Prevalence of drug resistant tuberculosis and evaluation of factors affecting the management of tuberculosis in Northern Region

Abstract

It is known that one of the weakest links of the TB control in the country is identification and treatment of drug resistant TB patients, thus prevalence of drug resistant TB in treatment centres are unknown. Also, inadequate TB treatment success rate with high mortality constitute an important challenge of TB control in Ghana. For the country to achieve the targets in the “End TB strategy”, it is essential to identify treatment center specific challenges earlier and find solutions to improve the situation. The study thus, aimed to investigate the prevalence of drug resistant TB, and treatment outcomes of TB and to find out compliance with the NTP treatment guidelines as well as drug/diagnostic availability in the Tamale Teaching Hospital TB clinic, Northern region. Drug susceptibility testing to first-line anti-TB medicines was performed on mycobacterial isolates from new TB patients in a cross sectional study (2017–2018) in the study site. In a separate exercise, review of treatment outcomes, and compliance with the NTP diagnosis and treatment guidelines of TB records (2015–2017) was conducted. Also, a mixed method study of availability of logistics for diagnosis and treatment of TB was carried out. Out of the 29 isolates analyzed, 17.2% were drug resistant which comprised of 6.9% isoniazid mono-resistant, 6.9% streptomycin mono-resistant and 3.4% isoniazid/streptomycin poly-drug resistant. From the 520 patients records reviewed, TB treatment success rate was 62.1% and unsuccessful outcome of 13.5% lost to follow-up, 0.6% failure and 23.8% death was observed. It was realized that 27.7% and 37.5% of TB cases did not comply with the NTP diagnosis and treatment guidelines respectively. It was recognized that only smear microscopy was used for TB diagnosis in the study site, 10% of anti-TB medicines was available at time of the survey, and 72% in the previous 12 months before the study. A predominance of primary drug resistance to isoniazid and streptomycin was observed. TB treatment outcomes was poor with high mortality rate. Compliance of diagnosis and treatment of TB with the NTP guidelines was unsatisfactory. There was inadequate logistics for diagnosis of TB and high stock out of anti-TB medicines.