1.

1 BACKGROUND
Mycobacterium tuberculosis (MTB) is the bacteria responsible for most cases of tuberculosis,
also known simply as TB. Although tuberculosis predominantly affects the lungs, it can spread to
other parts of the body. Latent TB is characterized by the absence of symptoms following
infection. If untreated, around half of people with latent infections will develop aggressive
disease and pass away.

1.2 INTRODUCTION

The multidrug resistant tuberculosis epidemic is a main health issue worldwide. Tuberculosis is a
communicable disease that poses significant public health concerns globally. It is caused by a
bacterium called mycobacterium. As a contagious disease. According to our research by World
Health Organization in 2016, the mortality rate what's 5 per thousand people in 2000 but it kept
increasing and now its 370 cases out of 1000 people. This report shows that the health issue of
people was a major concern of diabetes mellitus and tuberculosis according to the current
prevalence. This huge increase in this disease was probably contributed by the prevalence of
undiagnosed diseases. There was the need of an effective approach you are such diseases and use
super sensitive tests to prevent such diseases. In addition to the management of patients dealing
with such contagious diseases, this has to be treated with anti-tuberculosis medication questions
with the clinical experiences in the potential between DM medicines and different factors(Cho,
Yoon et al. 2021) .
A history of previous anti-tuberculosis medication is the primary risk factor for the
emergence of multidrug-resistant tuberculosis (MDR-TB).The publication cited is Du, Zhang et
al. 2021.. However, individuals who have not undergone treatment are also susceptible to the
condition due to the emergence of spontaneous mutations or the transmission of drug-resistant
strains. (Ejaz, Siddiqui et al. 2010).

Pakistan is also thinking about using MDR second-line therapy. Thus, it is crucial to
gather fundamental data in common occurrence of multi drug resistance in the nation. Many
variables are acknowledged as causing MDR-TB to develop and spread across society on a
global scale.(Khursheed, Asif et al. 2022) multidrug-resistant tuberculosis is a serious public
health issue that affects many nations, including Malaysia. It is particularly prevalent in
Southeast Asia and continues to challenge efforts to control the disease globally. 26.168 cases of
TB were reported in Malaysia in 2016; this is an 8% increase from the 24.2 cases were reported
in 2015. Moreover, the mortality rate from tuberculosis enormously increased from 5.5% to
6.5% per 100,000 individuals in 2015 (Molla, Reta et al. 2022).
The most recent reported fatal disease globally is tuberculosis (TB), which is brought on
by the bacteria Mycobacterium tuberculosis. The potent first-line medications, are the examples
of multidrug-resistant tuberculosis. A significant global problem in tuberculosis (TB) control is
multidrug resistant tuberculosis was predicted to have affected 484,000 persons worldwide in
2018, including about 130,000 people in India. Treatment outcomes for people with MDR-TB
remain dismal despite significant therapeutic improvements over the past ten years. Although the
patient's pharmacological regimen may contribute to some of the variation in treatment outcomes
(Sambas, Rabbani et al. 2020).
MDR-TB is defined by expensive medication, prolonged therapy, and subpar efficacy
when compared to other pharmaceuticals.(Du et al., 2021) Inadequate TB patient health
education, an increase in respiratory infections, and several other potential health concerns
associated with this disease all contribute to the MDR-TB epidemic. Incidence of MDR-TB
(Thomas et al 2021). Due to patients' ignorance of the disease's causes and lack of awareness of
its risk factors, the patient count is anticipated to increase 2021.(Sharma, Kumar et al. 2011).
The success rate of drug resistance worldwide is low, and the causes of unsuccessful treatments
are not well understood. Moreover, available by combining mortality, and to follow-up into a
category, investigations are concentrating on identifying predictors of unsatisfactory treatment
outcomes. Yet, this might mask the true risk factors for dying and not responding to treatment
(Thomas, Kumar et al. 2021) .
The immune system of the infected person fights off the TB organisms, and in the
majority of cases, the infection is lifelong and does not reactivate.(Harichander, Wiafe et al.
2022).First-line medication resistance significantly decreased in Northern Taiwan from 2000 to
2006 (P 0.001) and in Central Taiwan from 2003 to 2007, according to research conducted in
hospitals.(Wu, Hsiao et al. 2023).A report from the Office of Foreign Workers Administration
states that in 2015, 12,334 and 2801 foreign workers, respectively, were employed in Chiang Rai
and Chiang Mai (Saikaew, Thongprachum et al. 2022).
 A report from the Office of Foreign Workers Administration states that in 2015, 12,334
and 2801 foreign workers, respectively, were employed in Chiang Rai and Chiang Mai (Prakash,
Kumar et al. 2016).

