An epidemiological study of multi drug resistant tuberculosis cases registered under Revised National Tuberculosis Control Programme of Ahmedabad City

Gneyaa Bhatt, Sheetal Vyas, Kartik Trivedil
Indian Journal of Tuberculosis 2012, 59 (1): 18-27

BACKGROUND: The emergence of resistance to anti-tuberculosis drugs in general and Multi Drug Resistan Tuberculosis (MDR-TB) in particular, has become a significant public health problem and an obstacle to effective TB control. Baseline and adequate information on epidemiological factors and their interaction are prerequisites for its effective control.

OBJECTIVES: To study socio-demographic profile, housing environment, health-seeking behaviour, present and past history regarding treatment of tuberculosis, drug resistance pattern and the preventive practice adopted by the patients.

METHODOLOGY: A cross-sectional study was carried out on 81 MDR-TB patients registered under RNTCP of Ahmedabad city during July 2007-June 2008. To accomplish the objectives, information was collected by personal interviews using pre-designed, pre-tested proforma. Data, so collected, was analyzed and tabulated using appropriate statistical software.

RESULTS: More than 2/3rd were males and majority were in age group 16-45 years, educated up to primary level, living in overcrowded and ill-ventilated houses. Initially almost all had pulmonary TB. At the start of category II, maximum number of patients were defaulters, the prime cause being financial crunch. The mean number of Anti Tubercular Treatment (ATT) taken before start of category IV was 2.85. More than 90% experienced side-effects of drugs. Although indiscriminate spitting was less, other methods of sputum disposal were also unsafe. Resistance to all four drugs (H, R, S & E) was found in more than 2/3rd of cases. Smear and culture conversion rate at three month follow up was 62.0% and 58.7% respectively. Only one patient (1.2%) was reactive for HIV in the study. Most of the patients perceived some degree of improvement in their condition following treatment.

CONCLUSION: Most of the MDR cases were living in poor environmental conditions, had previous history of TB and defaulter of treatment regimen prescribed. Motivation of private practitioners for increasing referrals, use of incentives and enablers, enhancing contact tracing and increasing awareness regarding sputum disposal practices and measures to prevent the spread are necessary for effective control of tuberculosis.

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