Drug resistant tuberculosis in Karamoja region: prevalence, patterns and associated factors
Abstract
Introduction: Tuberculosis (TB) remains a major public health problem in Uganda
especially in Karamoja. Drug-resistance has been a major setback in fighting this infectious
disease. The prevalence of MDR among new cases is 0-4.5% in Uganda, and among
recurrent cases it is 12.1% - 17.7%. Karamoja is the region with the highest incidence of TB
in Uganda; with some 3,500 new cases identified and treated annually including increasing
cases of MDR. This study aimed at determining the prevalence, the patterns and factors
associated with drug resistant Tuberculosis among TB patients in Karamoja region in the
period from January 2015 to April 2018.
Methods: We conducted a cross sectional study to determine the prevalence and patterns of
DR-TB in Karamoja region during the months of January 2015 to April 2018. To determine
the factors associated, we conducted a matched case control study with 41 cases and usedrandom by sampled 164 controls. Three Focus group discussions (FGD), ten in-depth
interviews and Key informant interviews were used to collect qualitative data. Adjusted
Conditional logistic regression was used to determine associated factors. Ethical approval for
this study was obtained from School of Medicine Research Ethics Committee and the Uganda
National Council for Science and Technology.
Results: The prevalence of DR-TB in Karamoja was found to be 0.1% and 0.6% among the
new and previously treated TB patients respectively. The patterns found in the region were
Rifampicin Resistance and Multi Drug Resistant Tuberculosis. The major factors associated
with Drug resistant Tuberculosis were Type of patient (P=0.004) and Drug stock out
(P=0.001. The community was aware of high burden of TB and had positive perception of the
values of TB treatment but nomadic lifestyle, use of substances, congested homesteads and
poor attitudes of the health workers were a great challenge to effective treatment of TB.
Conclusion: Karamoja is still a low DR-TB prevalence region but with the highest TB
incidence, the numbers are likely to increase if not handled early. History of TB treatment,
and Drug stock out use were associated with DR-TB. Treatment adherence interventions
targeting susceptible TB patients and infection control for their close contacts with poor
socioeconomic status is recommended with more emphasis on improving the Directs
Observed Therapy (DOTs).