ANTITUBERCULOSIS DRUG-RESISTANCE SURVEILLANCE IN KENYA, 1995

SETTING: Twenty-two of the 42 administrative districts in Kenya. OBJEC TIVE: TO determine the prevalence of drug resistance in newly diagnose d patients with pulmonary tuberculosis, to determine possible risk fac tors associated with resistance, and to establish standard routine sur veillance of drug resistance. DESIGN: Cross-sectional study. METHODS: Sputum samples from newly diagnosed patients with smear-positive pulmo nary tuberculosis were analysed using standard procedures. RESULTS: Of 638 patients, 85% were culture positive for Mycobacterium tuberculosi s. Of 491 patients tested for susceptibility to isoniazid, streptomyci n, rifampicin and ethambutol, 90.8% had fully sensitive strains and 9. 2% had a strain resistant to one or more drugs. Of 445 patients with n o history of previous chemotherapy, 6.3% had a resistant strain. Of 46 patients with a history of previous chemotherapy, 37% had a resistant strain. No resistance to either rifampicin or ethambutol was detected . There was a strong association between previous chemotherapy and res istance. Resistance was not associated with age or sex. High concordan ce between Kenya's results and those of the Mycobacterium Reference Un it in the UK on both drug-sensitive and drug-resistant strains indicat es that clinically significant and comparable data can be obtained fro m laboratories employing unsophisticated and inexpensive standard proc edures. CONCLUSION: Rates of initial drug resistance are still low in Kenya. The increase in acquired resistance to isoniazid requires monit oring.