The burden of drug resistant tuberculosis in a predominantly nomadic population in Uganda: a mixed methods study
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Date
2021
Journal Title
Journal ISSN
Volume Title
Publisher
BMC Infectious Diseases
Abstract
Emergence of drug resistant tuberculosis (DR-TB) has aggravated the tuberculosis (TB) public health
burden worldwide and especially in low income settings. We present findings from a predominantly nomadic population
in Karamoja, Uganda with a high-TB burden (3500 new cases annually) and sought to determine the prevalence,
patterns, factors associated with DR-TB.
Methods: We used mixed methods of data collection. We enrolled 6890 participants who were treated for tuberculosis
in a programmatic setting between January 2015 and April 2018. A cross sectional study and a matched case
control study with conditional logistic regression and robust standard errors respectively were used to the determine
prevalence and factors associated with DR-TB. The qualitative methods included focus group discussions, in-depth
interviews and key informant interviews.
Results: The overall prevalence of DR-TB was 41/6890 (0.6%) with 4/64,197 (0.1%) among the new and 37/2693
(1.4%) among the previously treated TB patients respectively. The drug resistance patterns observed in the region
were mainly rifampicin mono resistant (68.3%) and Multi Drug-Resistant Tuberculosis (31.7%). Factors independently
associated with DR-TB were previous TB treatment, adjusted odds ratio (aOR) 13.070 (95%CI 1.552–110.135) and drug
stock-outs aOR 0.027 (95%CI 0.002–0.364). The nomadic lifestyle, substance use, congested homesteads and poor
health worker attitudes were a great challenge to effective treatment of TB.
Conclusion: Despite having the highest national TB incidence, Karamoja still has a low DR-TB prevalence. Previous TB
treatment and drug stock outs were associated with DR-TB. Regular supply of anti TB medications and health education
may help to stem the burden of TB disease in this nomadic population.
Description
Keywords
Drug resistant Tuberculosis, Nomadic, Uganda, Karamoja, Gene-Xpert, Low prevalence, Alcohol, Drug stock out, Stigma
Citation
Simbwa, B. N., Katamba, A., Katana, E. B., Laker, E. A., Nabatanzi, S., Sendaula, E., ... & Worodria, W. (2021). The burden of drug resistant tuberculosis in a predominantly nomadic population in Uganda: a mixed methods study. BMC Infectious Diseases, 21(1), 1-11. https://doi.org/10.1186/s12879-021-06675-7