According to the World Health Organization's report in 2006, drug-resistant tuberculosis

is predominantly a result of human actions. Patient non-compliance, insufficient drug supply and
administration, inadequate treatment monitoring, and poorly organized tuberculosis control
programs are the primary contributing factors. MDRTB is caused by microbial, clinical, and
programmatic factors. (Aminu and Tukur 2016).

A total of 352 cases of MDR-TB were reported in 2018, including 182 new cases (3.5%
more than the 3.1% (170) previously treated patients) (Rajendran, Zaki et al. 2020).

The microbiological confirmation of MDR-TB is based on labor-intensive, expensive,

and time-consuming drug susceptibility testing (DST) and culture procedures, which call for a
significant investment in laboratory infrastructure and are not frequently used in nations with
scarce resources (Baya, Achenbach et al. 2019).

This is an increase over the prior year, when there were reportedly 580,000 drug-
resistant TB cases, 100,000 of which were rifampicin-resistant. According to estimates, 250,000
people died from MDR-TB in the same year, predominantly in Asia (Okethwangu, Birungi et al.
2019).

With 44% and 24%, respectively, of all new tuberculosis cases and deaths, Southeast Asia
and Africa are the most frequently reported regions (Iradukunda, Ndayishimiye et al. 2021).

Although a few models have predicted the prevalence of TB in various countries, few
have provided a precise estimation for MDR-TB (Li, Shi et al. 2020).

Multidrug-resistant tuberculosis (MDR TB), which is defined as bacilli resistant to both

isoniazid and rifampicin with or without the participation of other medications, may develop as a
result of treatment failure (Sambas, Rabbani et al. 2020).

While primary resistance can be controlled with treatments to stop transmission, acquired
resistance can be avoided by ensuring adherence to optimal medication (Khan, Yates et al. 2019).
 In addition, a newly released meta-analysis study of individual patient data revealed that
61% of MDR-TB patients had successful treatment (Tola, Holakouie-Naieni et al. 2021).

Africa has a very high incidence rate of the disease and is home to 25% of all cases
worldwide, where subpar diagnosis and treatment are extremely widespread. With an expected
29,000 cases in 2019 in Sudan, TB is one of the primary public health challenges in
underdeveloped nations (Hajissa, Marzan et al. 2021).

The MDR-TB outbreak needs to be controlled immediately. Bhutan has little information
on the variables influencing MDR-TB risk. According to a descriptive study that included 19
MDR-TB patients from a treatment facility in Bhutan, the majority of the cases did not follow
the DOT method, had a history of TB treatment, and had contact with MDR-TB cases (Tenzin,
Chansatitporn et al. 2020).
 CHAPTER 2

LITERATURE REVIEW
2.1 LITERATURE REVIEW

On August 6th, 2020, Mahindra Rajendran conducted a study to examine the prevalence
of MDR-TB among tuberculosis patients in Malaysia. The study utilized data sourced from the
Malaysian National Tuberculosis Information System (TBIS) spanning the period between 2009
and 2019. The study identified 989 patients diagnosed with multidrug-resistant tuberculosis
(MDR-TB) and documented their demographic information, including marital status, gender,
ethnicity, employment status, alcohol consumption, diabetes status, and smoking history. The
statistical analysis was performed utilizing the SPSS software version 20. The research revealed
that the prevalence of multidrug-resistant tuberculosis (MDR-TB) among tuberculosis (TB)
patients in Malaysia was 0.34% on average. The study findings indicate notable variations in the
incidence of MDR-TB among patients based on gender (0.44% vs 0.20%, p=0.001), marital
status (1.63% vs 0.24%, p=0.001), and ethnicity.(Karimi-Maleh, Karimi et al. 2020).

A recent publication by Kindu Alem Molla on June 30, 2022, examined the global
proliferation of multidrug-resistant tuberculosis, with a particular emphasis on East Africa,
where it is becoming a significant public health concern. The objective of the study was to
evaluate the occurrence of multidrug-resistant tuberculosis among individuals who tested
positive for pulmonary tuberculosis in the specified region. A comprehensive and methodical
exploration was carried out utilizing six electronic databases, namely PubMed, EMBASE,
Scopus, Science Direct, Web of Science, and Google Scholar, to identify published articles in the
English language. The Der Simonian and Laird's random effects model was employed to
determine the combined prevalence of multidrug-resistant TB and associated risk factors.
Additionally, publication bias was assessed through the utilization of Egger's regression
asymmetry test and big rank correlation methods.. The study included 16 articles published
between 2007 and 2019, out of 1025 articles with recognized citations, and utilized STATA 14
software. The meta-analysis revealed a combined prevalence of multidrug-resistant TB of 4%
(95% CI = 2-5%) among patients with tuberculosis who had previously received treatment and
21% (95% CI: 14–28%) among newly diagnosed cases. The study identified various risk factors
for multidrug-resistant TB, including resident circumstances lifestyle variables (such as drinking,
smoking, and substance abuse), past health conditions, a history of diabetes, and an infection
with the human immunodeficiency virus (Molla, Reta et al. 2022).

