[Risk factors for multidrug-resistant tuberculosis in the city of Kinshasa in the Democratic Republic of Congo]. / Facteurs de risque de la tuberculose multi-résistante dans la ville de Kinshasa en République Démocratique du Congo.

BACKGROUND: The aim of this study was to determine the risk factors for multidrug-resistant tuberculosis (TB) in the city of Kinshasa in the Democratic Republic of Congo. METHODS: This was a case control study. The cases included all TB patients notified as resistant to rifampicin and isoniazid in Kinshasa from January 2012 to June 2013. The controls included TB patients treated during the same period as the cases and declared cured at the end of treatment. For this study, we obtained ethical clearance. RESULTS: The sample consisted of 213 participants, 132 men (62%) and 81 women (38%). The median age was 31 years (16-73 years). Factors associated with significant (p< 0,05) multidrug-resistant tuberculosis were the non-observance of the hours of taking drugs (0R = 111) (80% cases, 4% controls), the failure of treatment (0R = 20 (76% cases, 13% controls); the concept of multidrug-resistant tuberculosis in the family (0R = 6.4) (28% cases, 6% controls); a lack of knowledge of multidrug-resistant tuberculosis (0R = 3.2) (31% cases, 59% controls); a stay in prison (0R = 7.6) (10% cases, 1% controls) and the interruption of treatment (0R = 6.1) (59% cases, 19% controls). CONCLUSION: The emergence of multidrug-resistant tuberculosis can be avoided by the installation of suitable diagnosis and treatment strategies.

Childhood Tuberculosis in a Sub-Saharan Tertiary Facility: Epidemiology and Factors Associated with Treatment Outcome.

Childhood tuberculosis (TB) is a diagnostic challenge in developing countries, and patient outcome can be influenced by certain factors. We report the disease course, clinical profile and factors associated with treatment outcome in a tertiary facility of Kinshasa. Documentary and analytical studies were conducted using clinical and exploratory data for children aged up to 15 years who were admitted to the University Clinics of Kinshasa for TB. Data are presented as frequencies and averages, and binary and logistic regression analyses were performed. Of 283 children with TB, 82 (29.0%) had smear-negative TB, 40 (14.1%) had smear-positive TB, 159 (56.1%) had extra-pulmonary TB (EPTB), 2 (0.7%) had multidrug-resistant TB (MDR-TB), 167 (59.0%) completed treatment, 30 (10.6%) were cured, 7 (2.5%) failed treatment, 4 (1.4%) died, 55 (19.4%) were transferred to health centers nearest their home, and 20 (7.0%) were defaulters. In the binary analysis, reported TB contacts (p = 0.048), type of TB (p = 0.000), HIV status (p = 0.050), Ziehl-Nielsen test result (p = 0.000), Lowenstein culture (p = 0.004) and chest X-ray (p = 0.057) were associated with outcome. In the logistic regression, none of these factors was a significant predictor of outcome. Tertiary level care facilities must improve the diagnosis and care of patients with childhood TB, which justifies the development of alternative diagnostic techniques and the assessment of other factors that potentially affect outcome.