Factors associated with development of multidrug resistant tuberculosis: a case of Mbagathi, district hospital and Kenyatta national hospital in Kenya

Abstract

Tuberculosis is a communicable infectious disease caused by Mycobacterium tuberculosis bacteria. It is important to man due to social and economic implication and duration of treatment, its diverse effects in the body and social stigma attached to it. With the emergence of Multi Drug resistance Tuberculosis (MDR- TB), it has reversed the gains made in TB prevention and control. MDR- TB is the type of infection that does not respond to INH and Rifampicin being the main drugs used in TB management. This is virtually due to human error; inadequate treatment regiment, poor prescription, poor control programmes and non adherence to treatment on the part of the patient. The Broad objective was to determine the factors associated with development of MDR- TB , among patients at Kenyatta National Hospital and Mbagathi District Hospital. Specific objectives were: to establish socio economical factors of patients with MDR- TB and those without, to determine the medical management of MDR- TB patients verses non MDR TB patients , to determine any co-morbid illness among MDR-TB patients verses non MDR-TB, to assess the side effects of first line and second line mode of treatment of TB. The study was a cross-sectional descriptive comparative study that sought to determine factors that predispose clients to develop MDR- TB. The study sites were Mbagathi District Hospital being one of the referral TB hospital and KNH which is one Of the centers for treatment for MDR- TB patients. A total of 70 clients participated in the study; 28 from KNH and 42 from MDH. The median age of the participants was 30 years with the minimum age being 17years and , the maximum 72 years. The Majority of the participants were females at 56% (n=39). Those who had MDR-TB were mainly men at 22.8% (n=16) compared with women at 17.1% (n=12). Majority of the foreigners enrolled in the study had MDR-TB who accounted for 7.1% (n=5). Among them 5.7% (n=4) were from Somali compared to non MDR-TB who were 1.4% (n=l) who was a Sudanese. The reported side effects were mainly prickling and tickling sensation 45.7 % (n=32), nausea and vomiting 34.29% (n=2S) and itching 27.14% (n=19) among others. Previous treatment was common among ivIDR-TB clients who were 35.7% (n=2S) compared to non MDR-TB who were

(n=13) 18.6. % with p <0.0001. Majority of the Non MDR-TB had HIVAIDS who were 17.1% (n=12) compared with MDR-TB clients who were 1.4% (n=1). Regression analysis showed that previous treatment against TB Was a significant factor in development of MDR-TB (Odds Ratio:,,-'22.06, 95% CI 4.35-111.76). The other factors which include gender, nationality and co-morbid illness were not significant in this study. Recommendations from, this study are that DOT should be strengthened in the country especially .. those clients who are on intensive phase and Health education and advocacy should be enhanced so that the public are aware of the prevention modalities against MDR-TB.