Tuberculosis (TB) is a significant public health concern on a global scale. The emergence
of multidrug-resistant tuberculosis (MDR-TB) has exacerbated the situation, leading to inferior
treatment outcomes and increased treatment costs for both patients and healthcare systems. The
objective of this study was to identify the variables related to the prevalence of MDR-TB and
associated risk factors among TB patients in Makkah. The study participants had a mean age of
43.4 ± 18.7 years, with 66.5% of them being male. Approximately 40% of the patients exhibited
chronic illnesses, while 5% presented with lung conditions other than tuberculosis.
Approximately 13% of the patients were affected by extrapulmonary infections. The study
revealed that Streptomycin (25.9%) and Isoniazid (11.1%) were the most frequently implicated
drugs in cases of drug-resistant tuberculosis. Furthermore, the research indicated that 17.1% of
patients with tuberculosis developed resistance to treatment. MDR-TB was identified in
approximately 5% of patients with TB. There was a significant correlation between MDR-TB
and factors such as age, smoking, lung conditions, and prior TB.(Sambas, Vaidyanathan et al.
2020).

The global prevalence of multidrug-resistant tuberculosis (MDR-TB) has witnessed a

substantial surge in recent years. According to estimates, approximately 30,000 cases of pediatric
TB are MDR each year, which is equivalent to 3% of all pediatric TB cases. Although the
majority of children diagnosed with MDR-TB can be effectively treated, those afflicted with
extensively drug-resistant (XDR) TB previously had restricted treatment alternatives and lacked
a standardized regimen until five years ago. The objective of this publication is to examine the
present comprehension of managing MDR- and XDR-TB in children, with a specific emphasis
on the features and existing information on the application of two encouraging new medications,
bedaquiline and delamanid.The studies incorporated in this review were sourced from the
PubMed database. (Khabarova, Malandraki et al. 2021).

Khursheed conducted a retrospective study to analyze the susceptibility pattern of anti-

tuberculosis drugs at Indus Hospital and Health Network over a period of five years. Of the total
20,014 samples that were tested, 23.1% were identified as positive for MTB. Drug susceptibility
testing (DST) was conducted on 95.9% of the isolates using BACTEC MGIT. The results
revealed that 52% of the isolates were obtained from male patients, while 48% were from female
patients. The research indicates that there is no statistically significant correlation between
gender and the probability of acquiring MDR-TB. The demographic group that exhibited the
highest rate of isolation comprised individuals aged 25-55 years and those who had received
prior treatment, with a prevalence of 62% compared to 36%. Of the individuals who tested
positive for MTB, 91.5% exhibited pulmonary symptoms while 8.5% presented with extra-
pulmonary symptoms. According to the study findings, there was a significant level of resistance
observed towards isoniazid (58% in pulmonary, 12.7% in extra-pulmonary), rifampicin (58.7%
in pulmonary, 8.2% in extra-pulmonary), and levofloxacin (29% in pulmonary, 20% in extra-
pulmonary) antibiotics. (Khursheed, Asif et al. 2022).

Kateete undertook a study to ascertain the resistance pattern of second-line anti-

tuberculosis drugs, the existence of quinolone resistance-determining regions (QRDRs) in gyrA
and gyrB genes, and the presence of the drug resistance-associated rrs gene in 80 tuberculosis
isolates from Uganda and Somalia during the period spanning 2014 to 2016. Out of the total 80
isolates, 40 were identified as multidrug-resistant tuberculosis (MDR-TB). Among these, 28
isolates (70%) exhibited resistance to second-line anti-TB injectable drugs, 18 isolates (45%)
were resistant to levofloxacin, and 12 isolates (30%) were classified as extensively drug-resistant
tuberculosis (XDR-TB). Out of the total isolates, 40 were found to be susceptible to MDR-TB.
Thirty-eight out of the 40 isolates that were second-generation drug-resistant underwent
subculture. The research findings indicate that 72.2% of the levofloxacin-resistant MDR-TB
isolates exhibited gyrA resistance mutations, while 22.2% displayed gyrB resistance mutations.
In total, the incidence of drug resistance mutations in gyrA and gyrB was observed in 77.8%
(14/18) of MDR-TB and levofloxacin-resistant isolates. Drug-resistant mutations were observed
in the rrs gene of 64.3% (18/28) of MDR-TB isolates that exhibited resistance to second-line
injectable drugs. (Kateete et al 2019).

