Open Access Highly Accessed Research article

Characteristics of multidrug-resistant tuberculosis in Namibia

Philip M Ricks1*, Farai Mavhunga2, Surbhi Modi1, Rosalia Indongo2, Abbas Zezai3, Lauren A Lambert1, Nick DeLuca4, Jamie S Krashin1, Allyn K Nakashima1 and Timothy H Holtz1

Author Affiliations

1 Centers for Disease Control and Prevention, Atlanta, GA, USA

2 Ministry of Health and Social Services, Windhoek, Namibia

3 KNCV Tuberculosis Foundation, Windhoek, Namibia

4 Centers for Disease Control and Prevention, Windhoek, Namibia

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BMC Infectious Diseases 2012, 12:385  doi:10.1186/1471-2334-12-385

Published: 29 December 2012

Abstract

Background

To describe the epidemiology and possible risk factors for the development of multidrug-resistant tuberculosis (MDR-TB) in Namibia.

Methods

Using medical records and patient questionnaires, we conducted a case-control study among patients diagnosed with TB between January 2007 and March 2009. Cases were defined as patients with laboratory-confirmed MDR-TB; controls had laboratory-confirmed drug-susceptible TB or were being treated with WHO Category I or Category II treatment regimens.

Results

We enrolled 117 MDR-TB cases and 251 TB controls, of which 100% and 2% were laboratory-confirmed, respectively. Among cases, 97% (113/117) had been treated for TB before the current episode compared with 46% (115/251) of controls (odds ratio [OR] 28.7, 95% confidence interval [CI] 10.3–80.5). Cases were significantly more likely to have been previously hospitalized (OR 1.9, 95% CI 1.1–3.5) and to have had a household member with MDR-TB (OR 5.1, 95% CI 2.1–12.5). These associations remained significant when separately controlled for being currently hospitalized or HIV-infection.

Conclusions

MDR-TB was associated with previous treatment for TB, previous hospitalization, and having had a household member with MDR-TB, suggesting that TB control practices have been inadequate. Strengthening basic TB control practices, including expanding laboratory confirmation, directly observed therapy, and infection control, are critical to the prevention of MDR-TB.