Abstract
M.A. (Public Health)
Background: Tuberculosis (TB) remains a problem for South Africa, and for the City of Johannesburg, which is amongst eight countries which accounts for two thirds of the global total and is ranked 8th accounting for three percent (3%). Multi resistant TB (MDR TB) worsened in South Africa in 2013 but started to decrease in 2018. Objective: The overall objective of this study was to describe TB infections, and to explore the relationship between MDRTB and socio demographic factors, HIV status, TB treatment and TB outcomes in the City of Johannesburg Metropolitan municipality. Method: This was a cross-sectional study of 1703 records of TB patients who received treatment in the District City of Johannesburg. Administrative data were obtained from the City of Johannesburg for 2016 to 2018 and a secondary analysis was conducted. All the variables were compared by binary groupings of MDR status (positive or negative). The crude and adjusted odds ratios calculated were using logistic regression in SPSS and reported. Results: TB was related to socio-demographic characteristics. Patients, who are also participants with at least 1 TB treatment drug were more likely to have MDR, AOR 2.54 95% (1.05 -6.14). Patients on first line treatments were more likely to have MDR, AOR 9.13 95% (6.33 - 13.16), Patients with Resistance to Rifampicin, NIH, and Ofloxacin were more likely to have MDR, AOR 5.33 95% (3.27 - 10.21); AOR 18.01 95% (15.68 - 30.16) and AOR 3.09 95% (1.21 - 7.94), respectively. Patients who were hospitalized were likely to have MDR, AOR 6.17 95% (1.33 - 28.69). Patients who died; (A.O.R: 68) and (CI: 0.44 - 1.04) and were lost to follow-up, (A.O.R:1, 06) and (CI: 0.55 – 2.06). Only the hospitalization was more common among patients with MDR TB compared to those without MDR TB and this was statistically significant, (p-value<0.001) Conclusion: Multiple factors contribute to MDR TB and mortality including , HIV co-infected who were not on ART, and hospital admission for DR-TB treatment were independent risk factors for DR-TB , A multi-faceted approach to focus on above factors , including HIV treatment programs and appropriate infection control, is required to avert a large-scale MDR-TB epidemic factors.