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Free Content Anti-tuberculosis drug resistance in Madagascar in 1994–1995

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SETTING: A new tuberculosis control programme has been implemented in Madagascar since 1991. A survey on Mycobacterium tuberculosis resistance to the major drugs was conducted between August 1994 and December 1995.

OBJECTIVE: To determine primary and acquired resistance in pulmonary tuberculosis patients in four main cities.

DESIGN: Were included 401 randomly sampled new smear positive patients (36.2% of declared new patients) and 137 recurrent cases (72.9% of declared cases) from 8 centres. Drug susceptibility testing was performed on Löwenstein Jensen medium according to the proportion method.

RESULTS: The male to female ratio was 1.35:1 in new patients (age range 11–74 years) and 1.98:1 in recurrent patients (age range 16–76 years). The primary resistance rate to any drug was 20% (95% Confidence Interval [CI] 16–23) and the acquired resistance rate 40% (95% CI 32–48, P < 2.10−7). Primary resistance to one drug was 18% (95% CI 15–22), mainly attributable to streptomycin resistance (14.5%). Multidrug resistance (MDR) to isoniazid and rifampicin was 0.25% (95% CI 0–0.7) for primary resistance and 5% (95% CI 2.6–10.6) for secondary resistance. No difference was observed between sexes or ages.

CONCLUSION: This survey conducted in big cities gives a very negative picture of resistance in Madagascar.
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Keywords: Madagascar; resistance; tuberculosis

Document Type: Regular Paper

Affiliations: 1: Institut Pasteur, Antananarivo, Madagascar 2: Institut Pasteur, Antananarivo, Madagascar; and Programme National de Lutte contre la Tuberculose, Antananarivo, Madagascar 3: Programme National de Lutte contre la Tuberculose, Antananarivo, Madagascar

Publication date: 1997-10-01

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  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

    Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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