 Ahmad N, et al (2015) conducted an observational study in Pakistan which

revealed that several factors had a statistically significant association. Age more
than 40, baseline patient weight 40 kg, co-morbidity, chest X ray lung cavity and
modification of treatment showed positive association with unsuccessful
outcome. The authors also describes that the risk factors are generally identifiable
before the diagnosis of multi drug resistance.

 A retrospective study done in Armenia by Bastard M, et al.(2015) concluded that

four risk factors contributing in drug resistance. Refusal of treatment, drug side
effects, co morbid conditions and severe conditions were identified as significant
risk factors for resistance.
 Another study done in Bangladesh showed younger age, peri-urban locality,
history of contact, past tuberculosis history had the highest risk for drug resistant
tuberculosis. However they found no association of gender and socioeconomic
status. Treatment duration and sputum conversion was the significant outcome
predictors for resistant cases (Flora MS et al, 2013).

 Poudel S (2017) found four significant risk factors in her case control study
which was done in Nepal. According to the study irregular drug taking, large
family size, farming as occupation and history of tuberculosis was associated
with the drug resistance. She also describes that Male gender and younger
generation (age 21-30) was more vulnerable for the drug resistance.
 Ullah I et al (2016) conducted a study in Pakistan showed early age (10-25) and
previously treated tuberculosis patients was the risk factor for drug resistance.
But there was no gender association for developing resistance.
 Another study done in Pakistan in 2016 showed that male gender, reproductive
age group (15-45),urban ares and pulmonary cases are more vulnerable to
develop resistance (Akhtar AM et al 2016). So, this study opines gender and age
group has a role in development of TB drug resistance.
 One retrospective study done in Thailand described that clinical and diagnostic
signs can be a risk factor or predictors for drug resistant cases (Chuchottaworn et
al 2015). This study identifies more than 2 episodes of past TB, duration of
illness >60 days, sputum acid fast bacilli 3+, presence of lung cavities and
presence of plural effusion as predictors of drug resistance in tuberculosis. The
 authors also included chest radio graphic findings as a risk factor for drug
resistance. Lung cavity diameter >30, number of cavity >3, bilateral involvement
and >2 lung zones involvement were considered as predictors in their study. So,
there was a inclusion of risk factor criteria based on clinical and diagnostic tests.
 Farazi A et al. (2013) proved in their study that there is no association with
resistance to gender, nationality, close contact with TB patients and size of
montoux test. However they found significant association with previous
treatment, age <45 and positive smear at the end of 2nd and 3rd month.
 Sen HS et al. (2012) done a study in Turkey and found that drug resistance had no
association with age, gender, marital status or tuberculosis type. The authors also
found no significant association as a risk factor with presence of cavities on chest
X ray or smear positive cases. But the study surprisingly found a significantly
increased risk of multi drug resistance among those with poor socioeconomic
status, with diabetes and with previous history of tuberculosis.
 Workhicho A et al (2017) also done a case control study in India and they also
found age and history of previous treatment has significant association with the
drug resistance. But they also found no association with Gender and Diabetes
mallitus. This study showed no relationship as a risk factor with education level,
marital status, occupation, religion, smoking and alcohol use.
 Another retrospective case control study done in Portugal in the year 2014
identifies diabetes mellitus, previous tuberculosis treatment as risk factor for
resistance. However they pointed out intravenous drug use as a significant risk
factor which is different from other studies. They found no association with
gender, country of origin, employment, site of disease, co morbidity, HIV
infections, alcohol and smoking (Gomes M et al. 2014)
 A study done in Nigeria by Danial O (2011) concluded that only previous history
of tuberculosis can be a significant risk factor for drug resistance. The study also
shows no association with age and gender.

Previous history of Tb, irregular drug taking, HIV, diabetes age has the significant
association in multiple studies done in different regions of the world. However
among these studies there are some findings which are different from one another. For
example, Flora MS et al (2013) found no association of gender and socioeconomic
status with resistance. Ullah I et al (2016) also found no association wtih gender.
Although Poudel et al (2017) found association with age and gender, they identified
some unique risk factors like large family size and farming as occupation.

While multiple studies found younger age (10-25) as risk factor, Akhtar AM et al
(2016) and Ahmad N, et al (2015) identifies reproductive age group (15-45) and older
age group as a risk factor respectively. Chuchottaworn et al 2015 found the clinical
and diagnostic tests as predictors of drug resistance. This study done in Thailand
showed that clinically and radio-graphically risk factors can be a risk factor for drug
resistance which is unique from other studies. Although Sen HS et al. (2012) found
previous history of TB as risk factor, they found no significant association with age,
gender and chest radiography.

Diabetes and HIV was identified as a risk factor in multiple studies. Gomes M et al.
(2014) found diabetes as a highly significant risk factor for drug resistance. However
Workhicho A et al (2017) found no association with diabetes and Gomes M et al.
(2014) identified no significant relationship with HIV. The study done in Nigeria by
Daniel O (2011) concluded that only previous treatment has significant association
and there is no relationship of resistance with age and gender.