title: Risk factors for multidrug-resistant tuberculosis in urban Pakistan: A multicenter case-control study.
abstract: OBJECTIVE
  To evaluate risk factors for multidrug-resistant tuberculosis (MDR-TB) in an urban setting of Pakistan.
  
  
  METHODS
  In this multicenter case-control study, patients aged 15years old or older with sputum culture and sensitivity (C/S) diagnosed with pulmonary MDR-TB were defined as cases, whereas patients aged 15years old or older with sputum C/S diagnosed and susceptible to pulmonary TB were regarded as controls. Fifty cases and 75 controls were enrolled from three tertiary-care hospitals in Karachi.
  
  
  RESULTS
  Multivariable logistic regression models showed that cases were more likely to have had a TB patient in the house prior to the diagnosis of MDR-TB (adjusted odds ratio [ORadj]=3.1, 95% confidence interval [CI]: 1.2, 8.3) or had a history of prior TB treatment (ORadj=4.2, 95% CI: 1.1, 15.4). Furthermore, cases compared with controls tended to be male (ORadj=3.6, 95% CI: 1.4, 9.7), 15-25years of age (ORadj=3.7, 95% CI: 1.2, 11.3), of Sindhi ethnicity (adjusted OR=9.1, 95% CI: 1.9, 43.4) or with low educational attainment (ORadj OR=5.5, 95% CI: 1.7-17.6, for no formal schooling; ORadj=3.8, 95% CI: 1.1-14.1, 1 for 1-5 school years).
  
  
  CONCLUSIONS
  A TB patient in the house or a history of prior TB treatment was strongly associated with MDR-TB in this study. Furthermore, younger age, male gender, Sindhi ethnicity and poor educational attainment entailed a high risk for MDR-TB. Targeted educational intervention for patients and their contacts may minimize the noncompliance with prescribed TB treatment and lessen MDR-TB magnitude in settings like Karachi.
authors.affiliation: Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan.
authors.forename: Ahsan M
authors.initials: AM
authors.lastname: Ahmad
authors.affiliation: Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan; Department of Community Medicine and Behavioural Sciences, Faculty of Medicine, Kuwait University, Jabriya 90805, Kuwait. Electronic address: saeed.akhtar@hsc.edu.kw.
authors.forename: Saeed
authors.initials: S
authors.lastname: Akhtar
authors.affiliation: Department of Pathology and Microbiology, Aga Khan University, Karachi, Pakistan.
authors.forename: Rumina
authors.initials: R
authors.lastname: Hasan
authors.affiliation: Department of Medicine, Aga Khan University, Karachi, Pakistan.
authors.forename: Javaid A
authors.initials: JA
authors.lastname: Khan
authors.affiliation: Department of Medicine, Aga Khan University, Karachi, Pakistan.
authors.forename: Syed F
authors.initials: SF
authors.lastname: Hussain
authors.affiliation: Department of Medicine, Jinnah Postgraduate Medical Center, Karachi, Pakistan.
authors.forename: Nadeem
authors.initials: N
authors.lastname: Rizvi
keywords: History of prior tuberculosis treatment; Multidrug-resistant tuberculosis; Mycobacterium tuberculosis; Pakistan; Risk factors