title: Determinants of multidrug-resistant tuberculosis in Henan province in China: a case control study.
abstract: BACKGROUND
  Multi-drug resistance (MDR) has been a cause of concern for tuberculosis (TB) control in both developed and developing countries. This study described the characteristics and risk factors associated with MDR-TB among 287 cases and 291 controls in Henan province, China.
  
  
  METHODS
  A hospital-based case-control study was conducted between June 2012 and December 2013. The study subjects were selected using multistage probability sampling. Multivariate conditional logistic regression models were used to determine the risk factors associated with MDR-TB.
  
  
  RESULTS
  The following risk factors for MDR-TB were identified: previous TB treatment (AOR = 4.51, 95% CI: 3.55-5.56), male sex (AOR = 1.09, 95% CI: 0.24-1.88), high school or lower education degree (AOR = 1.87, 95% CI: 1.27-2.69), unemployment (AOR = 1.30, 95% CI: 0.78-2.52), long distance of residence from the health facility (AOR = 6.66,95% CI: 5.92-7.72), smoking (AOR = 2.07, 95% CI: 1.66-3.19), poor knowledge regarding MDR-TB (AOR = 2.06, 95% CI: 1.66-2.92), traveling by foot to reach the health facility (AOR = 1.85, 95% CI: 1.12-3.09), estimated amount of time to reach the health facility was greater than 3 h (AOR = 1.42, 95% CI: 0.51-2.35), social stigma (AOR = 1.17, 95% CI: 0.27-2.03), having an opportunistic infection (AOR = 1.45, 95% CI: 0.58-2.4), more than 3 TB foci in the lungs (AOR = 1.98, 95% CI: 1.49-3.25), total time of first treatment was more than 8 months (AOR = 1.39, 95% CI: 0.65-2.54), adverse effects of anti-TB medication (AOR = 2.39, 95% CI: 1.40-3.26), and more than 3 prior episodes of anti-TB treatment (AOR = 1.83, 95% CI: 1.26-2.80).
  
  
  CONCLUSIONS
  The identified risk factors should be given priority in TB control programs. Additionally, there is a compelling need for better management and control of MDR-TB, particularly through increasing laboratory capacity, regular screening, enhancing drug sensitivity testing, novel MDR-TB drug regimens, and adherence to medication.
authors.affiliation: Department of Tuberculosis, the First Hospital Affiliated to the Xinxiang Medical College, No. 88 Jiankang Road, Weihui, 453100, Henan, China.
authors.forename: Chunxiao
authors.initials: C
authors.lastname: Zhang
authors.affiliation: Department of Tuberculosis, the First Hospital Affiliated to the Xinxiang Medical College, No. 88 Jiankang Road, Weihui, 453100, Henan, China.
authors.forename: Yongliang
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Department of Tuberculosis, the First Hospital Affiliated to the Xinxiang Medical College, No. 88 Jiankang Road, Weihui, 453100, Henan, China.
authors.forename: Guangcan
authors.initials: G
authors.lastname: Shi
authors.affiliation: Department of Tuberculosis, the First Hospital Affiliated to the Xinxiang Medical College, No. 88 Jiankang Road, Weihui, 453100, Henan, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Han
authors.affiliation: Department of Tuberculosis, the First Hospital Affiliated to the Xinxiang Medical College, No. 88 Jiankang Road, Weihui, 453100, Henan, China.
authors.forename: Huayang
authors.initials: H
authors.lastname: Zhao
authors.affiliation: Department of Tuberculosis, the First Hospital Affiliated to the Xinxiang Medical College, No. 88 Jiankang Road, Weihui, 453100, Henan, China.
authors.forename: Huiqiang
authors.initials: H
authors.lastname: Zhang
authors.affiliation: Department of Tuberculosis, the First Hospital Affiliated to the Xinxiang Medical College, No. 88 Jiankang Road, Weihui, 453100, Henan, China. xixiue@outlook.com.
authors.forename: Xiue
authors.initials: X
authors.lastname: Xi
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D002681:China / Q000453:epidemiology; D003906:Developing Countries; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012737:Sex Factors; D012907:Smoking / Q000453:epidemiology; D057545:Social Stigma; D012959:Socioeconomic Factors; D018088:Tuberculosis, Multidrug-Resistant / Q000453:epidemiology* / Q000523:psychology