Multidrug resistant tuberculosis is a major global health problem. TB continues to be a great health treat in developing countries and is compounded by the high burden of MDR-TB [31]. There is still a serious knowledge gap about multidrug resistant tuberculosis in East Africa countries. Therefore, in order to find out the current circumstance of MDR-TB in the region, recent and evidence based studies are significantly required. Thus, this systematic review and meta-analysis addressed the prevalence of new MDR-TB and previously treated MDR-TB using 16 selected studies conducted from 2007 to 2019 in East Africa. In this review and meta-analysis, the prevalence of newly diagnosed MDR-TB ranged from 1% (95%CI: 0.0–2%) to 20% (95%CI: 11–29%) with a pooled prevalence of 4% (95%CI: 2–5%). The results of this meta-analysis showed that the pooled prevalence of newly diagnosed MDR-TB was somewhat higher than a previous meta-analysis report by Eshetie et al. [32] where 2% (95% CI 1–2%) of newly diagnosed TB patients have MDR-TB. According to the results of this meta-analysis, the prevalence of MDR-TB among previously treated cases ranged from 1% ((95%CI:-0.00-1.00) to 91% (95%CI: 81–101) with a pooled prevalence of 21% (95%CI: 14–28%). Similarly, the same study done in Ethiopia [32] showed that the pooled prevalence of MDR-TB among previously treated cases was 15% (95% CI 12% − 17%) which was lower than the present study. In this review, the researcher found that the level of MDR-TB were higher in East Africa than reported globally for both new and previously treated MDR-TB. This study result showed that MDR-TB estimates as almost six times higher as compared to the global average reported by WHO for both new and previously treated (21% vs 3.6%) TB positive patients [33]. According to this meta-analysis, the pooled prevalence of MDR-TB was higher than the pooled prevalence of MDR-TB with a previous meta-analysis report that was conducted in Ethiopia [23]. According to the WHO report of 2015, globally the prevalence of MDR-TB of new cases and previously treated cases of TB was 3.5% and 20.5%, respectively, while Sub-Saharan Africa countries contributing the highest proportion and these levels in recent years have remained unchanged [34, 35]. The main reasons behind the appearance of MDR-TB globally are multi-factor and are related to living conditions [36], life style [15], previous medical history [37, 38], diabetes history [39, 40], HIV infection [41], and education level [37].
Poor and crowded living conditions of a family might make easy the spread of TB. Thus, these lower socioeconomic family groups should get the highest concern for MDR-TB prevention efforts [42]. Patients that live in a household with more than one room were five times at lower risk of having MDR-TB than those living in a household with only one room [8]. This might be as a result of high risk of getting resistant strains from infected people in crowded places. Different lifestyles such as alcohol abuse, smoking, drugs use, etc. are the major risk factors associated with the development of MDR-TB. Cigarette smokers were more likely to be infected with MDR-TB infection and have less chance to be cured. Male cigarette smokers were more likely to be infected with MDR-TB and susceptible compared than females. This might be due to that men are predominantly drink alcohol, smoke and consume the drug compared to women [6, 43–45].
The longer exposure of a patient to anti-tuberculosis drugs was also associated with the development of MDR-TB. Patients under multiple situation of anti-tuberculosis treatment might create greater antibiotic resistance with the consequent development of MDR-TB and XDR-TB cases. Previous TB disease and chemotherapy are the most important risk factors associated with MDR-TB [37, 38, 46]. The global diabetes mellitus (DM) epidemic creates a serious bottleneck to the TB control program [47]. Individuals with diabetes, as compared to non-diabetic controls, were two-to three-folds more likely to develop TB. Weakened immunity in diabetic patients is thought to contribute to the development of latent TB infection to active cases [39, 40].
A study done in Ethiopia revealed that human immunodeficiency virus (HIV) infection was identified as a significant factor associated for MDR-TB [22]. Moreover, individuals living with HIV might also be more likely to be exposed to MDR-TB because of longer hospitalization in settings with low infection control. Drug malabsorption in HIV infected people can also lead to drug resistance and has been shown to result in treatment failure [48]. In one study conducted by Al-Darraji et al.[49] revealed that there was 20% higher occurrence of MDR-TB among HIV-positive persons than those HIV-negative persons. Patients with low education level have been associated with the development of MDR-TB. [37]. A study conducted by Ronaidi et al. [50] showed that the number of MDR-TB infected patients is significantly higher among the lower education group compared to the higher education group. It has been reported that the higher prevalence of pulmonary TB with unsuccessful treatment outcome was observed in patients who had a lower education level [51]. However, studies conducted in Ethiopia and Sudan showed that educational status was not significantly associated with MDR-TB [52–54].
Limitations
This review had some limitations. Out of 11 East Africa countries, only 6 countries had done studies that fulfilled the inclusion criteria. This review has been summarized the findings of 16 published articles about the prevalence and the associated risk factors of MDR-TB in East Africa. The findings of this review are limited because of a small number of study countries, small number of published articles, and small sample size of study samples conducted on the prevalence of MDR-TB. However, the findings of this review give reliable results on MDR-TB in East Africa.