title: Factors contributing to the high prevalence of multidrug-resistant tuberculosis: a study from China.
abstract: BACKGROUND
  The rapid spread of multidrug-resistant tuberculosis (MDR-TB) has attracted global concerns. This study aimed to identify factors contributing to the high prevalence of MDR-TB in China's Heilongjiang province.
  
  
  METHODS
  A cross-sectional survey following the WHO/International Union Against Tuberculosis and Lung Disease guidelines was conducted with consecutive recruitment of patients with TB in 30 counties selected at random in Heilongjiang in 2004. A total of 1995 patients were tested for MDR-TB. Factors associated with MDR-TB were identified through multilevel models and traditional logistic regression analysis, along with in-depth interviews with nine patients, five healthcare managers and four doctors.
  
  
  RESULTS
  241 patients (12%) were identified with MDR-TB. The retreatment patients were 5.48 times (95% CI 4.04 to 7.44) more likely to have MDR-TB than newly diagnosed patients. The patients who were treated with isoniazid and rifampin for >180 days were 4.82 times (95% CI 2.97 to 7.81) more likely to develop MDR-TB than those treated <180 days. Age and delay in initiating TB treatment were associated with MDR-TB. Financial burden, poor knowledge and side effects of TB treatment were perceived by the interviewees as influencing factors. Lack of coordination of services, unsatisfactory supervision of treatment and infection control jeopardised the control of MDR-TB.
  
  
  CONCLUSIONS
  Inappropriate treatment is the most important influencing factor of MDR-TB. Increasing people's awareness of TB, early detection and appropriate treatment of patients with TB should become a priority, which requires strong commitment and collaboration among health organisations and greater compliance with TB treatment guidelines by service providers and patients.
authors.affiliation: Department of Social Medicine, School of Public Health, Harbin Medical University, Harbin, Heilongjiang, People's Republic of China.
authors.forename: Libo
authors.initials: L
authors.lastname: Liang
authors.forename: Qunhong
authors.initials: Q
authors.lastname: Wu
authors.forename: Lijun
authors.initials: L
authors.lastname: Gao
authors.forename: Yanhua
authors.initials: Y
authors.lastname: Hao
authors.forename: Chaojie
authors.initials: C
authors.lastname: Liu
authors.forename: Yanguang
authors.initials: Y
authors.lastname: Xie
authors.forename: Hong
authors.initials: H
authors.lastname: Sun
authors.forename: Xinglu
authors.initials: X
authors.lastname: Yan
authors.forename: Fabin
authors.initials: F
authors.lastname: Li
authors.forename: Honghai
authors.initials: H
authors.lastname: Li
authors.forename: Hongxia
authors.initials: H
authors.lastname: Fang
authors.forename: Ning
authors.initials: N
authors.lastname: Ning
authors.forename: Yu
authors.initials: Y
authors.lastname: Cui
authors.forename: Liyuan
authors.initials: L
authors.lastname: Han
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000995:Antitubercular Agents / Q000627:therapeutic use*; D002681:China / Q000453:epidemiology; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification*; D015995:Prevalence; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D018088:Tuberculosis, Multidrug-Resistant / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D055815:Young Adult
chemical_list: D000995:Antitubercular Agents