Key factors influencing multidrug-resistant tuberculosis in patients under anti-tuberculosis treatment in two centres in Burundi: a mixed effect modelling study

Abstract Background Despite the World Health Organization efforts to expand access to the tuberculosis treatment, multidrug resistant tuberculosis (MDR-TB) remains a major threat. MDR-TB represents a challenge for clinicians and staff operating in national tuberculosis (TB) programmes/centres. In su...

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Autores principales:	Arnaud Iradukunda, Gabin-Pacifique Ndayishimiye, Darlene Sinarinzi, Emmanuel Nene Odjidja, Nestor Ntakaburimvo, Innocent Nshimirimana, Cheilla Izere
Formato:	article
Lenguaje:	EN
Publicado:	BMC 2021
Materias:	Tuberculosis Multidrug resistant tuberculosis Bayesian Bootstrap Burundi Public aspects of medicine RA1-1270
Acceso en línea:	https://doaj.org/article/83eb875277db496683c657d2d3136516
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spelling	oai:doaj.org-article:83eb875277db496683c657d2d31365162021-11-28T12:12:43ZKey factors influencing multidrug-resistant tuberculosis in patients under anti-tuberculosis treatment in two centres in Burundi: a mixed effect modelling study10.1186/s12889-021-12233-21471-2458https://doaj.org/article/83eb875277db496683c657d2d31365162021-11-01T00:00:00Zhttps://doi.org/10.1186/s12889-021-12233-2https://doaj.org/toc/1471-2458Abstract Background Despite the World Health Organization efforts to expand access to the tuberculosis treatment, multidrug resistant tuberculosis (MDR-TB) remains a major threat. MDR-TB represents a challenge for clinicians and staff operating in national tuberculosis (TB) programmes/centres. In sub-Saharan African countries including Burundi, MDR-TB coexists with high burden of other communicable and non-communicable diseases, creating a complex public health situation which is difficult to address. Tackling this will require targeted public health intervention based on evidence which well defines the at-risk population. In this study, using data from two referral anti-tuberculosis in Burundi, we model the key factors associated with MDR-TB in Burundi. Methods A case-control study was conducted from 1stAugust 2019 to 15th January 2020 in Kibumbu Sanatorium and Bujumbura anti-tuberculosis centres for cases and controls respectively. In all, 180 TB patients were selected, comprising of 60 cases and 120 controls using incidence density selection method. The associated factors were carried out by mixed effect logistic regression. Model performance was assessed by the Area under Curve (AUC). Model was internally validated via bootstrapping with 2000 replications. All analysis were done using R Statistical 3.5.0. Results MDR-TB was more identified among patients who lived in rural areas (51.3%), in patients’ residence (69.2%) and among those with a household size of six or more family members (59.5%). Most of the MDR-TB cases had already been under TB treatment (86.4%), had previous contact with an MDR-TR case (85.0%), consumed tobacco (55.5%) and were diabetic (66.6 %). HIV prevalence was 32.3 % in controls and 67.7 % among cases. After modelling using mixed effects, Residence of patients (aOR= 1.31, 95%C: 1.12-1.80), living in houses with more than 6 family members (aOR= 4.15, 95% C: 3.06-5.39), previous close contact with MDR-TB (aOR= 6.03, 95% C: 4.01-8.12), history of TB treatment (aOR= 2.16, 95% C: 1.06-3.42), tobacco consumption (aOR = 3.17 ,95% C: 2.06-5.45) and underlying diabetes’ ( aOR= 4.09,95% CI = 2.01-16.79) were significantly associated with MDR-TB. With 2000 stratified bootstrap replicates, the model had an excellent predictive performance, accurately predicting 88.15% (95% C: 82.06%-92.8%) of all observations. The coexistence of risk factors to the same patients increases the risk of MDR-TB occurrence. TB patients with no any risk factors had 17.6% of risk to become MDR-TB. That probability was respectively three times and five times higher among diabetic and close contact MDR-TB patients. Conclusion The relatively high TB’s prevalence and MDR-TB occurrence in Burundi raises a cause for concern especially in this context where there exist an equally high burden of chronic diseases including malnutrition. Targeting interventions based on these identified risk factors will allow judicious channel of resources and effective public health planning.Arnaud IradukundaGabin-Pacifique NdayishimiyeDarlene SinarinziEmmanuel Nene OdjidjaNestor NtakaburimvoInnocent NshimirimanaCheilla IzereBMCarticleTuberculosisMultidrug resistant tuberculosisBayesianBootstrapBurundiPublic aspects of medicineRA1-1270ENBMC Public Health, Vol 21, Iss 1, Pp 1-9 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Tuberculosis Multidrug resistant tuberculosis Bayesian Bootstrap Burundi Public aspects of medicine RA1-1270
