title: Association of Previous Smoking Habit and Perceived Social Discrimination with the Risk of Multi-Drug Resistant Tuberculosis in Central Nepal.
abstract: BACKGROUND
  Multidrug-resistant tuberculosis (MDR TB) caused by Mycobacterium tuberculosis resistant to both Isoniazid and Rifampicin with or without resistant to other drug, is among the most alarming pandemic problem. The objectives of this study was to assess the risk factors of MDR TB in Central Nepal.
  
  
  METHODS
  A matched case control study was conducted among 186 cases of MDR TB and 372 non-MDR TB controls from central region of Nepal. Pretested questionnaires containing socio-economic, cultural & behavioral; environmental, biological and health service factors were used. Variables significant in bivariate analysis were entered in multiple regression models for further analysis.
  
  
  RESULTS
  After adjusting for confounders, previous smoking habit (aOR= 4.5,(95%CI(1.24-16.2)) (p=0.04), and perceived social discrimination (aOR=5.83,95%CI (1.77-19.71)) (P=0.021) independently predicted greater MDR TB risk.
  
  
  CONCLUSIONS
  Encouraging MDR TB cases for smoking cessation through awareness activities should be a priority. Stigma reduction programs should include the empowerment of patients and communities while promoting TBrelated research for further exploration into the risk factors of TB and associated stigma.
authors.affiliation: Department of Community Medicine, Manmohan Memorial Medical College and Teaching Hospital, Kathmandu, Nepal.
authors.forename: S B
authors.initials: SB
authors.lastname: Marahatta
authors.affiliation: Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
authors.forename: B
authors.initials: B
authors.lastname: Adhikari
authors.affiliation: Research and International Relation Division, Manmohan Memorial Institute of Health Sciences, Lalitpur, Nepal.
authors.forename: S R
authors.initials: SR
authors.lastname: Mishra
authors.affiliation: Department of Microbiology, Lumbini Medical College, Palpa, Nepal.
authors.forename: S
authors.initials: S
authors.lastname: Raut
authors.affiliation: Department of Social and Environmental Medicine, Mahidol University, Bangkok, Thailand.
authors.forename: P
authors.initials: P
authors.lastname: Ramasoota
authors.affiliation: National Tuberculosis Centre, Bhaktapur, Nepal.
authors.forename: P
authors.initials: P
authors.lastname: Malla
authors.affiliation: Department of Tropical Hygiene, Mahidol University, Bangkok, Thailand.
authors.forename: J
authors.initials: J
authors.lastname: Kaewkungwal
authors.affiliation: Liverpool John Moores University, Liverpool, United Kingdom.
authors.forename: P
authors.initials: P
authors.lastname: Singhasivanon
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D002648:Child; D015897:Comorbidity; D003469:Culture; D004777:Environment; D005260:Female; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D009390:Nepal / Q000453:epidemiology; D012111:Residence Characteristics; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology*; D063508:Social Discrimination / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D018088:Tuberculosis, Multidrug-Resistant / Q000453:epidemiology*; D055815:Young Adult
keywords: Tuberculosis; drug resistance; smoking; stigma; Nepal.