title: Isolation of multidrug-resistant tuberculosis strains in patients from private and public health care facilities in Nairobi, Kenya.
abstract: METHODS
  Health care facilities in Nairobi, Kenya.
  
  
  OBJECTIVE
  To document the presence of multidrug-resistant tuberculosis (MDR-TB) strains in patients from Nairobi between September 1999 and October 2001.
  
  
  METHODS
  Descriptive study.
  
  
  RESULTS
  Of the 983 referred patients who submitted sputum for culture and drug susceptibility testing (DST), 59% were males. Two hundred and nine (21.3%) patients had a positive culture, of whom 15.2% had a request for DST against isoniazid, rifampicin, streptomycin and ethambutol. Of these, 65 (43.6%) had an isolate resistant to one or more drugs, while 17 (11.4%) had MDR-TB. Ten (59.0%) cases were referred from public health care facilities while seven (41%) were from the private sector. Sixteen isolates were resistant to all four drugs. All MDR-TB cases but one were from Nairobi.
  
  
  CONCLUSIONS
  The emergence of MDR-TB in Nairobi is a cause for concern. An outbreak would be catastrophic, creating not only increased morbidity and mortality but also a tremendous strain on already limited health care resources. Lack of policies for the treatment and management of MDR-TB and the unavailability of appropriate diagnostic facilities may increase its spread. Efforts to prevent outbreaks of MDR-TB should be emphasised.
authors.affiliation: Centre for Respiratory Diseases Research, Kenya Medical Research Institute (KEMRI), Nairobi. wgithui@hotmail.com
authors.forename: W A
authors.initials: WA
authors.lastname: Githui
authors.forename: H K
authors.initials: HK
authors.lastname: Meme
authors.forename: E S
authors.initials: ES
authors.lastname: Juma
authors.forename: P
authors.initials: P
authors.lastname: Kinyanjui
authors.forename: F
authors.initials: F
authors.lastname: Karimi
authors.forename: J M
authors.initials: JM
authors.lastname: Chakaya
authors.forename: J
authors.initials: J
authors.lastname: Kangangi
authors.forename: A
authors.initials: A
authors.lastname: Kutwa
mesh_terms: D000328:Adult; D000995:Antitubercular Agents / Q000494:pharmacology*; D004196:Disease Outbreaks; D018432:Drug Resistance, Multiple; D005260:Female; D006268:Health Facilities / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D007630:Kenya; D008297:Male; D009169:Mycobacterium tuberculosis / Q000187:drug effects* / Q000302:isolation & purification*; D014397:Tuberculosis, Pulmonary / Q000188:drug therapy* / Q000473:pathology; D014505:Urban Population
chemical_list: D000995:Antitubercular Agents