Rifampicin resistance among patients with Tuberculosis at the Olabisi Onabanjo University Teaching Hospital, Sagamu

  • Olusoji J Daniel Department of Community Medicine and Primary Care, Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria
  • Janet Olufisayo Bamidele http://orcid.org/0000-0003-1852-7540
  • John Kolawole Sodeinde
  • Adeola Adebayo Ekundayo
  • Adekunle Albert Salako
Keywords: Gene Xpert, Drug resistance, Rifampicin Resistance, Tuberculosis


Background: Tuberculosis (TB) is a major public health problem in Nigeria. The emergence of multidrug-resistant Tuberculosis poses a threat to global Tuberculosis control and if not effectively addressed, may wipe out the achievements of previous efforts in controlling Tuberculosis.

Objectives: To determine the prevalence and factors associated with rifampicin resistance amongpatients receiving care for TB at the OlabisiOnabanjo University Teaching Hospital, Sagamu.

Methods: A retrospective study of presumptive Tuberculosis cases managed between January 2013 and December 2016 at the Directly Observed Treatment clinic, OlabisiOnabanjoUniversity Teaching Hospital Sagamu, Ogun State, Nigeria,was done. One sputum sample was obtained from each patient for the Gene Xpert® test to diagnoseTB and to determine rifampicin resistance among patients with confirmed Mycobacterium tuberculosis infection. HIV screening  was also  carried out on all the patients using HIV Rapid Test kits. The sociodemographic data were retrieved from the presumptive Tuberculosis register.

Results: A total of 1572 presumptive TB patients were screened for TB, out of which 187 (11.8%) were confirmed to be infected with Mycobacterium tuberculosis (MTB). A total of 20 (10.7%) of the 187 MTB patients had rifampicin resistance using Gene Xpert® method. Rifampicin resistance rate was significantlyassociated with re-treatment TB category but not with age, sex or HIV status.

Conclusion: The study showed rifampicin drug resistance among confirmed TB patients. There is a need to decentralizethe use of  Gene Xpert® test for TB to the peripheral facilities and make it a point of care test for presumptive TB patients.