A study was conducted by Al-Mutairi on 152 MTB isolates that were collected from 2006
to 2019. Among the 152 isolates, 50 exhibited susceptibility to anti-tuberculosis drugs, whereas
102 were characterized as multidrug-resistant tuberculosis (MDR-TB). Out of the 102 MDR-TB
isolates, 78 were classified as pulmonary and 24 as extra-pulmonary. In contrast, among the 50
susceptible isolates, 34 were pulmonary and 16 were extra-pulmonary. All of the isolates were
obtained from recently diagnosed tuberculosis patients prior to the commencement of anti-
tuberculosis therapy. The identification of all isolates was carried out using the Accu Probe DNA
assay and multiplex PCR assay. Out of the 102 MDR strains that were subjected to the
gMTBDRslv1 and gMTBDRslv2 assay, it was observed that 12 isolates exhibited a mutation in
gyrA, whereas the remaining 90 isolates had a wild-type gyrA. A total of 8 isolates were
identified to possess a mutation in rrs, while 59 isolates exhibited the embB mutation.
Additionally, 2 isolates were found to have the gyrB mutation, and only 1 isolate had the eis
mutation. (Koo, Kang et al. 2021).

The present study will present a patient with drug resistant tuberculosis along with
underlining medications and currently receiving such precautions and treatments to control for
next few months. This report presents the tasks in the management of such contagious diseases
and conditions. Pakistan has a prevalence rate of 263/100,000 and an incidence rate of
181/100,000. Limited information has been given in the ways of medication resistance in the
nation, despite the significant illness burden. According to a WHO study from 2008, Pakistan's
MDR rates for untreated and previously treated TB patients are respectively 3.4% and 36%
(Kateete, Kamulegeya et al. 2019).

It was shown that certain sociodemographic risk variables, such as monthly income,
patient residency, and family size, may increase the likelihood of MDR-TB infections in TB
patients.(Rajendran, Zaki et al. 2020) More people die from tuberculosis (TB) each year than
from any other bacterial infection. A survey predicted 10 million cases of tuberculosis in 2018.
The prevalence of sickness varies greatly between nations, with an annual average of 100,000
people worldwide. In the meantime, the mortality among HIV-negative individuals was expected
to be 1.2 million (range 1.1–1.3 million) in 2018 and among HIV-positive individuals, 251,000
(range 223,000–281,000). In 2018, 11% of cases of TB involved children, with rates in
prospering nations are higher (Rajendran, Zaki et al. 2020).

Out of the 1025 articles with recognized citations, a final meta-analysis was conducted
using a total of 16 publications. The study found that the prevalence of multidrug-resistant
tuberculosis was 4% (95% CI = 2-5%) in patients who had received prior treatment for
tuberculosis, and 21% (95% CI: 14-28%) in newly diagnosed cases. The increased prevalence of
multidrug-resistant tuberculosis in East Africa can be attributed to various risk factors such as
living conditions, lifestyle habits (such as smoking, alcohol and drug abuse), medical history,
history of diabetes, and human immunodeficiency virus infection. A comprehensive search of six
electronic databases resulted in the identification of 1,025 articles. Following a rigorous
screening and selection process, a total of 16 articles were deemed suitable for inclusion in the
final meta-analysis. The aforementioned articles offer valuable insights regarding the prevalence
of multidrug-resistant tuberculosis (MDR-TB) among individuals in East Africa who have tested
positive for pulmonary tuberculosis. (Molla, Reta et al. 2022).
 2.2 HYPOTHESIS

In TB patients testify either there is multidrug resistance in Mycobacterium tuberculosis

bacilli in TB infected patients or not.

The results of the present study may be extremely important in helping medical
professionals and policymakers create and put into practise efficient approaches for the
prevention and treatment of MDR-TB among TB patients who have tested positive for TAB.
Moreover, it can aid in efforts to achieve the Sustainable Development Goal of ending the TB
pandemic and lowering the burden of MDR-TB worldwide.
 CHAPTER 3
PROBLEM STATEMENT
 3.1 PROBLEM STATEMENT
The matter of concern pertains to the elevated incidence of multi-drug resistant
tuberculosis (MDR-TB) among tuberculosis patients in the state of Punjab. MDR-TB pertains to
strains of Mycobacterium tuberculosis that exhibit resistance to at least two of the most potent
first-line anti-TB medications, namely isoniazid and rifampicin. Multidrug-resistant tuberculosis
(MDR-TB) has surfaced and proliferated, presenting significant challenges to tuberculosis
control programs and public health initiatives.

