title: Surveillance of drug-resistant tuberculosis and molecular evaluation of transmission of resistant strains in refugee and non-refugee populations in North-Eastern Kenya.
abstract: METHODS
  Three refugee camp complex clinics and an adjacent non-refugee treatment centre in North-Eastern Kenya.
  
  
  OBJECTIVE
  To use conventional and molecular epidemiology tools to determine: 1) the prevalence of drug resistance in newly diagnosed patients with smear-positive pulmonary tuberculosis in refugee and non-refugee populations; 2) risk factors for resistance in the two populations; and 3) whether IS6110 restriction fragment length polymorphism (RFLP) and spoligotyping showed similarities in DNA fingerprinting patterns of drug-resistant isolates that could infer transmission within and between the two populations.
  
  
  RESULTS
  Of 241 isolates from the camps, 44 (18.3%) were resistant to one or more drugs, seven of which (2.9%) were multidrug-resistant TB (MDR-TB). Of 88 isolates from the non-refugees, five (5.7%) were resistant to one or more drugs without MDR-TB. Drug resistance was higher in the camps than in the non-refugee population (OR = 3.7; 95%CI 1.42-9.68; P < 0.007). Resistance was significantly higher in one camp compared with the other two, despite a comparable ethnic distribution. Unusually, females were more associated with drug resistance than their male counterparts in both populations (OR = 2.3; 95%CI 1.2-4.8; P = 0.008). There was evidence of transmission of streptomycin-resistant strains in the refugee population. DNA fingerprints of resistant strains from the non-refugee population were unique and different from those in the refugee camps.
  
  
  CONCLUSIONS
  The observed high levels of drug resistance and MDR-TB, combined with evidence of transmission of strains resistant to streptomycin in the refugee population, suggest a need for strengthened TB control programmes in settings with a high risk of developing drug-resistant strains.
authors.affiliation: Centre for Respiratory Diseases Research, Kenya Medical Research Institute, Nairobi. wgithui@hotmail.com
authors.forename: W A
authors.initials: WA
authors.lastname: Githui
authors.forename: M P
authors.initials: MP
authors.lastname: Hawken
authors.forename: E S
authors.initials: ES
authors.lastname: Juma
authors.forename: P
authors.initials: P
authors.lastname: Godfrey-Faussett
authors.forename: O B
authors.initials: OB
authors.lastname: Swai
authors.forename: D K
authors.initials: DK
authors.lastname: Kibuga
authors.forename: J D
authors.initials: JD
authors.lastname: Porter
authors.forename: S M
authors.initials: SM
authors.lastname: Wilson
authors.forename: F A
authors.initials: FA
authors.lastname: Drobniewski
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D003430:Cross-Sectional Studies; D016172:DNA Fingerprinting; D004269:DNA, Bacterial / Q000235:genetics; D005260:Female; D006801:Humans; D017053:Infection Control; D007630:Kenya / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012150:Polymorphism, Restriction Fragment Length; D011159:Population Surveillance; D015995:Prevalence; D012036:Refugees; D012307:Risk Factors; D018088:Tuberculosis, Multidrug-Resistant / Q000453:epidemiology* / Q000235:genetics*; D014397:Tuberculosis, Pulmonary / Q000453:epidemiology* / Q000235:genetics*
chemical_list: D004269:DNA, Bacterial