spellingShingle	Tuberculosis Multidrug resistant tuberculosis Bayesian Bootstrap Burundi Public aspects of medicine RA1-1270 Arnaud Iradukunda Gabin-Pacifique Ndayishimiye Darlene Sinarinzi Emmanuel Nene Odjidja Nestor Ntakaburimvo Innocent Nshimirimana Cheilla Izere Key factors influencing multidrug-resistant tuberculosis in patients under anti-tuberculosis treatment in two centres in Burundi: a mixed effect modelling study
description	Abstract Background Despite the World Health Organization efforts to expand access to the tuberculosis treatment, multidrug resistant tuberculosis (MDR-TB) remains a major threat. MDR-TB represents a challenge for clinicians and staff operating in national tuberculosis (TB) programmes/centres. In sub-Saharan African countries including Burundi, MDR-TB coexists with high burden of other communicable and non-communicable diseases, creating a complex public health situation which is difficult to address. Tackling this will require targeted public health intervention based on evidence which well defines the at-risk population. In this study, using data from two referral anti-tuberculosis in Burundi, we model the key factors associated with MDR-TB in Burundi. Methods A case-control study was conducted from 1stAugust 2019 to 15th January 2020 in Kibumbu Sanatorium and Bujumbura anti-tuberculosis centres for cases and controls respectively. In all, 180 TB patients were selected, comprising of 60 cases and 120 controls using incidence density selection method. The associated factors were carried out by mixed effect logistic regression. Model performance was assessed by the Area under Curve (AUC). Model was internally validated via bootstrapping with 2000 replications. All analysis were done using R Statistical 3.5.0. Results MDR-TB was more identified among patients who lived in rural areas (51.3%), in patients’ residence (69.2%) and among those with a household size of six or more family members (59.5%). Most of the MDR-TB cases had already been under TB treatment (86.4%), had previous contact with an MDR-TR case (85.0%), consumed tobacco (55.5%) and were diabetic (66.6 %). HIV prevalence was 32.3 % in controls and 67.7 % among cases. After modelling using mixed effects, Residence of patients (aOR= 1.31, 95%C: 1.12-1.80), living in houses with more than 6 family members (aOR= 4.15, 95% C: 3.06-5.39), previous close contact with MDR-TB (aOR= 6.03, 95% C: 4.01-8.12), history of TB treatment (aOR= 2.16, 95% C: 1.06-3.42), tobacco consumption (aOR = 3.17 ,95% C: 2.06-5.45) and underlying diabetes’ ( aOR= 4.09,95% CI = 2.01-16.79) were significantly associated with MDR-TB. With 2000 stratified bootstrap replicates, the model had an excellent predictive performance, accurately predicting 88.15% (95% C: 82.06%-92.8%) of all observations. The coexistence of risk factors to the same patients increases the risk of MDR-TB occurrence. TB patients with no any risk factors had 17.6% of risk to become MDR-TB. That probability was respectively three times and five times higher among diabetic and close contact MDR-TB patients. Conclusion The relatively high TB’s prevalence and MDR-TB occurrence in Burundi raises a cause for concern especially in this context where there exist an equally high burden of chronic diseases including malnutrition. Targeting interventions based on these identified risk factors will allow judicious channel of resources and effective public health planning.
format	article
author	Arnaud Iradukunda Gabin-Pacifique Ndayishimiye Darlene Sinarinzi Emmanuel Nene Odjidja Nestor Ntakaburimvo Innocent Nshimirimana Cheilla Izere
author_facet	Arnaud Iradukunda Gabin-Pacifique Ndayishimiye Darlene Sinarinzi Emmanuel Nene Odjidja Nestor Ntakaburimvo Innocent Nshimirimana Cheilla Izere
author_sort	Arnaud Iradukunda
title	Key factors influencing multidrug-resistant tuberculosis in patients under anti-tuberculosis treatment in two centres in Burundi: a mixed effect modelling study
title_short	Key factors influencing multidrug-resistant tuberculosis in patients under anti-tuberculosis treatment in two centres in Burundi: a mixed effect modelling study
title_full	Key factors influencing multidrug-resistant tuberculosis in patients under anti-tuberculosis treatment in two centres in Burundi: a mixed effect modelling study
title_fullStr	Key factors influencing multidrug-resistant tuberculosis in patients under anti-tuberculosis treatment in two centres in Burundi: a mixed effect modelling study
title_full_unstemmed	Key factors influencing multidrug-resistant tuberculosis in patients under anti-tuberculosis treatment in two centres in Burundi: a mixed effect modelling study
title_sort	key factors influencing multidrug-resistant tuberculosis in patients under anti-tuberculosis treatment in two centres in burundi: a mixed effect modelling study
publisher	BMC
publishDate	2021
url	https://doaj.org/article/83eb875277db496683c657d2d3136516
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Key factors influencing multidrug-resistant tuberculosis in patients under anti-tuberculosis treatment in two centres in Burundi: a mixed effect modelling study

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