Determinants of drug-resistant Tuberculosis in Meru County, Kenya

Abstract

Background: Tuberculosis (TB) remains a major public health burden globally. In 2022, approximately 10.6 million TB cases and 1.3 million TB-related deaths were reported by the WHO. Globally, there were an estimated 410,000 Drug-resistant tuberculosis (DRTB) cases; Africa accounted for 62,000 cases, while Kenya reported 752 cases. In Meru County, DRTB cases have been increasing, with the county recording 111 cases in 2022, the highest in the country, representing 14.8% of the total cases. The Increasing incidence and complexity of resistance transmission underscore the important need to identify determinants associated with DRTB to inform targeted public health interventions. Objective: To determine sociodemographic, clinical, behavioural, and socioeconomic factors associated with drug-resistant tuberculosis in Meru County. Method: A case-control study was conducted among TB patients in Meru County. A case was defined as any drug-resistant TB patient (resistant to at least one or more first line anti-TB drugs). A control was a bacteriologically confirmed TB patient who turned sputum smear-negative after the treatment course's 2nd, 5th, and 6th month (cured). Drug-resistant tuberculosis registers were reviewed to identify the cases, and were subsequently recruited. Tuberculosis registers were reviewed to identify the controls, and two randomly selected unmatched controls were enrolled per case. Consent was sought from study participants, who were interviewed using a structured questionnaire. Descriptive analysis was conducted where continuous variables were summarized using measures of central tendency and dispersion, while categorical variables were summarized using frequencies and proportions. Crude odds ratio was used to measure association in bivariate analysis. Variables with a p-value of less than 0.2 in the bivariate analysis were subjected to unconditional multivariate binary logistic regression, and stepwise backward elimination was used to develop the final model. In the multivariate model, variables with a p-value of less than 0.05 were independently associated with drug-resistant tuberculosis. Results: A total of 83 cases and 166 controls were enrolled. The mean age of the cases was 39.9±SD12.2 years, and the controls were 37.7 ± SD 13.9 years. Males comprised 57 (68.7%) cases and 118 (71.7%) controls. Age group 25-34 contributed to 43 (51.8%) cases and 93 (56%) controls. The majority of the cases, 63 (75.9%), were mono resistant DRTB. Having no formal education increased drug-resistant tuberculosis occurrence by 3.37 times (aOR=3.37, 95% CI 1.02–11.75), contact with DRTB case (aOR=3.92, 95% CI 1.54–9.95), not hearing about DRTB (aOR=3.49, 95% CI 1.87 6.52), and alcohol consumption (aOR=2.52, 95% CI 1.25–5.13) were independently associated with drug-resistance tuberculosis. Conclusion: Having no formal education, contact with DRTB cases, alcohol consumption, and lack of prior information about DRTB increases the risk of DRTB. Recommendations: Meru County should enhance community health education by integrating TB education into community learning initiatives, expanding awareness campaigns, strengthening contact tracing and screening, and integrating alcohol abuse support programs into TB control efforts to reduce drug-resistant tuberculosis risk.