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Anti-tuberculosis drug resistance in Madagascar in 1994-1995
S Chanteau1, V Rasolofo, H Ramarokoto
1Institut Pasteur de Madagascar, Antananarivo, Madagascar. chanteau@pasteur.pasteur.mg
Setting:
A new tuberculosis control programme has been implemented in Madagascar since 1991. A survey on Mycobacterium tuberculosis resistance to the major drugs was conducted between August 1994 and December 1995.
Objective:
To determine primary and acquired resistance in pulmonary tuberculosis patients in four main cities.
Design:
Were included 401 randomly sampled new smear positive patients (36.2% of declared new patients) and 137 recurrent cases (72.9% of declared cases) from 8 centres. Drug susceptibility testing was performed on Löwenstein Jensen medium according to the proportion method.
Results:
The male to female ratio was 1.35:1 in new patients (age range 11-74 years) and 1.98:1 in recurrent patients (age range 16-76 years). The primary resistance rate to any drug was 20% (95% Confidence Interval [CI] 16-23) and the acquired resistance rate 40% (95% CI 32-48, P < 2.10(-7). Primary resistance to one drug was 18% (95% CI 15-22), mainly attributable to streptomycin resistance (14.5%). Multidrug resistance (MDR) to isoniazid and rifampicin was 0.25% (95% CI 0-0.7) for primary resistance and 5% (95% CI 2.6-10.6) for secondary resistance. No difference was observed between sexes or ages.
Conclusion:
This survey conducted in big cities gives a very negative picture of resistance in Madagascar.