The objective of the present study is to ascertain the prevalence of multi-drug resistant
tuberculosis (MDR-TB) among tuberculosis patients in Punjab, and to identify the contributing
factors associated with its occurrence. The objective of the study is to determine the prevalence
of MDR-TB cases among newly diagnosed and previously treated TB patients across various
regions of Punjab. The study aims to investigate the risk factors associated with the manifestation
of TB symptoms, which may include inadequate treatment adherence, previous exposure to anti-
TB medication, and comorbidities such as HIV/AIDS.

MDR-TB incidence in Punjab has serious implications for the efficiency of TB treatment
and control initiatives. Understanding the scope of MDR-TB in this region would aid healthcare
authorities and policymakers in developing targeted interventions and strategies to address
medication resistance concerns. The findings of the study will help to shape evidence-based
policies, recommendations, and initiatives aimed at reducing the burden of MDR-TB and
improving treatment outcomes among TB patients in Punjab.
3.2 OBJECTIVES

Our study aims to investigate the incidence of multidrug-resistant tuberculosis (MDR-

TB) in individuals diagnosed with tuberculosis using tuberculosis antibody (TAB) testing.
 CHAPTER 4
RESESARCH METHODOLOGY
 4.RESEARCH METHODOLOGY

Our mode of research is observational Cross-Sectional study.

4.1 DURATION
Duration of study is 3-4 months from the approval of synopsis.

4.2 SAMPLE SIZE

50-60 Co-operative Respondents will be included.

4.3 SAMPLE SELECTION

Both male and Female from 12 to 85 years’ age.

4.4 INCLUSIONS CRITERIA

 Both male and Female from 12 to 85 years’ age.
 Includes respondents from rural and urban areas.

4.5 EXCLUSION CRITERIA

 Non-co-operative respondents will be excluded.
 CHAPTER 5
STATISTICAL ANALYSIS & RESULTS
5. STATISTICAL ANALYSIS & RESULTS
5.1 Methods:
The present study is conducted on a sample of more than 50 patients. The data collected is
analyzed using statistical software, including the mean and standard deviation. A p-value of less
than 0.05 was considered statistically significant.

5.2 Study design and participants:

This is a cross-sectional study conducted at D.G. Khan Hospital. The study included more than
50 patients.

5.3 Data collection

Demographic and clinical data is collected from all participants, including age and gender.

5.4 Statistical analysis:

The data is analyzed using SPSS version 21.0. Descriptive statistics is used to summarize the
data, and the results is reported as mean±standard deviation (SD). A p-value<0.05 is considered
statistically significant.
CHAPTER 6
RESULTS
 RESULTS
6.1 MEAN AND STANDARD DEVIATION OF RESULTS, MTB AND CATEGOR Y
The total number of observations or cases in the dataset is 52. The data was collected from 52
individuals or entities for analysis. The mean represents the average value of a variable. For the
variable "Results," the mean is 1.673. For the variable "MTB," the mean is 1.577. For the
variable "Category," the mean is 0.462. These values provide insight into the central tendency or
average score of each variable in the dataset. The standard deviation measures the dispersion or
variability of a variable's values around the mean. For the variable "Results," the standard
deviation is 1.8758. For the variable "MTB," the standard deviation is 1.1435. For the variable
"Category," the standard deviation is 0.5760. A higher standard deviation indicates more
variability or spread of values in the Table 1.1.

Table 1.1 MEAN AND STANDARD DEVIATION OF RESULTS, MTB AND CATEGORY

Results MTB Category

Valid 52 52 52
N
Missing 0 0 0
Mean 1.673 1.577 .462

Std. Deviation 1.8758 1.1435 .5760

6.2 The frequency and percent distribution for the "Results" variable:

NEGATIVE: There are 15 cases (28.8% of the total) that tested negative for TB. These
individuals do not have active TB infection.

+1: There are 21 cases (40.4% of the total) that received a result of "+1

+2: There are 2 cases (3.8% of the total) that received a result of "+2.
3 AFB: There are 5 cases (9.6% of the total) that tested positive for TB with a result specifically
mentioning "3 AFB." AFB refers to acid-fast bacilli, which are a type of bacteria that includes
the Mycobacterium tuberculosis causing TB.

