Health Care Industry
Industry: Email Alert RSS FeedMultidrug-resistant tuberculosis in Central Asia
Emerging Infectious Diseases, May, 2004 by Helen Suzanne Cox, Juan Daniel Orozco, Roy Male, Sabine Ruesch-Gerdes, Dennis Falzon, Ian Small, Darebay Doshetov, Yared Kebede, Mohammed Aziz
Table 1. Key characteristics of the two regions and countries
included in the survey (a)
Uzbekistan Turkmenistan
Population (6) 25,256,000 4,834,000
GDP per capita (6) U.S.$ 2,333 U.S.$ 5,269
Health expenditure U.S.$ 86 U.S.$ 286
per capita (6)
Estimated TB incidence 92/100,000/y 84/100,000/y
rate (all cases) (7)
Estimated smear-positive 44% 68%
case detection (7) Karakalpakstan Dashoguz
Population (2001 1,549,761 1,041,372
estimated) (b)
DOTS implementation 1998 (pilot 2000 (pilot
districts)-2003 districts)-2002
(full coverage) (full coverage)
DOTS case notification 482/100,000/y 213/100,000/y
rate (all cases)
DOTS case notification 192/100,000/year 89/100,000/year
rate (smear-positive
cases)
% of smear-positive cases 55 53
previously treated (2002)
Success rate (new smear- 68% 82%
positive cases registered
in 2001)
(a) GDP, gross domestic product; TB, tuberculosis; DOTS, directly
observed treatment strategy.
(b) Source: ministries of health in each region.
Table 2. First-line anti-tuberculosis drug resistance results,
Karakalpakstan, Uzbekistan (a)
No. new No. retreatment
cases (%) cases (%) Total no. (%)
Total tested 106 107 213
Any resistance 51 (48.1) 86 (80.4) 137 (64.3)
Monoresistance
H only 3 (2.8) 7 (6.5) 10 (4.7)
R only 0 0 0
E only 0 0 0
S only 12 (11.3) 11 (10.3) 23 (10.8)
Z only 0 1 (0.9) 1 (0.5)
H and R resistance
MDR 14 (13.2) 43 (40.2) 57 (26.8)
HR only 0 1 (0.9) 1 (0.5)
HRE only 0 0 0
HRS only 4 (3.8) 10 (9.3) 14 (6.6)
HRZ only 0 0 0
HRES only 6 (5.7) 19 (17.8) 25 (11.7)
HREZ only 0 0 0
HRSZ only 1 (0.9) 0 1 (0.5)
HRESZ 3 (2.8) 13 (12.1) 16 (7.5)
H + other resistance
HE only 0 0 0
HS only 13 (12.3) 15 (14.0) 28 (13.1)
HZ only 1 (0.9) 1 2 (0.9)
HES only 2 (1.9) 4 (3.7) 6 (2.8)
HEZ only 0 0 0
HSZ only 1 (.9) 3 (2.8) 4 (1.9)
HESZ only 5 (4.7) 1 (0.9) 6 (2.8)
R + other resistance
RE only 0 0 0
RS only 0 0 0
RZ only 0 0 0
RES only 0 0 0
RESZ only 0 0 0
Any drug resistance
Any H resistance 39 (36.8) 74 (69.2) 113 (53.1)
Any R resistance 14 (13.2) 43 (40.2) 57 (26.8)
Any E resistance 16 (15.1) 37 (34.6) 53 (24.9)
Any S resistance 47 (44.3) 76 (71.0) 123 (57.7)
Any Z resistance 11 (10.4) 19 (17.8) 30 (14.1)
(a) H, isoniazid; R, rifampin; E, ethambutol; S, streptomycin;
Z, pyrizinamide.
Table 3. First-line anti-tuberculosis drug resistance results,
Dashoguz, Turkmenistan (a)
No. new No. retreatment
cases (%) cases(%) Total no. (%)
Total tested 105 98 203
Any resistance 32 (30.5) 61 (62.2) 93 (45.8)
Monoresistance
H only 6 (5.7) 8 (8.2) 14 (6.9)
R only 0 1 (1.0) 1 (0.5)
E only 0 0 0
S only 16 (15.2) 13 (13.3) 29 (14.3)
Z only 0 0 0
H and R resistance
MDR 4 (3.8) 18 (18.4) 22 (10.8)
HR only 0 0 0
HRE only 0 0 0
HRS only 3 (2.9) 7 (7.1) 10 (4.9)
HRZ only 0 0 0
HRES only 1 6 (6.1) 7 (3.4)
HREZ only 0 0 0
HRSZ only 0 3 (3.1) 3 (1.5)
HRESZ 0 2 (2.0) 2 (1.0)
H + other resistance
HE only 0 1 (1.0) 1 (0.5)
HS only 5 (4.8) 10 (10.2) 15 (7.4)
HZ only 0 1 (1.0) 1 (0.5)
HES only 1 (1.0) 6 (6.1) 7 (3.4)
HEZ only 0 0 0
HSZ only 0 3 (3.1) 3
HESZ only 0 0 0
R + other resistance
RE only 0 0 0
RS only 0 0 0
RZ only 0 0
RES only 0 0 0
RESZ only 0 0 0
Any drug resistance
Any H resistance 16 (15.2) 47 (48.0) 63
Any R resistance 4 (3.8) 19 (19.4) 23
Any E resistance 2 (1.9) 15 (15.3) 17
Any S resistance 26 (24.8) 50 (51.0) 76
Any Z resistance 0 9 (9.2) 9
(a) H, isoniazid; R, rifampin; E, ethambutol; S, streptomycin;
Z, pyrizinamide.
Table 4. Second-line drug resistance results (a)
New Retreatment
Total Resistant (%) Total Resistant (%)
Karakalpakstan
(Uzbekistan)
Prothionamide 106 7 (7) 107 11 (10)
Capreomycin 88 1 (1) 101 1 (1)
Ofloxacin 88 2 (2) 101 4 (4)
Dashoguz
(Turkmenistan)
Prothionamide 105 1 (1) 98 4 (4)
Capreomycin 89 0 93 0
Ofloxacin 89 0 93 0
MDR-TB (b)
Total Resistant (%)
Karakalpakstan
(Uzbekistan)
Prothionamide 57 9 (16)
Capreomycin 56 1 (2)
Ofloxacin 56 1 (2)
Dashoguz
(Turkmenistan)
Prothionamide 22 2 (9)
Capreomycin 21 0
Ofloxacin 21 0
(a) All strains were tested for prothionamide; a representative
subset of these were tested for both capreomycin and ofloxacin.
(b) MDR-TB, multidrug-resistant tuberculosis.
Table 5. Factors associated with MDR-TB in univariate and
multivariable logistic regression analysis (a)
Odds ratios (95% confidence limits)
Factor Univariate analysis Logistic regression
Previous TB treatment 4.5 (2.6 to 8.0) 5.1 (2.8 to 9.3)
Region (Karakalpakstan) 3.0 (1.8 to 5.1) 3.6 (2.0 to 6.4)
Female gender 1.3 (0.8 to 2.2) 2.0 (1.1 to 3.7)
Unemployment 2.3 (1.1 to 5.1) 2.1 (0.9 to 4.8)
Previous imprisonment 1.7 (0.9 to 3.0) 1.3 (0.6 to 2.8)
Alcohol use 0.9 (0.4 to 2.3) 0.7 (0.3 to 1.9)
(a) MDR-TB, multidrug-resistant tuberculosis.
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