ANTITUBERCULOSIS DRUG-RESISTANCE IN MADAGASCAR IN 1994-1995

SETTING: A new tuberculosis control programme has been implemented in Madagascar since 1991. A survey on Mycobacterium tuberculosis resistan ce to the major drugs was conducted between August 1994 and December 1 995. OBJECTIVE: To determine primary and acquired resistance in pulmon ary tuberculosis patients in four main cities. DESIGN: Were included 4 01 randomly sampled new smear positive patients (36.2% of declared new patients) and 137 recurrent cases (72.9% of declared cases) from 8 ce ntres. Drug susceptibility testing was performed on Lowenstein 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 i n recurrent patients (age range 16-76 years). The primary resistance r ate to any drug was 20% (95% Confidence Interval [CI] 16-23) and the a cquired resistance rate 40% (95% CI 32-48, P < 2.10(-7)). Primary resi stance to one drug was 18% (95% CI 15-22), mainly attributable to stre ptomycin resistance (14.5%). Multidrug resistance (MDR) to isoniazid a nd 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.