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Volume 19, Number 3—March 2013

Dispatch

Multidrug-Resistant Tuberculosis, Somalia, 2010–2011

Ireneaus Sindani, Christopher Fitzpatrick, Dennis Falzon, Bashir Suleiman, Peter Arube, Ismail Adam, Samiha Baghdadi, Amal Bassili, and Matteo ZignolComments to Author 

Author affiliations: Author affiliations: World Health Organization, Nairobi, Kenya (I. Sindani); World Health Organization, Geneva, Switzerland (C. Fitzpatrick, D. Falzon, M. Zignol); World Health Organization, Hargeisa, Somalia (B. Suleiman); World Vision International, Nairobi (P. Arube); National TB Control Program, Hargeisa (I. Adam); World Health Organization, Cairo, Egypt (S. Baghdadi, A. Bassili): and Medical Research Institute, Alexandria University, Alexandria, Egypt (A. Bassili)

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Table

Prevalence of resistance to first-line antituberculosis drugs in patients with sputum smear–positive pulmonary tuberculosis, Somalia, 2010–2011*

Drug-resistance pattern Patients, % (95% CI)
New, n = 754 Previously treated, n = 96 All
Susceptible 85.6 (81.5–89.7) 46.2 (29.1–63.2) 81.4 (77.7–85.2)
Any resistance to
Isoniazid 10.9 (7.8–13.9) 51.4 (35.8–67.0) 15.2 (12.2–18.2)
Rifampin 8.7 (5.2–12.1) 43.2 (25.9–60.6) 12.3 (9.1–15.6)
Total
14.4 (10.3–18.5)
53.8 (36.8–70.9)
18.6 (14.8–22.3)
Monoresistance to
Isoniazid 5.7 (4.1–7.4) 10.6 (0.0–21.5) 6.2 (4.5–7.9)
Rifampin 3.5 (1.1–6.0) 2.4 (0.0–5.4) 3.4 (1.0–5.8)
Total
9.2 (6.1–12.4)
13.0 (1.4–24.5)
9.6 (6.6–12.6)
Multidrug resistance 5.2 (2.8–7.5) 40.8 (24.7–57.0) 8.9 (6.5–11.4)

*Prevalence estimates were obtained by using logistic regression (Stata’s svy: logit command, Stata Corp., College Station, TX, USA) on the binary treatment history variable; each new/retreatment case with a drug-susceptibility test result was weighted by the number of new/retreatment cases notified in its cluster in 2010 (the year in which the survey started), divided by the total number of new/retreated cases with a drug-susceptibility test result in its cluster. The estimation of odds ratios reported elsewhere in the text also included the expansion of categorical sex, age group, and zone variables (xi: logit), with clustering and CIs of variance. The findings were robust to multiple imputation of missing data (adding another 78 new and 18 retreatment cases to the sample), use of sampling weights based on 2007 notifications (the year in which cluster samples were calculated), and no use of sampling weights at all; prevalence estimates were equivalent to or slightly higher than those reported here.

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