الفهرس 
Title pageOnly 14 pages are availabe for public view
 |  | from | 101 |  |  |
| | | from | 101 | | |
Abstract
TB is a highly contagious disease and one of the leading causes of death worldwide. In 2019, around 10 million people around the world were infected with tuberculosis, and an estimated 1.2 million HIV-negative people died from the disease, with an additional 208, 000 HIV-positive people dying. WHO plans to reduce TB incidence by 90% and mortality by 95% by 2035, with the ultimate goal of eliminating TB globally. The United Nations (UN) Sustainable Development Objectives and WHO End TB Program have set ambitious targets for 2020–2035, including a 35% decrease in the actual number of TB fatalities and a 20% DROP in TB incidence by 2020, relative to 2015, but unfortunately, the world in general, most WHO areas, and many high-TB-burden nations were not on the list.
The present pandemic’s implications have the potential to last much longer than the current period. It could reverse progress toward global TB targets that were achieved by the end of 2019. Increased societal awareness of growing infectious disease risks, as well as the concepts of disease transmission and acquisition, may lead to more engagement with the AMR problem.
MDR TB is defined as bacilli resistant towards both isoniazid and rifampicin, with or without the presence of other medications resistance. MDR-TB has been regarded as a significant public health issue in a number of countries, as well as an obstacle to worldwide TB control efforts. In comparison to drug-susceptible TB (DS-TB), MDR-TB treatment takes longer time, the medications employed have substantial adverse effects, and cure rates are often lower Identifying clinical and socio-demographic factors associated with MDR-TB is important for the provision of targeted preventive and control services.
Aims of the study
The aim of this study was to determine, identify, and quantify the risk factors for MDR-TB in Alexandria, Egypt in the last eight years (from January 2012 to December 2019) and to assess the prevalence of MDR-TB in Alexandria in the study period.
Methods:
Study design and setting
A hospital-based case-control study that was conducted at El Maamoura chest hospital.
Study population
Cases were all confirmed drug resistant TB (DR-TB) patients admitted to the MDR-TB treatment department of El Maamoura chest hospital during the period from (January 2012 to December 2019).
Controls were drug sensitive tuberculosis (DS-TB) patients admitted to the same hospital in the same period (January 2012 to December 2019).
Sample size calculation
NCSS/ PASS software was used for sample size calculation, for a case-control study, a sample of 130 cases of MDR-TB and 390 control DS-TB (total 520) , achieves 90% power to detect an odds ratio of ≥ 2.5 for any risk factor present at least in 10% of controls , using a significance level of 0.05.
Sampling technique
Cases included all patients with MDR-TB during the period from January 2012 to December 2019. All cases that were found in the records in the last eight years were 130.
For the selection of DS-TB patients, controls were recruited using a systematic random sampling technique.
Eligibility criteria
Pulmonary tuberculosis cases with or without extra-pulmonary TB, all age groups, and patients with any co-morbidities were included in the study. While, Patients with extra-pulmonary TB only without pulmonary TB were specifically excluded.
Statistical analysis
Quantitative variables were described using mean and standard deviation or median and range according to test of normality. Categorical variables were described using percent and frequency. The associations between categorical variables were examined by chi-square test or Fisher’s exact or Monte Carlo test .Independent t-test or Mann whitney test were applied to compare between two groups for quantitative variables. Multivariate logistic regression analysis was done to assess the predictors of MDR-TB and calculate adjusted odds ratio. Variables with a p value less than 0.05 in univariate analysis were included in the Multivariate logistic regression model. The adjusted odds ratio (OR) and 95% confidence interval (CI) were calculated. In all statistical tests, level of significance of 0.05 was used, below which the results are considered to be statistically significant. Data were analyzed using the Statistical Package for Social Sciences (IBM SPSS ver.23).
The most important findings of our study:
The significant predictors of MDR TB were: rural residence, defaulters of previous anti-TB treatment, chronic obstructive pulmonary disease (COPD), history of previous anti-TB drugs, drugs addiction, and history of contact with TB patient.
MDR-TB prevalence was found to be 3.3% of all TB patients in Alexandria from January 2012 to December 2019, 0.6% of new TB patients, and 18.7% of retreatment patients in the governorate of Alexandria.
from 2012 to 2017, the number of diagnosed MDR TB cases was increasing, but by the end of 2019, the number of cases had dropped to lower levels. Cases of MDR-TB increased during 2020 and 2021
The majority of cases (59.2%) had monoresistance (rifampin resistance), 35% of cases had multidrug resistant tuberculosis (MDR TB), 5% were polyresistant TB, and 1% had extensive drug resistant TB
History of previous anti-TB drugs was responsible for the largest proportion of cases of MDR-TB in this sample, with PAR% of 74.9%. This means that 74.9% of MDR-TB is attributed to previous administration of anti-TB drugs.