[Study on the epidemiology and determinants of drug-resistant tuberculosis in northern rural area of Jiangsu province].
OBJECTIVE
To understand the determinants and epidemiology of drug-resistant tuberculosis (TB) in rural area.


METHODS
All the diagnosed TB patients in a county with directly observed treatment (DOTS) short-course program in 2002 and a sample of patients in another county without DOTS program located in northern Jiangsu province were surveyed with questionnaires. Drug susceptibility testing (DST) for positive cultures were performed by standardized proportion method. Univariable analysis and multivariate nonconditional logistic regression modeling were applied for data analysis.


RESULTS
Among the 152 patients with DST results, 32.9% of the cases showed resistance to at least one of the first-line anti-tuberculosis drugs with 26.3% to isoniazid, 18.4% to rifampin and 17.1% to both isoniazid and rifampin respectively. Previous treatments for TB and residence in the county without DOTS program were independent risk factors for isoniazid and rifampin resistance. TB patients showing indifferent to their health and delayed health seeking for more than 1 month were more likely to have rifampin resistance. Independent predictors of multidrug-resistant TB would include delayed health seeking for more than 1 month (OR = 4.66, 95% CI: 1.26 - 17.24), residing in the county without a DOTS program (OR = 3.01, 95% CI: 1.10 - 8.22), indifference to their health condition (OR = 5.13, 95% CI: 1.06 - 24.90) and suffering from chronic diseases (OR = 0.22, 95% CI: 0.05 - 0.87).


CONCLUSIONS
Drug-resistant TB was quite serious in this rural areas, mainly associated with man-made factors but partly due to the availability of the transmission.
Department of Epidemiology, School of Public Health, Fudan University, Shanghai 200032, China.
Ben-fu
BF
Yang
Biao
B
Xu
Wei-li
WL
Jiang
Pei-yuan
PY
Zhou
Qing-wu
QW
Jiang
D000328:Adult; D000995:Antitubercular Agents / Q000494:pharmacology*; D002681:China / Q000453:epidemiology; D004352:Drug Resistance, Microbial; D018432:Drug Resistance, Multiple; D004977:Ethambutol / Q000627:therapeutic use; D006801:Humans; D015994:Incidence; D007538:Isoniazid / Q000627:therapeutic use; D016015:Logistic Models; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D012293:Rifampin / Q000627:therapeutic use; D012423:Rural Health; D013307:Streptomycin / Q000627:therapeutic use; D011795:Surveys and Questionnaires; D014397:Tuberculosis, Pulmonary / Q000453:epidemiology* / Q000382:microbiology
D000995:Antitubercular Agents; D004977:Ethambutol; D007538:Isoniazid; D012293:Rifampin; D013307:Streptomycin