitudes, and practices among northern Ethiopian prisoners: Implications for TB control efforts. PLOS ONE.
- Adebanjo, N. M. (2015). Knowledge and practices about multidrug-resistanttuberculosis amongst healthcare workers in Maseru. Afr J Prm HealthCare Fam Med, 7(1).
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- doi: http://dx.doi.org/10.4103/1119-3077.154212
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- Website: https://www.omicsonline.org
- Chunxiao Zhang, Y. W. (2016). Determinants of multidrug-resistanttuberculosis in Henan province in China: acase control study. BMC Public Health.
- Website: https://doi.org/10.1186/s12889-016-2711-z
- Cindy Toms, R. S. (2014). Tuberculosis notifications in australia . annual report .
- Dr. Shiv Kumar YadavDr. Mani Tiwari1, D. R. (2015, july). Assessment of Knowledge and Treatment Seeking Behaviouramong Tuberculosis and Multi-Drug Resistant TuberculosisPatients:-A Case Control Study. IOSR Journal of Dental and Medical Sciences (IOSR-JDMS), 14(7), 66-71.
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- Eva Nathanson, P. N. (2014). MDR Tuberculosis — Critical Steps for Prevention and Control. The new england journal of medicine.
- Fazlu Rehman, R. M. (2017). Knowledge about Tuberculosis and its Complication among the Patientsin a Teaching Hospital. Journal ofPulmonary & Respiratory Medicine.
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- doi: 10.1016/j.ijmyco.2015.12.004
- Jayneetha Maharaj, A. R. (2015). Multidrug-resistant tuberculosis in KwaZulu-Natal,South Africa: An overview of patients’ reported knowledge and attitudes. African Journal of Primary Health Care & Family Medicine.
- DOI: https://doi.org/10.4102/phcfm.v8i1.1089
- Joshua R Francis, C. C. (1998-2012). Multi drug resistance tuberculosis in Western Australia.
- Lestari, B. W., & Soeroto, A. Y. (2016). Knowledge and Attitude about Multidrug-Resistant Tuberculosis. Althea Medical Journal.
- Libo Liang, 1. Q. (2012). Factors contributing to the high prevalence of multidrug-resistant tuberculosis: a study from China.
- Lou Joseph Kenyia, ,. T. (2014). Knowledge, attitude and practice(KAP) of tuberculosis patients enrolled on treatment in Juba City, South Sudan 2010: a pilot study. South Sudan Medical Journal, 7.
- Marahatta SB, .A. (2015, Jan – Apr). Previous Smoking Habit and Perceived Social. J Nepal Health Res Counc, 13(29), 95-101.
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- National Tuberculosis Program Nepal. (2017). Annual report. sano thimi,bhaktapur.
- T. Baird, E. D. (2018). Multidrug-resistant tuberculosis in Queensland, Australia: an ongoing cross-border challenge. The internationa journal of tuberculosis.
- WHO. (2017). GLOBAL TUBERCULOSIS REPORT. Geneva,Switzerland.
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