Clinical Risk Factors for Multi-Drug Resistance Tuberculosis in Ethiopia: A Meta-Analysis

Abstract

Background: The main purpose of this meta-analysis is to evaluate the association between clinical risk factors and multi-drug resistance tuberculosis. More specifically, it tried to measure the association of the risk of MDR-TB with HIV serostatus, previous anti-TB, contact history with known TB case and with known MDR-TB case.

Methods: A separate meta-analysis was done for commonly reported clinical risk factors of MDR-TB. Literature search strategy includes searching PubMed/Medline, HINARI, EMBASE, and the Google scholar using keywords. Researches written in English, done in Ethiopia, observational studies which assessed the association of MDR-TB with at least one of the most commonly reported clinical risk factors were included. Rev Man 5 used to analyze data. The pooled OR estimated with random-effects model using the Mantel-Haenszel method. The heterogeneity among the studies was assessed with chi-square, I2 and p-values. Publication bias was assessed with funnel plots and trim-and-fill analysis was done with STATA 11 to adjust the report bias.

Results: The effect of HIV on MDR-TB was not statistically significant both before [pooled-OR=1.63, 95%CI: 0.76, 3.49] and after [pooled-LogOR=-0.133, 95%CI: -0.921, 0.654] trim-and-fill analysis. Previous anti-TB treatment is a risk factor for MDR-TB before [pooled-OR=7.63, 95%CI: 3.76, 15.5] and after trim-and-fill [pooled-Log-OR=1.156 95%CI: 0.394, 1.918]. Contact history to TB patient is a risk factor for MDR-TB before [pooled-OR=2.04, 95% CI: 1.57, 2.65] and after trim-and-fill analysis [pooled-Log-OR=0.641, 95%CI: 0.420, 0.682]. Contact history to MDR-TB patient is also found to be a risk factor for developing MDR-TB before trim-and fill [pooled-OR=2.85, 95%CI: 1.82-4.44].

Conclusion: Except HIV, previous anti-TB treatment, contact with TB and MDR-TB patients are risk factors of MDR-TB. Infection prevention and anti-TB drug management should be strictly practiced. A legal framework for anti-TB drug management practice should be designed. Further synthesis of evidence should be conducted using meta-regression.