Multi-drug resistant Mycobacterium tuberculosis in Port Harcourt, Nigeria

Global prevalence of drug-resistant tuberculosis: a systematic review and meta-analysis

BACKGROUND

Tuberculosis is a bacterial infectious disease, which affects different parts of a human body, mainly lungs and can lead to the patient's death. The aim of this study is to investigate the global prevalence of drug-resistant tuberculosis using a systematic review and meta-analysis.

METHODS

In this study, the PubMed, Scopus, Web of Science, Embase, ScienceDirect and Google Scholar repositories were systematically searched to find studies reporting the global prevalence of drug-resistant tuberculosis. The search did not entail a lower time limit, and articles published up until August 2022 were considered. Random effects model was used to perform the analysis. The heterogeneity of the studies was examined with the I² test. Data analysis was conducted within the Comprehensive Meta-Analysis software.

RESULTS

In the review of 148 studies with a sample size of 318,430 people, the I² index showed high heterogeneity (I² = 99.6), and accordingly random effects method was used to analyze the results. Publication bias was also examined using the Begg and Mazumdar correlation test which indicated the existence of publication bias in the studies (P = 0.008). According to our meta-analysis, the global pooled prevalence of multi-drug resistant TB is 11.6% (95% CI: 9.1-14.5%).

CONCLUSIONS

The global prevalence of drug-resistant tuberculosis was found to be very high, thus health authorities should consider ways to control and manage the disease to prevent a wider spread of tuberculosis and potentially subsequent deaths.

EO. Medication Adherence among Pulmonary Tuberculosis Patients in Treatment Centers in a Southern Nigerian Local Government Area: Question Mark on Performance of DOTS Services

Background

Directly observed treatment short-course (DOTS) offers free, accessible and effective treatments with high treatment success rate and retention. Despite this, evidence from Rivers State suggest a downward trend in tuberculosis (TB) cure rate and a high burden of drug resistance among pulmonary tuberculosis (PTB) patients. Medication adherence appears to play a key role in TB evolution. Aim: to assess medication adherence and its determinants among pulmonary TB clients in DOTS centers.

Methodology

A total of 225 adult PTB clients from eightactive DOTS centers in Obio/Akpor Local Government Area of Rivers State were selected. A validated questionnaire, Morisky Medication adherence Scale-8 was used to collect medication-taking behaviour of clients, dichotomised into adherent and non-adherent. Binary logistic regression was conducted to check crude association between medication adherence and client/treatment factors. Variables with p<0.2 were selected and subjected to multivariate logistic regression with alpha set at p<0.05.

Results

Non-adherence to medication was 35.1% with forgetfulness and stress with medication plan as top reasons for non-adherence. Factors associated with non-adherence included persisting sputum production (aOR: 2.951(1.027-8.482);p=0.045), past treatment history (aOR: 5.422(1.93-15.228);p=0.001) and smoking (aOR: 7.779(1.58-38.305);p=0.012).

Conclusion

Over one-thirds of PTB clients in DOTS centers in Obio/Akpor LGA were non-adherent to anti-TB medications. Factors associated with non-adherence included persisting sputum production, past treatment history and smoking. To attenuate these risk factors for non-adherence, training and retraining of DOTS center staff on counselling is a smart option that can be explored by the LGA, providers and managers of the DOTS programme.

Epidemiological Characteristics and Risk Factors Related to Drug-resistant Tuberculosis in Luanda, Angola

Tuberculosis (TB) is a major cause of illness and public health concern, especially in resource-limited countries. This study analyzed the characteristics related to anti-TB drug resistance. Moreover, we examined the evidence-based indications for the treatment of active TB in Angola. This study evaluated the medical records of 176 patients screened for TB from January to September 2016 in Luanda, the capital city of Angola. Approximately 66.5% of the patients were newly diagnosed with active TB. The residence area showed a significant relationship with TB (P = 0.025), whereas age group (P = 0.272), gender (P = 0.853), and HIV status (P = 0.284) did not showed any relationship with TB. Overall, 72.4% of TB patients had resistance to at least one of the anti-TB drugs. The risk of anti-TB drug resistance was higher in males (odds ratio [OR]: 1.22; 95% confidence interval [CI]: 0.42-3.58, P = 0.685] and in TB-HIV coinfected patients [OR: 1.39; (95% CI: 0.26-7.28), P = 0.700], whereas it was lower in patients aged 30 years or older (OR: 0.56; 95% CI: 0.18-1.69) P = 0.303) and in patients living in urbanized areas (OR: 0.74; 95% CI: 0.17-3.25; P = 0.685). Our findings showed that drug-resistant TB is emerging in Angola. Further studies on factors related to anti-TB drug resistance are urgently needed to ascertain the magnitude of the problem and to proffer strategies toward TB control in Angola.

Differential yield of universal versus selective drug susceptibility testing of patients with tuberculosis in high-burden countries: a systematic review and meta-analysis

Introduction

Although universal drug susceptibility testing (DST) is a component of the End-TB Strategy, over 70% of drug-resistant tuberculosis (DR-TB) cases globally remain undetected. This detection gap reflects difficulties in DST scale-up and substantial heterogeneity in policies and implemented practices. We conducted a systematic review and meta-analysis to assess whether implementation of universal DST yields increased DR-TB detection compared with only selectively testing high-risk groups.