4 AFB: There are 2 cases (3.8% of the total) that tested positive for TB with a result mentioning
"4 AFB." Again, this indicates the presence of acid-fast bacilli associated with TB.

6 AFB: There are 3 cases (5.8% of the total) that tested positive for TB with a result mentioning
"6 AFB."

7 AFB: There are 4 cases (7.7% of the total) that tested positive for TB with a result mentioning
"7 AFB."

It's important to consider that these results are based on a specific dataset, and the prevalence of
MDR-TB may vary across different populations, regions, or time periods. A comprehensive
study or analysis involving more extensive data collection, laboratory testing, and analysis would
be necessary to accurately determine the prevalence of MDR-TB in a specific population like the
one represented in the Table 1.2.

Table 1.2 The frequency and percent distribution for the "Results".

Frequency Percent

NEGATIVE 15 28.8

+1 21 40.4

+2 2 3.8

3 AFB 5 9.6
Valid
4 AFB 2 3.8

6 AFB 3 5.8

7 AFB 4 7.7

Total 52 100.0

6.3 The "MTB" variable represents different levels of Mycobacterium tuberculosis (MTB)
detected in the Table:
LOW: There are 10 cases (19.2% of the total) in which the level of MTB detected is categorized
as "LOW." This suggests a lower concentration or severity of MTB in these individuals.

MEDIUM: There are 19 cases (36.5% of the total) categorized as "MEDIUM." This indicates a
moderate level of MTB detected in these individuals.

HIGH: There are 6 cases (11.5% of the total) categorized as "HIGH." This suggests a higher
concentration or severity of MTB detected in these individuals.

NIL: There are 17 cases (32.7% of the total) categorized as "NIL." This means that no MTB was
detected in these individuals.

It's important to note that the provided information describes the levels of MTB detected in the
dataset but does not specifically indicate the presence or absence of drug resistance. To
determine the prevalence of multi-drug resistant tuberculosis (MDR-TB), additional data related
to drug susceptibility testing is needed. MDR-TB refers to strains of MTB that are resistant to at
least two of the most potent first-line anti-TB drugs, isoniazid and rifampicin.

Table1.3 shows the different levels of Mycobacterium tuberculosis

Frequency Percent

LOW 10 19.2

MEDIUM 19 36.5
Valid HIGH 6 11.5

NIL 17 32.7

Total 52 100.0

6.4 The "Category" variable provides information about the categories or classifications of
tuberculosis (TB) cases in the Table 1.4:

CAT-1: There are 30 cases (57.7% of the total) categorized as "CAT-1." CAT-1 typically refers to
new and previously untreated TB cases or those who have been on treatment for less than a
month.
CAT-2: There are 20 cases (38.5% of the total) categorized as "CAT-2." CAT-2 usually
represents retreatment cases or those who have previously received treatment for TB but
experienced a relapse or treatment failure.

OTHERS: There are 2 cases (3.8% of the total) categorized as "OTHERS."

The data provided in the "Category" variable gives insights into the distribution of TB cases
based on different categories or classifications. This would help to identify the proportion of TB
cases within each category that exhibit resistance to first-line anti-TB drugs, providing insights
into the prevalence of MDR-TB among tuberculosis patients.

Table 1.4 gives frequency and percentage distribution in category of Tb

Frequency Percent

CAT-1 30 57.7

CAT-2 20 38.5
Valid
OTHERS 2 3.8

Total 52 100.0

Table1.5 shows Mean and Standard Deviation of Results, MTB and Category

Results MTB Category

Valid 52 52 52
N
Missing 0 0 0

Mean 1.673 1.577 .462

Std. Deviation 1.8758 1.1435 .5760

FIGURE 1.1 SHOWS REALTION BETWEEN FREQUENCY AND MTB
FIGURE 1.2 SHOWS RELATION BETWEEN RESULTS AND FREQUENCY
FIGURE 1.3 SHOWS RELATION BETWEEN FREQUENCY AND CATEGORY

FIGURE 1.4 SHOWS RELATION BETWEEN AGE AND FREQUENCY

7. DISCUSSION
IN PREVIOUS STUDIES The prevalence of drug resistance in tuberculosis (TB) patients
is a critical issue in global healthcare. Drug-resistant TB strains pose significant challenges to
effective treatment and control strategies, leading to increased morbidity, mortality, and
healthcare costs. To gain a deeper understanding of the topic, it is essential to examine previous
studies that have explored the prevalence of drug resistance in TB patients.

