Retrospective Study of the Prevalence of Rifampicin Resistance Amongst Tuberculosis Patients in a Hospital in Kaduna

Abstract

Background: The prevalence of tuberculosis is second to COVID- 19 as the leading cause of death from a single infectious agent with mortality rates doubling that of HIV/AIDS. Drug resistant tuberculosis remains a public health crisis, a health security threat and a limiting factor to the WHO end TB strategy of 2030. Drug resistance TB results in treatment failure, increasing morbidity and mortality rates. Nigeria ranks 11^th among the 27 high multi- drug-resistant countries killing 268 people every day. Rifampicin is one of the first line antitubercular drugs used in combination with isoniazid (INH) for the treatment of tuberculosis. However, Rifampicin (RIF) resistance is a predictor of multidrug resistant tuberculosis (MDR-TB) because resistance to RIF, in most instances, co-exists with resistance to isoniazid (INH). With six years to the end of 2030 TB strategic plan as implemented by WHO, it is imperative to determine the current burden of rifampicin resistance amongst diagnosed TB patients within Kaduna state.

Aim: The aim of this study is to determine the prevalence of rifampicin resistance among tuberculosis patients in a hospital within Kaduna metropolis.

Study Design: Four years retrospective study

Study Area and Period of Study: The study was carried out in the Direct Observed Treatment (DOT) unit of a teaching hospital within Kaduna Metropolis. .

Methods: Tuberculosis record registers from January 2020 - October 2024 were used to identify all patients who were confirmed TB patients at the Hospital. Data on age, sex, year of treatment and drug susceptibility test (DST) results were collected. The data collected was subjected to statistical analysis using Microsoft Excel.

Results: A total of 1396 cases were reported within the period under review, and 3.3% (46) cases were rifampicin resistant. Demographic assessment showed that 65% (30) of patients that had rifampicin resistant TB cases in the hospital were male and 35% (16) were females. While 96.7% (1350) were susceptible to Rifampicin with 54% (729) being males and 46% (621) females. The prevalence rate of rifampicin resistance increased from 1.8% in 2020 to 5.39% in 2022. However, there was a decrease in the year 2023 and 2024 with prevalence rates of 4.18% and 2 .99% respectively. The pooled prevalence rate over the five-year period was 3.29%.

Conclusions: This study observed an increased prevalence of rifampicin resistance from 1.8% in 2020 to 5.39% in 2022 with a decrease to 4.18% in 2023 and 2.99% in 2024 respectively. The number of cases of tuberculosis and rifampicin resistant tuberculosis was more in males (65%) than females (35%).  The highest number of recorded cases of TB fell within the age groups of 21-30 while the least number of cases was found within the age groups of > 60. With six years to the WHO end TB strategy of 2030, further studies are needed to determine the national burden of drug resistance tuberculosis within Nigeria so as to meet the targets set by the WHO end TV strategy of 2030.