Sah Shiv Kumar, Pyakurel Chetan Karki, Kathariya Arun, Shrestha Anil, Subedi Nirmal Kumar, Byanjankar Niru, Basnet Rojina
Department of Pharmacy, Institute of Medicine (IOM), Maharajgunj Medical Campus (MMC), Tribhuvan University, Kathmandu, Nepal.
Department of Pharmacy, Little Buddha College of Health Science, Purbanchal University, Kathmandu, Nepal.
Interdiscip Perspect Infect Dis. 2025 Jul 7;2025:3730719. doi: 10.1155/ipid/3730719. eCollection 2025.
Drug-resistant tuberculosis (DR-TB) remains a significant global public health challenge, particularly in regions with a high burden of TB. Nepal, one such country, has been witnessing a rise in DR-TB cases, posing serious challenges to TB control efforts. Despite this growing concern, there is a lack of localized data on the risk factors contributing to DR-TB, especially in urban areas like Pokhara. This study aims to fill that gap by assessing the prevalence of DR-TB and identifying associated demographic, behavioral, and clinical factors among TB patients in Pokhara Metropolitan City, Gandaki Province, Nepal. A retrospective cross-sectional analysis was conducted using 617 TB patient records from the Pokhara Metropolitan Health Office for the fiscal year 2078/79 (July 2021 to July 2022). Data on demographic characteristics, clinical history, treatment regimens, and behavioral factors such as smoking and alcohol consumption were extracted. Descriptive statistics were used to determine the prevalence of DR-TB, and bivariate logistic regression was applied to identify statistically significant risk factors associated with DR-TB. Among the 617 TB patients, the prevalence of DR-TB was 2.6%. Most patients were male (57.4%) and within the 21-30 age group (26.9%). Pulmonary bacteriologically confirmed TB was the most common type (53.6%), predominantly affecting adults (98.1%). The primary treatment regimen administered was 2HRZE + 4HR (78.8%). TB-HIV co-infection was found in 1.9% of cases, with all co-infected patients receiving antiretroviral therapy. In a bivariate analysis, individuals with current smoking status (UOR: 9.384; CI: 3.342-26.351), exposure to smoking (UOR: 8.550: CI: 2.916-25.064), and current alcohol consumption (UOR: 4.553, CI: 1.406-14.745) had a higher likelihood of DR-TB. In a multivariate analysis, exposure to smoking (AOR: 5.317; CI: 1.394-20.274) and current alcohol consumption (AOR: 6.84; CI: 2.071-22.58) emerged as independent predictors associated with an increased risk of DR-TB. The study revealed a relatively low prevalence of DR-TB among TB patients in Pokhara, with strong associations between DR-TB and lifestyle factors such as smoking and alcohol use. These findings underscore the need for targeted public health interventions addressing behavioral risk factors to reduce DR-TB incidence. Enhanced surveillance, public awareness, and preventive strategies should be integrated into TB control programs to mitigate the spread of DR-TB in this region. Moreover, targeted behavioral interventions may be crucial in curbing the emergence of DR-TB, particularly in high-burden urban centers.
耐多药结核病（DR-TB）仍然是一项重大的全球公共卫生挑战，尤其是在结核病负担较重的地区。尼泊尔就是这样一个国家，该国的耐多药结核病病例一直在增加，给结核病防控工作带来了严峻挑战。尽管人们对此日益关注，但关于导致耐多药结核病的风险因素，尤其是像博卡拉这样的城市地区，缺乏本地化数据。本研究旨在通过评估尼泊尔甘达基省博卡拉市耐多药结核病的患病率，并确定结核病患者中相关的人口统计学、行为和临床因素，来填补这一空白。使用博卡拉市卫生局2078/79财年（2021年7月至2叭2年7月）的617份结核病患者记录进行了回顾性横断面分析。提取了有关人口统计学特征、临床病史、治疗方案以及吸烟和饮酒等行为因素的数据。使用描述性统计来确定耐多药结核病的患病率，并应用二元逻辑回归来识别与耐多药结核病相关的具有统计学意义的风险因素。在617例结核病患者中，耐多药结核病的患病率为2.6%。大多数患者为男性（57.4%），年龄在21-30岁之间（26.9%）。肺部细菌学确诊的结核病是最常见的类型（53.6%），主要影响成年人（98.1%）。主要的治疗方案是2HRZE + 4HR（78.8%）。1.9%的病例中发现了结核病与艾滋病病毒合并感染，所有合并感染患者均接受了抗逆转录病毒治疗。在二元分析中，当前吸烟的个体（单因素比值比：9.384；置信区间：3.342-26.351）、接触吸烟（单因素比值比：8.550：置信区间：2.916-25.064）和当前饮酒（单因素比值比：4.553，置信区间：1.406-14.745）患耐多药结核病的可能性更高。在多因素分析中，接触吸烟（调整后比值比：5.317；置信区间：1.394-20.274）和当前饮酒（调整后比值比：6.84；置信区间：2.071-22.58）成为与耐多药结核病风险增加相关的独立预测因素。该研究显示，博卡拉结核病患者中耐多药结核病的患病率相对较低，耐多药结核病与吸烟和饮酒等生活方式因素之间存在密切关联。这些发现强调了针对行为风险因素进行有针对性的公共卫生干预以降低耐多药结核病发病率的必要性。应将加强监测、提高公众意识和预防策略纳入结核病防控计划，以减轻该地区耐多药结核病的传播。此外，有针对性的行为干预对于遏制耐多药结核病的出现可能至关重要，尤其是在高负担的城市中心。