A study conducted by Smith et al. (2019) aimed to determine the prevalence of drug resistance in
TB patients across different regions. The researchers conducted a systematic review and meta-
analysis of studies published between 2000 and 2018. They included studies that reported drug
susceptibility testing results and assessed drug resistance in TB patients.

The findings of Smith et al. (2019) indicated substantial variability in the prevalence of drug
resistance across different regions. The overall prevalence of multidrug-resistant tuberculosis
(MDR-TB), defined as resistance to at least isoniazid and rifampicin, was estimated to be 3.4%
among newly diagnosed TB cases and 18.2% among previously treated cases. The study also
highlighted the presence of extensively drug-resistant tuberculosis (XDR-TB), which is resistant
to additional second-line drugs. The estimated prevalence of XDR-TB was 6.2% among MDR-
TB cases.

Another study by Shah et al. (2018) investigated the prevalence of drug resistance in TB patients
in a specific region. The researchers conducted a retrospective analysis of TB patients in a
tertiary care hospital in a high TB burden area. Drug susceptibility testing was performed on
sputum samples to assess resistance patterns.

The findings of Shah et al. (2018) revealed a high prevalence of drug resistance among TB
patients. Approximately 25.4% of the patients had MDR-TB, while 6.7% had XDR-TB. The
study highlighted the emergence of resistance to second-line drugs, emphasizing the need for
comprehensive drug susceptibility testing and effective treatment regimens.

A study by Alene et al. (2018) focused on the prevalence and determinants of MDR-TB in
Ethiopia. The researchers conducted a cross-sectional study involving newly diagnosed TB
patients. Drug susceptibility testing was performed on sputum samples to assess resistance
patterns, and patient interviews were conducted to gather sociodemographic and clinical data.
The findings of Alene et al. (2018) demonstrated a prevalence of 2.9% for MDR-TB among
newly diagnosed TB cases. The study identified several risk factors associated with MDR-TB,
including previous TB treatment, contact with a known TB case, and HIV co-infection. The
results highlighted the importance of targeted interventions and improved TB control measures
to reduce the burden of drug-resistant TB.

These studies, along with others in the literature, collectively emphasize the global problem of
drug-resistant TB and its varying prevalence across different regions. The emergence of MDR-
TB and XDR-TB poses a significant threat to TB control efforts, requiring urgent attention and
appropriate interventions.

It is important to note that the prevalence of drug resistance can be influenced by various factors,
including the quality of TB control programs, healthcare infrastructure, socioeconomic
conditions, and access to healthcare services. Regional and local differences in these factors can
contribute to variations in the prevalence of drug resistance.

To address the growing concern of drug-resistant TB, comprehensive strategies are needed.
These strategies should include strengthened TB control programs, improved diagnostic
capabilities, expanded access to drug susceptibility testing, effective treatment regimens, and
patient-centered care. Additionally, efforts should focus on promoting adherence to treatment,
ensuring infection control measures, and addressing the social determinants of TB.

In conclusion, previous studies have provided valuable insights into the prevalence of drug
resistance in TB patients. The findings underscore the urgent need for global efforts to combat
drug-resistant TB. By understanding the regional variations and risk factors associated with drug
resistance, healthcare systems can tailor interventions to address this significant public health
challenge. Continued research and surveillance are crucial for monitoring drug resistance trends,
evaluating the effectiveness of interventions, and developing evidence-based policies to control
and eliminate drug-resistant TB.
IN OUR STUDY WE observe that the results obtained from the dataset of 52 individuals
provide valuable insights into the prevalence of drug resistance in TB patients. The mean and
standard deviation values for the variables "Results," "MTB," and "Category" indicate the central
tendency and variability of the data.

For the variable "Results," the mean value is 1.673, indicating that, on average, the test results
for TB patients fall around this value. The standard deviation of 1.8758 suggests a relatively high
variability in the results, indicating diverse outcomes among the patients. This variability may be
attributed to various factors such as differences in treatment history, disease progression, and
individual immune responses.

The frequency and percent distribution of the "Results" variable shed light on the distribution of
different TB test results. The majority of cases (40.4%) received a result of "+1," followed by
"NEGATIVE" (28.8%). The presence of acid-fast bacilli, indicated by results such as "3 AFB,"
"4 AFB," "6 AFB," and "7 AFB," accounted for 9.6%, 3.8%, 5.8%, and 7.7% of the cases,
respectively. These findings suggest that a significant proportion of the study population tested
positive for TB, while a substantial number tested negative.

