title: Characteristics of multidrug-resistant tuberculosis in Namibia.
abstract: BACKGROUND
  To describe the epidemiology and possible risk factors for the development of multidrug-resistant tuberculosis (MDR-TB) in Namibia.
  
  
  METHODS
  Using medical records and patient questionnaires, we conducted a case-control study among patients diagnosed with TB between January 2007 and March 2009. Cases were defined as patients with laboratory-confirmed MDR-TB; controls had laboratory-confirmed drug-susceptible TB or were being treated with WHO Category I or Category II treatment regimens.
  
  
  RESULTS
  We enrolled 117 MDR-TB cases and 251 TB controls, of which 100% and 2% were laboratory-confirmed, respectively. Among cases, 97% (113/117) had been treated for TB before the current episode compared with 46% (115/251) of controls (odds ratio [OR] 28.7, 95% confidence interval [CI] 10.3-80.5). Cases were significantly more likely to have been previously hospitalized (OR 1.9, 95% CI 1.1-3.5) and to have had a household member with MDR-TB (OR 5.1, 95% CI 2.1-12.5). These associations remained significant when separately controlled for being currently hospitalized or HIV-infection.
  
  
  CONCLUSIONS
  MDR-TB was associated with previous treatment for TB, previous hospitalization, and having had a household member with MDR-TB, suggesting that TB control practices have been inadequate. Strengthening basic TB control practices, including expanding laboratory confirmation, directly observed therapy, and infection control, are critical to the prevention of MDR-TB.
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, GA, USA. hgp4@cdc.gov
authors.forename: Philip M
authors.initials: PM
authors.lastname: Ricks
authors.forename: Farai
authors.initials: F
authors.lastname: Mavhunga
authors.forename: Surbhi
authors.initials: S
authors.lastname: Modi
authors.forename: Rosalia
authors.initials: R
authors.lastname: Indongo
authors.forename: Abbas
authors.initials: A
authors.lastname: Zezai
authors.forename: Lauren A
authors.initials: LA
authors.lastname: Lambert
authors.forename: Nick
authors.initials: N
authors.lastname: DeLuca
authors.forename: Jamie S
authors.initials: JS
authors.lastname: Krashin
authors.forename: Allyn K
authors.initials: AK
authors.lastname: Nakashima
authors.forename: Timothy H
authors.initials: TH
authors.lastname: Holtz
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009276:Namibia / Q000453:epidemiology; D012307:Risk Factors; D018088:Tuberculosis, Multidrug-Resistant / Q000453:epidemiology*; D055815:Young Adult