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Epidemiol Health > Volume 41; 2019 > Article
Epidemiology and Health 2019;41: e2019014-0.
DOI: https://doi.org/10.4178/epih.e2019014    Published online April 20, 2019.
Assessment of the risk factors associated with multidrug-resistant tuberculosis in Sudan: a case-control study
Adel Hussein Elduma1  , Mohammad Ali Mansournia2  , Abbas Rahimi Foroushani2  , Hamdan Mustafa Hamdan Ali3, Asrar M A/Salam Elegail4, Asma Elsony5, Kourosh Holakouie-Naieni2 
1Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences-International Campus, Tehran, Iran
2Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
3Multidrug-Resistant Tuberculosis Unit, Communicable and Non-Communicable Diseases Control Directorate, Ministry of Health, Khartoum, Sudan
4National Tuberculosis Reference Laboratory, National Public Health Laboratory, Ministry of Health, Khartoum, Sudan
5The Epidemiological Laboratory (Epi-Lab), Khartoum, Sudan
Correspondence  Kourosh Holakouie-Naieni ,Email: holakoik@hotmail.com
Received: April 1, 2019  Accepted after revision: April 20, 2019
Abstract
OBJECTIVES:
The emergence of multidrug-resistant tuberculosis (MDR-TB) is a major challenge for the global control of tuberculosis (TB). The aim of this study was to determine the risk factors associated with MDR-TB in Sudan.
METHODS:
This case-control study was conducted from May 2017 to February 2019. Patients newly diagnosed with MDR-TB were selected as cases, and controls were selected from TB patients who responded to first-line anti-TB drugs. A questionnaire was designed and used to collect data from study participants. Logistic regression was used to evaluate associations between risk factors and MDR-TB infection. The best multivariate model was selected based on the likelihood ratio test.
RESULTS:
A total of 430 cases and 860 controls were selected for this study. A history of previous TB treatment (adjusted odds ratio [aOR], 54.85; 95% confidence interval [CI], 30.48 to 98.69) was strongly associated with MDR-TB infection. We identified interruption of TB treatment (aOR, 7.62; 95% CI, 3.16 to 18.34), contact with MDR-TB patients (aOR, 5.40; 95% CI, 2.69 to 10.74), lower body weight (aOR, 0.89; 95% CI, 0.87 to 0.91), and water pipe smoking (aOR, 3.23; 95% CI, 1.73 to 6.04) as factors associated with MDR-TB infection.
CONCLUSIONS:
Previous TB treatment and interruption of TB treatment were found to be the main predictors of MDR-TB. Additionally, this study found that contact with MDR-TB patients and water pipe smoking were associated with MDR-TB infection in Sudan. More efforts are required to decrease the rate of treatment interruption, to strengthen patients’ adherence to treatment, and to reduce contact with MDR-TB patients.
Keywords: Risk factors, Tuberculosis, Multidrug resistant, Sudan


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