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Review
. 2022 Oct 14;7(10):300.
doi: 10.3390/tropicalmed7100300.

Mycobacterium tuberculosis Drug Resistance in Ethiopia: An Updated Systematic Review and Meta-Analysis

Melese Abate Reta  1   2 , Birhan Alemnew Tamene  2 , Biruk Beletew Abate  3 , Eric Mensah  1 , Nontuthuko Excellent Maningi  4 , P Bernard Fourie  1
Affiliations
Review

Mycobacterium tuberculosis Drug Resistance in Ethiopia: An Updated Systematic Review and Meta-Analysis

Melese Abate Reta et al. Trop Med Infect Dis. .

Abstract

Background: Tuberculosis (TB) remains a significant global public health issue, despite advances in diagnostic technologies, substantial global efforts, and the availability of effective chemotherapies. Mycobacterium tuberculosis, a species of pathogenic bacteria resistant to currently available anti-TB drugs, is on the rise, threatening national and international TB-control efforts. This systematic review and meta-analysis aims to estimate the pooled prevalence of drug-resistant TB (DR-TB) in Ethiopia. Materialsand Methods: A systematic literature search was undertaken using PubMed/MEDLINE, HINARI, the Web of Science, ScienceDirect electronic databases, and Google Scholar (1 January 2011 to 30 November 2020). After cleaning and sorting the records, the data were analyzed using STATA 11. The study outcomes revealed the weighted pooled prevalence of any anti-tuberculosis drug resistance, any isoniazid (INH) and rifampicin (RIF) resistance, monoresistance to INH and RIF, and multidrug-resistant TB (MDR-TB) in newly diagnosed and previously treated patients with TB. Results: A total of 24 studies with 18,908 patients with TB were included in the final analysis. The weighted pooled prevalence of any anti-TB drug resistance was 14.25% (95% confidence interval (CI): 7.05-21.44%)), whereas the pooled prevalence of any INH and RIF resistance was found in 15.62% (95%CI: 6.77-24.47%) and 9.75% (95%CI: 4.69-14.82%) of patients with TB, respectively. The pooled prevalence for INH and RIF-monoresistance was 6.23% (95%CI: 4.44-8.02%) and 2.33% (95%CI: 1.00-3.66%), respectively. MDR-TB was detected in 2.64% (95%CI: 1.46-3.82%) of newly diagnosed cases and 11.54% (95%CI: 2.12-20.96%) of retreated patients with TB, while the overall pooled prevalence of MDR-TB was 10.78% (95%CI: 4.74-16.83%). Conclusions: In Ethiopia, anti-tuberculosis drug resistance is widespread. The estimated pooled prevalence of INH and RIF-monoresistance rates were significantly higher in this review than in previous reports. Moreover, MDR-TB in newly diagnosed cases remained strong. Thus, early detection of TB cases, drug-resistance testing, proper and timely treatment, and diligent follow-up of TB patients all contribute to the improvement of DR-TB management and prevention. Besides this, we urge that a robust, routine laboratory-based drug-resistance surveillance system be implemented in the country.

Keywords: Ethiopia; MDR-TB; Mycobacterium tuberculosis; drug-resistance; meta-analysis.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Figure 1
Figure 1
Flow chart of the study identification via databases, results of the search, and reasons for exclusion of articles.
Figure 2
Figure 2
Forest plot showing the weighted pooled prevalence of any anti-TB drug resistance in patients with TB.
Figure 3
Figure 3
Forest plot showing the weighted pooled prevalence of any isoniazid (INH) resistance in tuberculosis (TB) patients.
Figure 4
Figure 4
Forest plot showing the weighted pooled prevalence of any rifampicin (RIF) resistance in tuberculosis (TB) patients.
Figure 5
Figure 5
Forest plot showing the weighted pooled prevalence of isoniazid (INH)-monoresistance in tuberculosis (TB) patients.
Figure 6
Figure 6
Forest plot showing the weighted pooled prevalence of rifampicin (RIF)-monoresistance in tuberculosis (TB) patients.
Figure 7
Figure 7
Forest plot showing the weighted pooled prevalence of multidrug-resistant tuberculosis (MDR-TB) in newly diagnosed TB cases.
Figure 8
Figure 8
Forest plot showing the weighted pooled prevalence of multidrug-resistant tuberculosis (MDR-TB) among patients retreated with TB.
Figure 9
Figure 9
Forest plot showing the weighted pooled prevalence of multidrug-resistant tuberculosis (MDR-TB) among overall TB cases.
See this image and copyright information in PMC

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