title: The burden of adverse events during treatment of drug-resistant tuberculosis in Namibia.
abstract: OBJECTIVE
  Namibia faces a dual burden of HIV/AIDS and tuberculosis (TB). In 2010, HIV prevalence was 18.8%, the TB case notification rate was 634 cases per 100,000 population and the TB/HIV co-infection rate was 58%. There were 372 cases of drug-resistant TB (DR-TB) in 2009. The objective of this study was to assess the prevalence, profile and outcome of adverse events (AEs) associated with treatment of DR-TB and to explore possible influences of HIV disease on the occurrence of adverse events.
  
  
  METHODS
  This was a cross-sectional descriptive study. After ethical approval, data were collected from treatment records of all patients treated for DR-TB at the study facility between January 2008 and February 2010 using a structured data collection form.
  
  
  RESULTS
  A total of 141 adverse events of varying severity were experienced in 90% (53/59) of patients.The TB/HIV co-infection rate was 53% (n=31). The prevalence of gastrointestinal tract adverse events (abdominal pains, constipation, diarrhea, nausea and vomiting) was 64%, tinnitus 45%, joint pain 28%and decreased hearing 25%. Abdominal pains, rash, nausea, decreased hearing and joint pain were more common in HIV infected than in HIV uninfected patients.
  
  
  CONCLUSIONS
  Adverse events of varying severity are common during treatment of DR-TB, particularly in the intensive phase of therapy. Some adverse events were more prevalent in DR-TB patients co-infected with HIV. The study concludes that the characteristics and risk factors of serious adverse events should be further examined.
authors.affiliation: School of Public Health, University of the Western Cape, Cape Town, South Africa ; Utrecht Institute for Pharmaceutical Sciences, Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, Utrecht, the Netherlands ; Management Sciences for Health, Strengthening Pharmaceutical Systems Program, Namibia.
authors.forename: Evans
authors.initials: E
authors.lastname: Sagwa
authors.forename: Aukje Kaija
authors.initials: AK
authors.lastname: Mantel-Teeuwisse
authors.forename: Nunurai
authors.initials: N
authors.lastname: Ruswa
authors.forename: Jean Paul
authors.initials: JP
authors.lastname: Musasa
authors.forename: Shanthi
authors.initials: S
authors.lastname: Pal
authors.forename: Panganai
authors.initials: P
authors.lastname: Dhliwayo
authors.forename: Brian
authors.initials: B
authors.lastname: van Wyk
keywords: Namibia; adverse events; drug resistance; second-line drugs; tuberculosis