Analysis of the Factors Leading to Causation of Multidrug Resistant Tuberculosis among Cases Registered under Revised National Tuberculosis Control Programme in East Sikkim – A Case Control Study

BACKGROUND Tuberculosis (TB) is a curable and preventable disease. Emergence of multi drug resistance TB (MDR TB) threatens to undo the progress made towards control of TB. While treatment is available for MDR TB, it is of a long duration and is also more expensive and toxic. Understanding the various factors that are associated with MDR TB may help to formulate and implement effective preventive practices for control of MDR TB. We wanted to assess the various epidemiological factors among MDR TB cases registered under Revised National Tuberculosis Control Programme (RNTCP) in East Sikkim and study the current & past TB treatment including adverse drug reactions. METHODS A community-based case control study was conducted over 4 months in the eastern district of Sikkim. MDR TB cases registered under Revised National Tuberculosis Control Programme (RNTCP) in the first two quarters of 2019 were compared with matched healthy controls. Data was collected by a door to door survey using a pre-designed and pre-tested questionnaire and analysed on Statistical Package for the Social Sciences (SPSS) 20. RESULTS A total of 62 cases (14 non-respondents) of MDR TB were identified and were matched with 63 controls. 30.5 % cases were young adults in the age group 15 to 25 years, 66 % of the cases reported being currently unemployed, 16 % were homemakers, 11 % of cases fell below poverty line. A higher proportion of cases as compared to controls reported a habit of skipping a meal, poor housing conditions and comorbidities than controls. A known history of contact with a case of tuberculosis was given by 11.3 % cases; 18 % cases gave a previous history of TB; about 51 % cases reported a delay in diagnosis which delayed treatment initiation. CONCLUSIONS Previous history of TB with history of relapse / failure, contact of MDR TB emerged as the most significant risk factors and presence of comorbid conditions like diabetes & hypertension can be used to indicate higher risks of drug resistance. KEYWORDS Multi Drug Resistant Tuberculosis, MDR TB, Case control, Revised National Tuberculosis Control Programme, Sikkim