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. 2021 Sep 14;21(1):950.
doi: 10.1186/s12879-021-06675-7.

The burden of drug resistant tuberculosis in a predominantly nomadic population in Uganda: a mixed methods study

Brenda Nakafeero Simbwa  1 , Achilles Katamba  2 , Elizabeth B Katana  3 , Eva A O Laker  4 , Sandra Nabatanzi  3 , Emmanuel Sendaula  3 , Denis Opio  3 , Jerry Ictho  5 , Peter Lochoro  5 , Charles A Karamagi  3   6 , Joan N Kalyango  3 , William Worodria  2   7
Affiliations

The burden of drug resistant tuberculosis in a predominantly nomadic population in Uganda: a mixed methods study

Brenda Nakafeero Simbwa et al. BMC Infect Dis. .

Abstract

Background: Emergence of drug resistant tuberculosis (DR-TB) has aggravated the tuberculosis (TB) public health burden worldwide and especially in low income settings. We present findings from a predominantly nomadic population in Karamoja, Uganda with a high-TB burden (3500 new cases annually) and sought to determine the prevalence, patterns, factors associated with DR-TB.

Methods: We used mixed methods of data collection. We enrolled 6890 participants who were treated for tuberculosis in a programmatic setting between January 2015 and April 2018. A cross sectional study and a matched case control study with conditional logistic regression and robust standard errors respectively were used to the determine prevalence and factors associated with DR-TB. The qualitative methods included focus group discussions, in-depth interviews and key informant interviews.

Results: The overall prevalence of DR-TB was 41/6890 (0.6%) with 4/64,197 (0.1%) among the new and 37/2693 (1.4%) among the previously treated TB patients respectively. The drug resistance patterns observed in the region were mainly rifampicin mono resistant (68.3%) and Multi Drug-Resistant Tuberculosis (31.7%). Factors independently associated with DR-TB were previous TB treatment, adjusted odds ratio (aOR) 13.070 (95%CI 1.552-110.135) and drug stock-outs aOR 0.027 (95%CI 0.002-0.364). The nomadic lifestyle, substance use, congested homesteads and poor health worker attitudes were a great challenge to effective treatment of TB.

Conclusion: Despite having the highest national TB incidence, Karamoja still has a low DR-TB prevalence. Previous TB treatment and drug stock outs were associated with DR-TB. Regular supply of anti TB medications and health education may help to stem the burden of TB disease in this nomadic population.

Keywords: Alcohol; Drug resistant Tuberculosis; Drug stock out; Gene-Xpert; Karamoja; Low prevalence; Nomadic; Stigma; Uganda.

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Conflict of interest statement

The authors declare that they do not have any competing interest.

Figures

Fig. 1
Fig. 1
Patient flow chart during the study in Karamoja region, 2018
Fig. 2
Fig. 2
Conceptual framework showing the possible factors associated with drug resistance
See this image and copyright information in PMC

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