1. WHO 2016. What is TB? How is it treated? Available at www.who.int/features/qa/08/en/ Accessed on 05/01/2016
2. WHO 2016. Global Tuberculosis Report. Available at www.who.int/tb/publicaations/global_report/en/ Accessed on 05/01/2016
3. Federal Republic of Nigeria. Guidelines for programmatic and clinical management of drug resistant TB in Nigeria 2015. Available at stoptbng.org/…/2015. Accessed on 08/02/2016
4. Federal Ministry of Health, Nigeria: National Tuberculosis and Leprosy Control Program. National TB Prevalence Survey Report 2014
5. Federal Ministry of Health, Nigeria: National Drug Resistant Tuberculosis Survey Report. August 2012
6. Sharma SK, Mohan A. Multidrug-resistant tuberculosis. Indian J Med Res 2004; 120: 354–376.
7. Sunita T, Rajesh K, Surya DS. Prevalence of Multidrug Resistant Pulmonary Tuberculosis in North Bihar. J Clin Diagn Res 2015; 9(11): LC09-LC12.
8. Andrews JR, Gandhi NR, Moodley P, Shah NS, Bohlken L, Moll AP. Exogenous Reinfection as a Cause of Multidrug-Resistant and Extensively Drug-Resistant Tuberculosis in Rural South Africa. J Infect Dis2008; 198(11): 1582–1589.
9. Agarwal AK, Chugh IM, Shah A. Multidrug resistant tuberculosis : successful treatment with an unconventional regimen. Ind J Tub 1998; 45: 227-229.
10. Sharma SK, Kumar S, Saha PK, George N, Arora SK, Gupta D, et al. Prevalence of multidrug-resistant tuberculosis among Category II pulmonary tuberculosis patients. Indian J Med Res 2011; 133: 312–315.
11. Pillay M, Sturm AW. Evolution of the extensively drug-resistant F15/LAM4/ KZN strain of Mycobacterium tuberculosis in KwaZulu-Natal, SouthAfrica.Clin Infect Dis 2007; 45: 1409–1414.
12. World Health Organization 2010. WHO endorses new rapid tuberculosis test. Available at www.who.int/mediacentre/news/releases/2010/ . Accessed on 04/01/2016
13. WHO. Automated real-time nucleic acid amplification technology for rapid and simultaneous detection of tuberculosis and rifampicin resistance: Xpert MTB/RIF. Policy statement. 2011;
14. World Health Organisation. Global Tuberculosis Control: WHO report 2016. Geneva, Switzerland: World Health Organisation, 2016.
15. Otu A, Umoh V, Habib A, Ameh S, Lawsun L, Ansa V. Drug Resistance Among Pulmonary Tuberculosis Patients in Calabar Nigeria. Pulm Med 2013; 2013:235190:
16. Aliyu G,El-Kamary S,Abimiku A, Ezati N, Iwakun M, Hungerford L, et al. Mycobacterial Etiology of Pulmonary Tuberculosis and association with HIV infection and multidrug Resistance in Northern Nigeria. Tuberculosis Research and Treatment. 2013. doihttp:\\dx.doi.org\10.1155\2013650561
17. Farazi A, Sofian N, Katebi F, Hoseini SD, Kashavarz R. Drug resistance pattern and associated risk factors of tuberculosis patients in central province of Iran. Caspian. J Int Med 2013; 4(4): 785-789.
18. Yang Y, Zhou C, Shi L, Meng H, Yan H. Prevalence And Characterization Of Drug Resistant Tuberculosis In A Local Hospital In Northeast China. Int J Infec Dis 2014; 22: 85-86.
19. Nwadioha SI, Nwookedi EO, Ezema GC, Eronini GC, Eronini NC, Anikwe A, et al. Drug resistant Mycobacterium Tuberculosis in Benue, Nigeria. Br Microbiol Res J 2014; 4(9): 988-995.
20. Boehme CC, Nicol MP, Nabeta P, Michael JS, Gotuzzo E, Tahirli R, et al. Feasibility, diagnostic accuracy, and effectiveness of decentralised use of the Xpert MTB/RIF test for diagnosis of tuberculosis and multidrug resistance: a multicentre implementation study. Lancet 2011; 377 (9776): 1495–1505. Available: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=3085933&tool=pmcentrez&rendertype=abstract[PMC free article
21. Coovadia YM, Mahomed S, Pillay M, Werner L, Mlisana K (2013) Rifampicin Mono-Resistance in Mycobacterium tuberculosisin KwaZulu-Natal, South Africa: A Significant Phenomenon in a High Prevalence TB-HIV Region. PLoS ONE 8(11): e77712. https://doi.org/10.1371/journal.pone.0077712
22. Yang X, Li Y, Wen X, Wu X, Li X. Risk Factors for Drug Resistance in Pulmonary Tuberculosis in Patients. J Evid Based Med 2010; 3:162-167.
23. Faustini A, Hall A J and Perucci C A. Risk Factors for MultiDrug Resistant Tuberculosis in Europe. A Systemic Review. Thorax 2006; 61: 158-163.
24. Lomtadze N, Aspindzelasvili R, Janjgava M, Mirtskhulava V, Wright A, Blumbery H M and Salakaia A. Prevalence and Risk Factors for MultiDrug Resistant Tuberculosis in Republic of Georgia: A Population Based Study. Int J Tuberculosis Lung Dis 2009; 13: 68-73.
25. Liu Y, Zhu L, Shao Y, Song H, Li G, Zhon Y, et al. Rates and Risk Factors of Drug Resistant Tuberculosis in Northeastern China. BMC Public Health 2013; 13: 1171.
26. Federal Ministry of Health: National TB Workers Manual. 2010.
27. C. Dye, B. G. Williams, M. A. Espinal, and M. C. Raviglione. Erasing the world's slow stain: strategies to beat multidrug-resistant tuberculosis. Science 2002; 295(5562): 2042–2046.
28. K. B. Patel, R. Belmonte, H. M. Crowe. Drug malabsorption and resistant tuberculosis in HIV-infected patients. New Eng J Med 1995; 332(5): 336–337.
29. Abdella K, Abdissa K, Kebede W, Abebe G. Drug Resistance Patterns of Mycobacterium Tuberculosis Complex and associated factors among retreatment cases around JimmaSouthEast Ethiopia. BMC Public Health 2015 2; 15: 599
30. Range N, Friis H, Mfaume S, Magnussen P, Chanualucha J, Kilale A, Mugomela A, Andersen AB. Anti-tuberculosis drug resistance pattern among pulmonary tuberculosis patients with or without HIV infection in Mwanza, Tanzania.Tanzan J Health Res 2012; 14(4): 243-249
Original Research