Epidemiology of multi-drug resistant Tuberculosis in the western region of Kenya

George O Lugonzo; Ezekiel M. Njeru; William Songock; Albert A. Okumu; Eric M. Ndombi; George O Lugonzo; Ezekiel M. Njeru; William Songock; Albert A. Okumu; Eric M. Ndombi

doi:10.3934/microbiol.2024014

AIMS Microbiology

2024, Volume 10, Issue 2: 273-287. doi: 10.3934/microbiol.2024014

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Research article

Epidemiology of multi-drug resistant Tuberculosis in the western region of Kenya

1.
Department of Biochemistry, Microbiology, and Biotechnology, Kenyatta University, Nairobi, Kenya
2.
Department of Medical Microbiology and Parasitology, Kenyatta University, Nairobi, Kenya
3.
Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya

Received: 09 November 2023 Revised: 08 April 2024 Accepted: 10 April 2024 Published: 22 April 2024

Multidrug-resistant tuberculosis (TB) (MDR-TB), or TB that is simultaneously resistant to both isoniazid (INH) and rifampicin (RIF), is a barrier to successful TB control and treatment. Stratified data on MDR-TB, particularly in the high-burden western Kenya region, remain unknown. This data is important to monitor the efficacy of TB control and treatment efforts. Herein, we determined the molecular epidemiology of drug-resistant TB and associated risk factors in western Kenya. This was a non-experimental, population-based, cross-sectional study conducted between January and August 2018. Morning sputum samples of individuals suspected of pulmonary TB were collected, processed, and screened for Mycobacterium tuberculosis (Mtb) and drug resistance using line probe assay (LPA) and Mycobacterium growth indicator tubes (MGIT) culture. MGIT-positive samples were cultured on brain heart infusion (BHII) agar media, and the presence of Mtb was validated using Immunochromatographic assay (ICA). Drug sensitivity was performed on MGIT and ICA-positive but BHI-negative samples. Statistical significance was set at P < 0.05. Of the 622 Mtb isolates, 536 (86.2%) were susceptible to RIF and INH. The rest, 86 (13.83%), were resistant to either drugs or both. A two-sample proportional equality test revealed that the MDR-TB prevalence in western Kenya (5%) did not vary significantly from the global MDR-TB estimate (3.9%) (P = 0.196). Men comprised the majority of susceptible and resistant TB (75.9% and 77.4%%, respectively). Also, compared with healthy individuals, the prevalence of HIV was significantly higher in MDR-TB patients (35.9% vs 5.6%). Finally, TB prevalence was highest in individuals aged 25–44 years, who accounted for 58.4% of the total TB cases. Evidently, the prevalence of MDRTB in western Kenya is high. Particular attention should be paid to men, young adults, and those with HIV, who bear the greatest burden of resistant TB. Overall, there is a need to refine TB control and treatment programs in the region to yield better outcomes.
- tuberculosis,
- HIV,
- isoniazid,
- rifampicin,
- multidrug-resistant tuberculosis,
- risk factors,
- western Kenya
Citation: George O Lugonzo, Ezekiel M. Njeru, William Songock, Albert A. Okumu, Eric M. Ndombi. Epidemiology of multi-drug resistant Tuberculosis in the western region of Kenya[J]. AIMS Microbiology, 2024, 10(2): 273-287. doi: 10.3934/microbiol.2024014

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Abstract

Multidrug-resistant tuberculosis (TB) (MDR-TB), or TB that is simultaneously resistant to both isoniazid (INH) and rifampicin (RIF), is a barrier to successful TB control and treatment. Stratified data on MDR-TB, particularly in the high-burden western Kenya region, remain unknown. This data is important to monitor the efficacy of TB control and treatment efforts. Herein, we determined the molecular epidemiology of drug-resistant TB and associated risk factors in western Kenya. This was a non-experimental, population-based, cross-sectional study conducted between January and August 2018. Morning sputum samples of individuals suspected of pulmonary TB were collected, processed, and screened for Mycobacterium tuberculosis (Mtb) and drug resistance using line probe assay (LPA) and Mycobacterium growth indicator tubes (MGIT) culture. MGIT-positive samples were cultured on brain heart infusion (BHII) agar media, and the presence of Mtb was validated using Immunochromatographic assay (ICA). Drug sensitivity was performed on MGIT and ICA-positive but BHI-negative samples. Statistical significance was set at P < 0.05. Of the 622 Mtb isolates, 536 (86.2%) were susceptible to RIF and INH. The rest, 86 (13.83%), were resistant to either drugs or both. A two-sample proportional equality test revealed that the MDR-TB prevalence in western Kenya (5%) did not vary significantly from the global MDR-TB estimate (3.9%) (P = 0.196). Men comprised the majority of susceptible and resistant TB (75.9% and 77.4%%, respectively). Also, compared with healthy individuals, the prevalence of HIV was significantly higher in MDR-TB patients (35.9% vs 5.6%). Finally, TB prevalence was highest in individuals aged 25–44 years, who accounted for 58.4% of the total TB cases. Evidently, the prevalence of MDRTB in western Kenya is high. Particular attention should be paid to men, young adults, and those with HIV, who bear the greatest burden of resistant TB. Overall, there is a need to refine TB control and treatment programs in the region to yield better outcomes.

Acknowledgments

We thank the Ministry of Health-Kenya and Kenya Medical Research Institute, Centre for Global Health Research (KEMRICGHR) for using their facilities.

Conflict of interest

All authors declare no conflicts of interest in this paper.

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