Methods

PubMed, Embase, Global Health, Cochrane Library and Web of Science Core Collection were searched for publications reporting on the differential yield of universal versus selective DST implementation on the proportion of DR-TB, from January 2007 to June 2019. Random-effects meta-analyses were used to calculate respective pooled proportions of DR-TB cases detected; Higgins test and prediction intervals were used to assess between-study heterogeneity. We adapted an existing risk-of-bias assessment tool for prevalence studies.

Results

Of 18 736 unique citations, 101 studies were included in the qualitative synthesis. All studies used WHO-endorsed DST methods, and most (87.1%) involved both high-risk groups and the general population. We found only cross-sectional, observational, non-randomised studies that compared universal with selective DST strategies. Only four studies directly compared the testing approaches in the same study population, with the proportion of DR-TB cases detected ranging from 2.2% (95% CI: 1.4% to 3.2%) to 12.8% (95% CI: 11.4% to 14.3%) with selective testing, versus 4.4% (95% CI: 3.3% to 5.8%) to 9.8% (95% CI: 8.9% to 10.7%) with universal testing. Broad population studies were very heterogeneous. The vast majority (88/101; 87.1%) reported on the results of universal testing. However, while 37 (36.6%)/101 included all presumptive TB cases, an equal number of studies applied sputum-smear as a preselection criterion. A meaningful meta-analysis was not possible.

Conclusion

Given the absence of randomised studies and the paucity of studies comparing strategies head to head, and selection bias in many studies that applied universal testing, our findings have limited generalisability. The lack of evidence reinforces the need for better data to inform policies.

Prevalence of Multi-Drug Resistant Tuberculosis among Tuberculosis Patients Attending Chest Clinics in Osun-State, Nigeria

BACKGROUND

The development of multidrug-resistant tuberculosis (MDR-TB) poses a considerable threat to tuberculosis control programmes in Nigeria. There is an increase in the prevalence of MDR-TB worldwide both among new tuberculosis cases as well as previously-treated ones. There is also a rise in transmission of resistant strains due to an increase in MDR-TB patients largely due to the poor drug compliance and the impact of Human immunodeficiency virus infection. Therefore, we intend to determine the extent of MDR-TB among attendees of chest clinics in Osun-State, Nigeria.

OBJECTIVES

The objective of this study was to determine the prevalence of MDR-TB among confirmed tuberculosis patients attending chest clinics in Osun-State, Nigeria.

METHODS

This study was conducted among 207 attendees of chest clinics in Osun-State between June, 2015 and October 15, 2016. Sputum and blood samples of the participants were collected. GeneXpert test was carried out first on the samples for simultaneous identification of MTB and rifampicin resistance. Sputum samples were cultured on Lowenstein-Jensen (L-J) medium using N-acetyl-Lcysteine- sodium hydroxide (NALC-NaOH) decontamination method. Drug susceptibility testing (DST) to three first-line drugs was carried out using the proportion DST method.

RESULTS

The prevalence of MTB was found to be 27.5% while the prevalence of MDR-TB from the fifty-seven isolates was 10.5%. Previously treated and new cases had a prevalence of 7.0% and 3.5% MDR-TB, respectively. Seventy (33.8%) participants were positive for HIV infection, out of which twenty-six (12.6%) had co-infection of tuberculosis and HIV. The mono-resistance rates of the three first-line drugs used were: 5.3% and 8.7% for ethambutol (EMB) and isoniazid (INH), respectively. No isolate had mono-resistance (0%) to rifampicin (RIF).

CONCLUSION

This study observed the prevalence of 27.5% MTB and a prevalence of 10.5% MDR-TB among the MTB isolates. The prevalence of TB is high in Osun State. MDR-TB prevalence is higher compared with the national estimate of MDR-TB (5.1%) of 2017. Resistant TB is a threat to national tuberculosis control and it is recommended that all the facilities be equipped to cater to its diagnosis.

Rifampicin-Resistant Tuberculosis in a Toddler: A Report of a Rare Paediatric Case in Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria

The emergence of resistant strains of mycobacterium tuberculosis (TB) to antituberculous drugs has compounded the management of the chronic infection. More than 90% of rifampicin (RIF)-resistant isolates are also isoniazid resistant; hence, rifampicin resistance (RR) is a surrogate marker for multidrug resistant TB (MDR-TB). Although there are limited reports of pediatric RR/MDR-TB in Nigeria, there had not been similar report in our hospital until now. A 2-year-old girl was admitted with 2-month history of fever, cough with dyspnea, and progressive weight loss. There was no known contact with adult who had chronic cough; the toddler and her parents have not been treated for TB in the past. Her chest X-ray showed nodular opacities, while gastric washout for GeneXpert MTB/RIF confirmed RIF-resistant TB. The parents declined screening for TB despite counseling. The patient was subsequently referred to a specialized center for the management of drug-resistant TB, but the parents failed to go for the treatment. Young children are at risk of developing TB disease and MDR/RR-TB, which is more complex to manage than drug-susceptible TB due to longer treatment duration, increased toxicity, as well as poor parental compliance to the demand of treatment.