Risk Factors and Patterns of Drug-Resistant Tuberculosis in Kaduna State, Nigeria: A Case–Control Study

• ¹, Air Force Institute of Technology, Kaduna,

Background: Drug-resistant tuberculosis (DR-TB) threatens global TB control. Nigeria bears a high burden of TB and resistance, yet local data to guide interventions remain limited. We aimed to determine patterns and predictors of DR-TB in Kaduna State, Nigeria.

Methods: We conducted a matched case–control study in TB treatment centers across Kaduna State from January to December 2022. Cases were patients with microbiologically confirmed DR-TB. Each case was matched to two drug-susceptible TB (DS-TB) controls. Data were extracted from medical records and supplemented by interviews where necessary. Multivariable logistic regression identified independent risk factors. Model performance was assessed by receiver operating characteristic (ROC) analysis.

Results: We included 399 participants, with 133 DR-TB cases and 266 DS-TB controls. Prior TB treatment was strongly associated with DR-TB (adjusted odds ratio [aOR] 3.70; 95% confidence interval [CI] 2.10 to 6.80). Smear-positive disease (aOR 4.85; 95% CI 2.81 to 8.36) and alcohol use (aOR 5.81; 95% CI 1.80 to 18.70) were independent risk factors. Higher socioeconomic status was protective (aOR 0.54; 95% CI 0.33 to 0.88). DR-TB was more likely to present as pulmonary disease. Rifampicin monoresistance was the most common resistance pattern, observed in 76.1% of DR-TB cases. The ROC curve showed excellent discrimination (area under the curve 0.90).

Conclusion: In Kaduna State, DR-TB is driven by prior treatment, alcohol use, and socioeconomic disadvantage. The predominance of rifampicin monoresistance highlights the limitations of current diagnostics. Expanded drug-susceptibility testing and socioeconomic interventions are crucial to curtail DR-TB and improve outcomes.