Risk factors for drug resistant tuberculosis in Ankole region, a cattle corridor in south-western Uganda - a mixed methods study

Abstract

Background: Tuberculosis (TB) is one of the world’s leading causes of death from a single infectious agent and a major cause of deaths related to drug resistance (DR). Uganda, one of the 30 countries with a high burden of HIV/TB in the world with an estimated 96000 people falling ill with TB annually, has 2 out every 100 people with TB having DR-TB. Ankole region in Southwestern Uganda has consistently been among regions with a high DR-TB burden yet no study has been carried out to understand the risk factors of DR-TB in the region. The study aimed to determine risk factors for DR-TB in Ankole and specifically to identify the individual risks, assess the social and community risks, examine the health system risks and explore the experiences and opinions of people diagnosed with TB. It was a mixed methods study involving a case-control and a qualitative study targeting people aged 18 years and above, diagnosed with DR-TB and DS-TB, and health workers. Quantitative data was collected using a structured questionnaire and qualitative data was collected through Key informant and In-depth interviews. Results: Significant independent predictors of DR-TB included previous TB treatment, (aPOR = 2.0, 95% CI: 1.3–3.0, p = 0.001), other chronic medical conditions (aPOR = 1.8, 95% CI: 1.2–2.6, p = 0.001), Daily alcohol consumption (aPOR = 2.3, 95% CI: 1.7–3.0, p < 0.001), low income (aPOR = 1.5, 95% CI: 1.1–2.0, p = 0.004). Smoking tobacco was negatively associated with DR-TB (aPOR = 0.2, 95% CI: 0.1–0.8, p = 0.019). Qualitative study revealed stigma, lack of transport, inadequate funding of health TB services, inadequate patient monitoring and follow-up, inadequate knowledge about TB treatment by transferred staff and patients and reliance on one staff to offer TB services as being risks. Conclusions. A combined influence of previous TB treatment, chronic illnesses, daily alcohol consumption, stigma, lack of transport, and health system-level deficiencies contributed to DR-TB. Provision of appointment registers to health facilities, integrated chronic disease management, provision of social protection incentives to all people with TB, increasing the budget for TB and increased staffing are recommended