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BMJ Open. 2015 Sep 8;5(9):e008273. doi: 10.1136/bmjopen-2015-008273.

Factors related to previous tuberculosis treatment of patients with multidrug-resistant tuberculosis in Bangladesh.

Author information

1
Faculty of Health and Medicine, School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia Health Nutrition and Population Programme, BRAC, Dhaka, Bangladesh.
2
Faculty of Health and Medicine, School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia.
3
National Tuberculosis Control Programme, Dhaka, Bangladesh.
4
The Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.

Abstract

OBJECTIVE:

Previous tuberculosis (TB) treatment status is an established risk factor for multidrug-resistant TB (MDR-TB). This study explores which factors related to previous TB treatment may lead to the development of multidrug resistant in Bangladesh.

DESIGN:

We previously conducted a large case-control study to identify risk factors for developing MDR-TB in Bangladesh. Patients who had a history of previous TB treatment, either MDR-TB or non-MDR-TB, were interviewed about their previous treatment episode. This study restricts analysis to the strata of patients who have been previously treated for TB. Information was collected through face-to-face interviews and record reviews. Unadjusted and multivariable logistic regression was used for data analysis.

SETTING:

Central-level, district-level and subdistrict-level hospitals in rural and urban Bangladesh.

RESULTS:

The strata of previously treated patients include a total of 293 patients (245 current MDR-TB; 48 non-MDR-TB). Overall, 54% of patients received previous TB treatment more than once, and all of these patients were multidrug resistant. Patients with MDR-TB were more likely to have experienced the following factors: incomplete treatment (OR 4.3; 95% CI 1.7 to 10.6), adverse reactions due to TB treatment (OR 8.2; 95% CI 3.2 to 20.7), hospitalisation for symptoms associated with TB (OR 16.9; CI 1.8 to 156.2), DOTS (directly observed treatment, short-course) centre as treatment unit (OR 6.4; CI 1.8 to 22.8), supervised treatment (OR 3.8; CI 1.6 to 9.5); time-to-treatment centre (OR 0.984; CI 0.974 to 0.993).

CONCLUSIONS:

Incomplete treatment, hospitalisation for TB treatment and adverse reaction are the factors related to previous TB treatment of patients with MDR-TB. Although the presence of supervised treatment (DOT), less time-to-treatment centres and being treated in DOTS centres were relatively higher among the patients with MDR-TB compared with patients without MDR-TB, these findings include information of their most recent TB treatment episode only. Most (64.5%) of the patients with MDR-TB had received TB treatment more than once.

PMID:
26351185
PMCID:
PMC4563275
DOI:
10.1136/bmjopen-2015-008273
[Indexed for MEDLINE]
Free PMC Article

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