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Meta-Analysis
. 2017 Mar 20;17(1):219.
doi: 10.1186/s12879-017-2323-y.

Multidrug resistant tuberculosis in Ethiopian settings and its association with previous history of anti-tuberculosis treatment: a systematic review and meta-analysis

Setegn Eshetie  1 , Mucheye Gizachew  2 , Mulat Dagnew  2 , Gemechu Kumera  3 , Haile Woldie  4 , Fekadu Ambaw  5 , Belay Tessema  2   6 , Feleke Moges  2
Affiliations
Meta-Analysis

Multidrug resistant tuberculosis in Ethiopian settings and its association with previous history of anti-tuberculosis treatment: a systematic review and meta-analysis

Setegn Eshetie et al. BMC Infect Dis. .

Abstract

Background: Efforts to control the global burden of tuberculosis (TB) have been jeopardized by the rapid evolution of multi-drug resistant Mycobacterium tuberculosis (MTB), which is resistant to at least isoniazid and rifampicin. Previous studies have documented variable prevalences of multidrug-resistant tuberculosis (MDR-TB) and its risk factors in Ethiopia. Therefore, this meta-analysis is aimed, firstly, to determine the pooled prevalence of MDR-TB among newly diagnosed and previously treated TB cases, and secondly, to measure the association between MDR-TB and a history of previous anti-TB drugs treatment.

Methods: PubMed, Embase and Google Scholar databases were searched. Studies that reported a prevalence of MDR-TB among new and previously treated TB patients were selected. Studies or surveys conducted at national or sub-national level, with reported MDR-TB prevalence or sufficient data to calculate prevalence were considered for the analysis. Two authors searched and reviewed the studies for eligibility and extracted the data in pre-defined forms. Forest plots of all prevalence estimates were performed and summary estimates were also calculated using random effects models. Associations between previous TB treatment and MDR-MTB infection were examined through subgroup analyses stratified by new and previously treated patients.

Results: We identified 16 suitable studies and found an overall prevalence of MDR-TB among newly diagnosed and previously treated TB patients to be 2% (95% CI 1% - 2%) and 15% (95% CI 12% - 17%), respectively. The observed difference was statistically significant (P < 0.001) and there was an odds ratio of 8.1 (95% CI 7.5-8.7) for previously treated TB patients to develop a MDR-MTB infection compared to newly diagnosed cases. For the past 10 years (2006 to 2014) the overall MDR-TB prevalence showed a stable time trend.

Conclusions: The burden of MDR-TB remains high in Ethiopian settings, especially in previously treated TB cases. Previous TB treatment was the most powerful predictor for MDR-MTB infection. Strict compliance with anti-TB regimens and improving case detection rate are the necessary steps to tackle the problem in Ethiopia.

Keywords: Ethiopia; Meta-analysis; Multidrug resistant tuberculosis; Systematic review.

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Figures

Fig. 1
Fig. 1
Flow chart shows selected articles for meta-analysis
Fig. 2
Fig. 2
Time trends of MDR-TB prevalence: Observed and fitted estimates
Fig. 3
Fig. 3
Forest plot of the pooled prevalence of MDR-TB among new TB cases
Fig. 4
Fig. 4
Forest plot of the pooled prevalence of MDR-TB among Previously treated TB cases
Fig. 5
Fig. 5
Funnel plots, exploring publication bias for the analysis of pooled estimate
Fig. 6
Fig. 6
Forest plot of the pooled odds ratio indicating the association of previous TB treatment with MDR-MTB infection
Fig. 7
Fig. 7
Funnel plot, exploring publication bias for the analysis of odds ratio
See this image and copyright information in PMC

References

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