{"title":"Determinants, risk factors and spatial analysis of multi-drug resistant pulmonary tuberculosis in Jodhpur, India.","authors":"Nikhilesh Ladha, Pankaj Bhardwaj, Nishant Kumar Chauhan, Kikkeri Hanumantha Setty Naveen, Vijaya Lakshmi Nag, Dandabathula Giribabu","doi":"10.4081/monaldi.2022.2026","DOIUrl":null,"url":null,"abstract":"<p><p>This study was planned to estimate the proportion of confirmed multi-drug resistance pulmonary tuberculosis (TB) cases out of the presumptive cases referred to DTC (District Tuberculosis Center) Jodhpur for diagnosis; to identify clinical and socio-demographic risk factors associated with the multidrug-resistant pulmonary TB and to assess the spatial distribution to find out clustering and pattern in the distribution of pulmonary TB with the help of Geographic Information System (GIS). In the Jodhpur district, 150 confirmed pulmonary multi-drug resistant tuberculosis (MDR-TB) cases, diagnosed by probe-based molecular drug susceptibility testing method and categorized as MDR in DTC's register (District Tuberculosis Center), were taken. Simultaneously, 300 control of confirmed non-MDR or drug-sensitive pulmonary TB patients were taken. Statistical analysis was done with logistic regression. In addition, for spatial analysis, secondary data from 2013-17 was analyzed using Global Moran's I and Getis and Ordi (Gi*) statistics. In 2012-18, a total of 12563 CBNAAT (Cartridge-based nucleic acid amplification test) were performed. 2898 (23%) showed M. TB positive but rifampicin sensitive, and 590 (4.7%) showed rifampicin resistant. Independent risk factors for MDR TB were ≤60 years age (AOR 3.0, CI 1.3-7.1); male gender (AOR 3.4, CI 1.8-6.7); overcrowding (AOR 1.6, CI 1.0-2.7); using chulha (smoke appliance) for cooking (AOR 2.5, CI 1.2-4.9), past TB treatment (AOR 5.7, CI 2.9-11.3) and past contact with MDR patient (AOR 10.7, CI 3.7-31.2). All four urban TUs (Tuberculosis Units) had the highest proportion of drug-resistant pulmonary TB. There was no statistically significant clustering, and the pattern of cases was primarily random. Most of the hotspots generated were present near the administrative boundaries of TUs, and the new ones mostly appeared in the area near the previous hotspots. A random pattern seen in cluster analysis supports the universal drug testing policy of India. Hotspot analysis helps cross administrative border initiatives with targeted active case finding and proper follow-up.</p>","PeriodicalId":520711,"journal":{"name":"Monaldi archives for chest disease = Archivio Monaldi per le malattie del torace","volume":" ","pages":""},"PeriodicalIF":0.8000,"publicationDate":"2022-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"1","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Monaldi archives for chest disease = Archivio Monaldi per le malattie del torace","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.4081/monaldi.2022.2026","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 1
Abstract
This study was planned to estimate the proportion of confirmed multi-drug resistance pulmonary tuberculosis (TB) cases out of the presumptive cases referred to DTC (District Tuberculosis Center) Jodhpur for diagnosis; to identify clinical and socio-demographic risk factors associated with the multidrug-resistant pulmonary TB and to assess the spatial distribution to find out clustering and pattern in the distribution of pulmonary TB with the help of Geographic Information System (GIS). In the Jodhpur district, 150 confirmed pulmonary multi-drug resistant tuberculosis (MDR-TB) cases, diagnosed by probe-based molecular drug susceptibility testing method and categorized as MDR in DTC's register (District Tuberculosis Center), were taken. Simultaneously, 300 control of confirmed non-MDR or drug-sensitive pulmonary TB patients were taken. Statistical analysis was done with logistic regression. In addition, for spatial analysis, secondary data from 2013-17 was analyzed using Global Moran's I and Getis and Ordi (Gi*) statistics. In 2012-18, a total of 12563 CBNAAT (Cartridge-based nucleic acid amplification test) were performed. 2898 (23%) showed M. TB positive but rifampicin sensitive, and 590 (4.7%) showed rifampicin resistant. Independent risk factors for MDR TB were ≤60 years age (AOR 3.0, CI 1.3-7.1); male gender (AOR 3.4, CI 1.8-6.7); overcrowding (AOR 1.6, CI 1.0-2.7); using chulha (smoke appliance) for cooking (AOR 2.5, CI 1.2-4.9), past TB treatment (AOR 5.7, CI 2.9-11.3) and past contact with MDR patient (AOR 10.7, CI 3.7-31.2). All four urban TUs (Tuberculosis Units) had the highest proportion of drug-resistant pulmonary TB. There was no statistically significant clustering, and the pattern of cases was primarily random. Most of the hotspots generated were present near the administrative boundaries of TUs, and the new ones mostly appeared in the area near the previous hotspots. A random pattern seen in cluster analysis supports the universal drug testing policy of India. Hotspot analysis helps cross administrative border initiatives with targeted active case finding and proper follow-up.
本研究旨在估计到焦特布尔地区结核病中心诊断的推定病例中确诊的耐多药肺结核(TB)病例的比例;利用地理信息系统(GIS)识别与多药耐药肺结核相关的临床和社会人口危险因素,并对其空间分布进行评估,找出肺结核分布的聚类和模式。在焦特布尔区,采用探针分子药敏试验方法诊断并在DTC登记处(区结核病中心)分类为MDR的确诊肺部耐多药结核病(MDR- tb)病例150例。同时,对照300例确诊的非耐多药或药物敏感肺结核患者。采用logistic回归进行统计分析。此外,利用Global Moran’s I和Getis and Ordi (Gi*)统计数据对2013- 2017年的二次数据进行空间分析。2012- 2018年共进行了12563次CBNAAT(墨盒核酸扩增试验)。结核分枝杆菌阳性2898例(23%)对利福平敏感,耐药590例(4.7%)。耐多药结核病的独立危险因素为≤60岁(AOR 3.0, CI 1.3-7.1);男性(AOR 3.4, CI 1.8-6.7);过度拥挤(AOR 1.6, CI 1.0-2.7);使用炊具做饭(AOR 2.5, CI 1.2-4.9),既往结核病治疗(AOR 5.7, CI 2.9-11.3)和既往与耐多药患者接触(AOR 10.7, CI 3.7-31.2)。所有4个城市结核病单位耐药肺结核比例最高。没有统计学意义上的聚类,病例的模式主要是随机的。产生的热点多出现在区域行政边界附近,新增热点多出现在原有热点附近。聚类分析中看到的随机模式支持印度的普遍药物检测政策。热点分析有助于跨行政边界的举措,有针对性地主动发现病例并进行适当的跟踪。