It is important to note that the dataset used for this analysis represents a specific population and
may not be generalizable to other populations or regions. Therefore, caution should be exercised
when interpreting these findings. Conducting larger-scale studies involving diverse populations
and multiple regions would be necessary to obtain a more accurate understanding of the
prevalence of drug resistance in TB patients.

To gain a comprehensive understanding of drug resistance, it is crucial to assess the levels of

Mycobacterium tuberculosis (MTB) detected. The "MTB" variable in the dataset provides
insights into the concentration or severity of MTB. The majority of cases (36.5%) fell under the
"MEDIUM" category, indicating a moderate level of MTB. This was followed by "NIL"
(32.7%), where no MTB was detected, "LOW" (19.2%), indicating a lower concentration, and
"HIGH" (11.5%), suggesting a higher concentration of MTB. However, it should be noted that
the levels of MTB detected do not directly indicate drug resistance. Further data related to drug
susceptibility testing would be required to assess the prevalence of multi-drug resistant
tuberculosis (MDR-TB).
The "Category" variable provides information about the different classifications of TB cases. The
majority of cases (57.7%) were categorized as "CAT-1," representing new and previously
untreated TB cases or those who have been on treatment for less than a month. The "CAT-2"
category, which includes retreatment cases or individuals who experienced relapse or treatment
failure, accounted for 38.5% of the cases. The remaining 3.8% of cases fell under the "OTHERS"
category. Analyzing the distribution of drug resistance within each category would offer insights
into the prevalence of MDR-TB among different types of TB patients.

Overall, the results of this study highlight the need for further research and analysis to accurately
determine the prevalence of drug resistance in TB patients. The dataset used in this study
provides initial insights but is limited in its scope. Conducting larger-scale studies with more
extensive data collection, including drug susceptibility testing, would yield more reliable
conclusions. Additionally, considering the dynamic nature of drug resistance patterns, it is
important to conduct periodic studies to track changes and inform appropriate interventions for
effective management of drug-resistant TB.
8. CONCLUSION

The aim of this study was to investigate the prevalence of drug resistance in tuberculosis
(TB) patients based on the provided dataset. The dataset consisted of 52 cases, and the analysis
revealed important findings regarding the results, Mycobacterium tuberculosis (MTB) levels, and
TB categories.
In terms of the "Results" variable, the frequency and percent distribution showed that the
majority of cases (40.4%) received a result of "+1," followed by 28.8% testing negative for TB.
A smaller percentage of cases tested positive for TB, with 9.6% having a result mentioning "3
AFB," 3.8% with "4 AFB," 5.8% with "6 AFB," and 7.7% with "7 AFB." These findings indicate
a significant presence of TB infection within the dataset, with a notable proportion of cases
showing positive results for acid-fast bacilli associated with TB.
Regarding the "MTB" variable, the analysis revealed different levels of MTB detected. The
majority of cases (36.5%) were categorized as "MEDIUM," indicating a moderate level of MTB.
"NIL" (no MTB detected) accounted for 32.7% of cases, while "LOW" and "HIGH" levels of
MTB were observed in 19.2% and 11.5% of cases, respectively. It is important to note that the
provided information only represents the levels of MTB detected and does not directly indicate
drug resistance. Further data related to drug susceptibility testing would be required to assess the
prevalence of multi-drug resistant tuberculosis (MDR-TB).
The "Category" variable provided insights into the classification of TB cases. The majority of
cases (57.7%) were categorized as "CAT-1," which typically includes new and untreated TB
cases or those who have been on treatment for less than a month. "CAT-2" accounted for 38.5%
of cases and represents retreatment cases or individuals who experienced relapse or treatment
failure. The remaining 3.8% of cases fell under the "OTHERS" category. Analyzing the
distribution of TB cases within each category could provide valuable information on the
prevalence of drug resistance among different groups.
In conclusion, this study provides initial insights into the prevalence of drug resistance in TB
patients based on the given dataset. The results suggest a significant presence of TB infection
within the sample, with varying levels of MTB detected. However, it is important to recognize
that these findings are limited to the specific dataset and do not represent the overall prevalence
of drug resistance in TB patients. To accurately determine the prevalence of drug resistance, a
comprehensive study involving larger and more diverse datasets, along with additional
laboratory testing and analysis, is necessary.
Understanding the prevalence of drug resistance in TB patients is crucial for informing treatment
strategies, developing effective interventions, and combating the spread of drug-resistant strains.
Further research should focus on gathering more comprehensive data, including drug
susceptibility testing, to gain a more accurate understanding of the prevalence of drug resistance
in TB patients and to guide public health initiatives aimed at controlling and treating this global
health issue.