Shri Ram Ganesh R. T, A. Manimaran, K. Namasivayam, N. Uma, J. Jasmine
BACKGROUND Drug resistance in tuberculosis is one of the major problems worldwide. There is an estimated 99,000 annual incident cases of MDR-TB in India. MDR-TB poses therapeutic and treatment challenges with significantly higher rates of morbidity and mortality. It is easy to prevent multidrug resistant tuberculosis if the risk factors are known. The aim of the study is to evaluate the risk factors in MDR TB cases among rural population of Thanjavur district, Tamilnadu, India. MATERIALS AND METHODS The medical record of patients with multidrug resistant tuberculosis diagnosed as per RNTCP DOTS PLUS guidelines admitted for pretreatment evaluation in DOTS PLUS centre, Thanjavur Medical College, were examined. These cases were diagnosed or registered during Jan-2015 to Dec-2015. All selected patients were categorized into four groups: Below 30 years, 31-40 years, 41-50 years, 51-60 years and above 60 years. The variables analysed include age, gender, site of the disease, personal history regarding alcoholism & smoking were recorded. Previous treatment history and default status were analysed. Each potential risk was evaluated using Univariate Conditional Logistic Regression Model / Chi-Square test. RESULTS Of the 96 cases studied, default majority were males (85.4%), predominant age groups 41-60 (51.1%). alcoholism (57.3%) were found to be the risk factors for drug resistance in tuberculosis. There is significant association between previous treatment and age group. Drug intolerance, default & relapse were more common in 41-60 age groups. Alcoholism plays a role in treatment failure and default. CONCLUSION Male gender, adult age groups (41-60), alcoholism, were the significant risk factors for MDR TB in our study and it showed statistical significance of p<0.05. On analysis of the risk factors, alcohol abuse was found to be the major behavioural risk factor for treatment default. Hence alcohol deaddiction could be included as an essential programme in DOTS plus strategy. Since people between age groups 41-60 were also found to be major defaulters, they should be educated about regular intake of ATT, drug toxicity, diet schedule and emergence of multidrug resistance and regular follow up. Drug intolerance symptoms like vomiting and giddiness need to be managed appropriately with due care.
