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Abouyannis M, Dacombe R, Dambe I, Mpunga J, Faragher B, Gausi F, Ndhlovu H, Kachiza C, Suarez P, Mundy C, Banda HT, Nyasulu I, Squire SB. Drug resistance of Mycobacterium tuberculosis in Malawi: a cross-sectional survey. Bull World Health Organ 2014; 92:798-806. [PMID: 25378741 PMCID: PMC4221759 DOI: 10.2471/blt.13.126532] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Revised: 07/31/2014] [Accepted: 08/07/2014] [Indexed: 11/29/2022] Open
Abstract
Objective To document the prevalence of multidrug resistance among people newly diagnosed with – and those retreated for – tuberculosis in Malawi. Methods We conducted a nationally representative survey of people with sputum-smear-positive tuberculosis between 2010 and 2011. For all consenting participants, we collected demographic and clinical data, two sputum samples and tested for human immunodeficiency virus (HIV).The samples underwent resistance testing at the Central Reference Laboratory in Lilongwe, Malawi. All Mycobacterium tuberculosis isolates found to be multidrug-resistant were retested for resistance to first-line drugs – and tested for resistance to second-line drugs – at a Supranational Tuberculosis Reference Laboratory in South Africa. Findings Overall, M. tuberculosis was isolated from 1777 (83.8%) of the 2120 smear-positive tuberculosis patients. Multidrug resistance was identified in five (0.4%) of 1196 isolates from new cases and 28 (4.8%) of 581 isolates from people undergoing retreatment. Of the 31 isolates from retreatment cases who had previously failed treatment, nine (29.0%) showed multidrug resistance. Although resistance to second-line drugs was found, no cases of extensive drug-resistant tuberculosis were detected. HIV testing of people from whom M. tuberculosis isolates were obtained showed that 577 (48.2%) of people newly diagnosed and 386 (66.4%) of people undergoing retreatment were positive. Conclusion The prevalence of multidrug resistance among people with smear-positive tuberculosis was low for sub-Saharan Africa – probably reflecting the strength of Malawi’s tuberculosis control programme. The relatively high prevalence of such resistance observed among those with previous treatment failure may highlight a need for a change in the national policy for retreating this subgroup of people with tuberculosis.
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Affiliation(s)
- Michael Abouyannis
- Centre for Applied Health Research & Delivery, Department of Clinical Sciences, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, England
| | - Russell Dacombe
- Centre for Applied Health Research & Delivery, Department of Clinical Sciences, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, England
| | - Isaias Dambe
- National Tuberculosis Control Programme, Lilongwe, Malawi
| | - James Mpunga
- National Tuberculosis Control Programme, Lilongwe, Malawi
| | - Brian Faragher
- Centre for Applied Health Research & Delivery, Department of Clinical Sciences, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, England
| | - Francis Gausi
- National Tuberculosis Control Programme, Lilongwe, Malawi
| | - Henry Ndhlovu
- Research for Equity and Community Health Trust, Lilongwe, Malawi
| | - Chifundo Kachiza
- Tuberculosis Control Assistance Programme, Management Sciences for Health, Lilongwe, Malawi
| | - Pedro Suarez
- Management Sciences for Health, Arlington, United States of America
| | - Catherine Mundy
- Management Sciences for Health, Arlington, United States of America
| | - Hastings T Banda
- Research for Equity and Community Health Trust, Lilongwe, Malawi
| | | | - S Bertel Squire
- Centre for Applied Health Research & Delivery, Department of Clinical Sciences, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, England
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Salaniponi FM, Kwanjana J, Nyasulu I, Dambe I, Gondwe M, Machinjili A, Harries AD. Loss of tuberculosis officers from a national tuberculosis programme: the Malawi experience, 1993-1997. Int J Tuberc Lung Dis 1999; 3:174-5. [PMID: 10091888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
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