Epidemiology and genetic diversity of multidrug-resistant tuberculosis in East Africa.
Multidrug-resistant tuberculosis (MDR-TB) is an emerging problem in many parts of the world, and levels of MDR-TB among new TB patients are increasing in sub-Saharan Africa. We reviewed the prevalence and molecular epidemiology of MDR-TB in East Africa, including Burundi, Kenya, Rwanda, Tanzania, and Uganda. In 16 epidemiologic surveys, the prevalence of MDR among new cases ranges from 0.4% in Tanzania to 4.4% in Uganda, and among recurrent cases ranges from 3.9% in Tanzania to 17.7% in Uganda. There is a gap of 5948 cases between the estimated number of MDR-TB cases in East Africa and the number actually diagnosed. The only confirmed risk factors for MDR-TB are prior treatment for TB and refugee status. HIV has not been reported as a risk factor, and there are no reports of statistical association between spoligotype and drug resistance pattern. Increased capacity for diagnosis and treatment of MDR-TB is needed, with an emphasis on recurrent TB cases and refugees.
Department of Biochemistry and Molecular Biology, School of Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania; Center for Global Health, Division of Infectious Diseases, Weill Cornell Medical College, New York, NY, United States of America. Electronic address: benkidenya@gmail.com.
Benson R
BR
Kidenya
Center for Global Health, Division of Infectious Diseases, Weill Cornell Medical College, New York, NY, United States of America.
Lauren E
LE
Webster
Center for Global Health, Division of Infectious Diseases, Weill Cornell Medical College, New York, NY, United States of America.
Sehan
S
Behan
Center for Global Health, Division of Infectious Diseases, Weill Cornell Medical College, New York, NY, United States of America; Department of Internal Medicine, School of Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania.
Rodrick
R
Kabangila
Center for Global Health, Division of Infectious Diseases, Weill Cornell Medical College, New York, NY, United States of America; Department of Internal Medicine, School of Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania.
Robert N
RN
Peck
Department of Microbiology and Immunology, School of Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania.
Stephen E
SE
Mshana
Center for Global Health, Division of Infectious Diseases, Weill Cornell Medical College, New York, NY, United States of America; Les Centres GHESKIO, Port-au-Prince, Haiti.
Oksana
O
Ocheretina
Center for Global Health, Division of Infectious Diseases, Weill Cornell Medical College, New York, NY, United States of America.
Daniel W
DW
Fitzgerald
D000351:Africa, Eastern / Q000453:epidemiology; D000995:Antitubercular Agents / Q000627:therapeutic use*; D014644:Genetic Variation; D005838:Genotype; D006801:Humans; D017720:Molecular Epidemiology; D009154:Mutation; D009169:Mycobacterium tuberculosis / Q000235:genetics*; D015995:Prevalence; D012036:Refugees / Q000706:statistics & numerical data*; D012307:Risk Factors; D055502:Secondary Prevention; D018571:Sentinel Surveillance; D018088:Tuberculosis, Multidrug-Resistant / Q000453:epidemiology* / Q000235:genetics / Q000517:prevention & control
D000995:Antitubercular Agents
East Africa; Genetic diversity; Multidrug-resistant tuberculosis (MDR-TB); Prevalence; Risk factors