Exploring the Pattern of Resistance to Anti-Tuberculosis Drugs Among Tuberculosis Patients in Kwara State, Nigeria
Authors: Muhammed Oyeniyi , Popoola Israel , Uthman Muhammed , Daniel Ebenezer , Bello Ahmed , Popoola Taiwo , Avwerhota Michael , Ogun Adebanke , Ekwuluo Celestine , Danladi Aremu , Tomori Michael , Ogundeji Adedamola , Adewole Jacob 
Published: February 2025

Tuberculosis (TB) remains a substantial global health challenge, particularly in Nigeria, which has the highest TB incidence in Africa, with approximately 590,000 new cases annually. Multidrug-resistant TB (MDR-TB) complicates treatment and control efforts, necessitating a deeper understanding of drug resistance patterns. This study used a descriptive cross-sectional design to investigate resistance to first- and second-line anti-TB drugs among TB patients in Kwara State, Nigeria. A multi-stage sampling technique was used to recruit 272 participants from selected Local Government Areas. Data collection included questionnaires and laboratory testing using the Hain Line Probe Assay (LPA) and GeneXpert MTB/Rif system. Results showed that age was a statistically significant factor, with resistance rates notably higher among younger individuals aged &lt;i&gt;20-29 years&lt;/i&gt; (&lt;i&gt;p = 0.044&lt;/i&gt;), while no significant associations were found for gender (&lt;i&gt;p = 0.166&lt;/i&gt;), ethnicity (&lt;i&gt;p = 0.984&lt;/i&gt; for first-line drugs; &lt;i&gt;p = 0.601&lt;/i&gt; for second-line), or educational level (&lt;i&gt;p = 0.131&lt;/i&gt; for first-line; &lt;i&gt;p = 0.260&lt;/i&gt; for second-line). &lt;i&gt;Notably, 84.7%&lt;/i&gt; of participants who adhered to Directly Observed Treatment Short-course (DOTS) were sensitive to anti-TB drugs, but adherence alone did not exhibit a statistically significant association with resistance (&lt;i&gt;p = 0.278&lt;/i&gt;), questioning assumptions about DOTS effectiveness in this context. Alcohol consumption emerged as a significant predictor of drug resistance (&lt;i&gt;p = 0.0423&lt;/i&gt;), with patients consuming alcohol being &lt;i&gt;six times more likely to develop resistance&lt;/i&gt; (OR = 6.025, &lt;i&gt;95% CI = 4.950 - 13.632&lt;/i&gt;) than non-drinkers, underscoring the need to address alcohol-related non-adherence to improve outcomes. Conversely, smoking, incarceration, and contact with TB patients showed no significant association with resistance, challenging global assumptions about these risk factors in the Nigerian context. This study highlights the complex nature of TB drug resistance, influenced by socio-demographic and behavioral factors unique to local contexts. The absence of statistically significant correlations for several known risk factors, such as smoking (&lt;i&gt;p = 0.761&lt;/i&gt;) and prior TB contact (&lt;i&gt;p = 0.2165&lt;/i&gt;), suggests that interventions in Nigeria should be localized and tailored to specific populations rather than relying on generalized global models. Comprehensive strategies targeting &lt;i&gt;alcohol use&lt;/i&gt; and &lt;i&gt;younger age groups&lt;/i&gt;, alongside strengthened healthcare delivery, are essential to curbing the spread of drug-resistant TB strains in Nigeria.