Risk factors associated with drug-resistant tuberculosis in Ethiopia: A
systematic review and meta-analysis
Abstract
The emergence of drug-resistant tuberculosis (DR-TB) is becoming a
challenge to the national TB control programs including Ethiopia.
Different risk factors are associated with the emergence of DR-TB.
Identifying these risk factors in a local setting is important to
strengthen the effort to prevent and control DR-TB. Thus, this study
aimed to assess the risk factors associated with drug-resistant TB in
Ethiopia. The Preferred Reporting Items for Systematic Reviews and
Meta-analysis checklist was followed to conduct this study. We
systematically searched the articles from electronic databases and gray
literature sources. We used the Joanna Briggs Institute Critical
Appraisal tools to assess the quality of studies. Data were analyzed
using STATA version 15. We estimated the pooled OR along with 95%CI for
each risk factor. The heterogeneity of the studies was assessed using
the forest plot and I 2 heterogeneity test. Besides,
we explored the presence of publication bias through visual inspection
of the funnel plot and Egger’s regression test. After intense searching,
we found 2238 articles, and 27 eligible studies were included in the
final analysis. Based on the pooled analysis of the odds ratio,
unemployment (OR; 2.71, 95% CI; 1.64, 3.78), having a history of the
previous TB (OR; 4.83, 95% CI; 3.02, 6.64), having contact with a known
TB patient (OR; 1.72, 95% CI; 1.05, 2.40), having contact with a known
MDR-TB patient (OR; 2.54, 95% CI; 1.46, 3.63), and having pulmonary TB
(OR; 1.80, 95% CI; 1.14, 2.45) were found to be the risk factors of
drug-resistant TB. While older age TB patients (OR; 0.77, 95% CI; 0.60,
0.95) including age above 45 years OR; (0.76, 95% CI; 0.55, 0.97), and
males (OR; 0.86, 95% CI; 0.76, 0.97) were found to had lower risk of
DR-TB compared to their counterparts. A previous history of TB treatment
is a major risk factor for acquiring DR-TB in Ethiopia that might be due
to poor adherence during the first-line anti TB treatment. Besides,
having contact with a known TB patient, having contact with a known
MDR-TB patient, having pulmonary TB, and being unemployed were the risk
factors of DR-TB in Ethiopia. Thus, active screening of TB contacts for
DR-TB might help to detect DR-TB cases as early as possible and could
help to mitigate its further transmission across the community.