REVIEW

Bali Medical Journal (Bali MedJ) 2021, Volume 10, Number 3 Special Issue ICONURS: 1294-1303
P-ISSN.2089-1180, E-ISSN: 2302-2914

Modifiable and non-modifiable factors on

previous tuberculosis treatment as a predisposition
of multi drug resistance tuberculosis (mdr-tb):
scoping review

Maksi Puasa1, Nur Chayati2*

ABSTRACT

1
Master of Nursing students, Universitas
Muhammadiyah Yogyakarta, Indonesia;
2
Lecturer, Master of Nursing Program,
Universitas Muhammadiyah Yogyakarta,
Indonesia;
*Corresponding author:
Nur Chayati;
Lecturer, Master of Nursing Program,
Universitas Muhammadiyah Yogyakarta,
Indonesia;
nchayati1983@gmail.com
Received: 2021-11-03
Accepted: 2021-12-20
Published: 2021-12-30
Introduction: The increasing number of patients with resistant tuberculosis requires attention and efforts for prevention.
Resistance causes more expensive cost of treatment, longer duration of treatment, more severe side effects and decreasing
the chance of recovery. The specific purpose of this literature review was to identify modifiable and nonmodifiable factors
associated with previous treatment as predisposing factors for MDR-TB.
Method: This study applies scoping review method of JBI (Joanna briggs Institute) by using 5 databases: Scopus, Ebscohost,
Proquest, Science direct and google scholar publication 2015-2021. keywords for MDR-TB search, predisposing factors,
previously treatment and adult.
Results: Modifiable factors related to previous tuberculosis treatment include treatment failure or discontinuation, non-
adherence, lack of supervision, unclear or inadequate instructions. Meanwhile modifiable factors are side effects and relapse.
Conclusion: The cause of MDR-TB which can be modified and cannot be modified is very important to know. The government
as a policy maker can use the results of this research to strengthen tuberculosis control programs and prevention of resistant
tuberculosis.
Keywords: MDR-TB, predisposition factor, previously treatment, tuberculosis.
Cite This Article: Puasa, M., Chayati, N. 2021. Modifiable and non-modifiable factors on previous tuberculosis treatment
as a predisposition of multi drug resistance tuberculosis (mdr-tb): scoping review. Bali Medical Journal 10(3) Special Issue
ICONURS: 1294-1303. DOI: 10.15562/bmj.v10i3.2901

INTRODUCTION
Tuberculosis (TB) is a chronic infectious
respiratory disorder is a major public
health problem worldwide, causes
high mortality and ranks at the top
with HIV-AIDS with 5,000 deaths per
day.1–4 According to the World Health
Organization (WHO) Global TB report,
it is estimated that 10 million people are
at risk of contracting TB in 2018. One of
the problems in TB management is the
increasing number of MDR-TB (Multi
drug resistance Tuberculosis) patients.5
In 2015 WHO estimates that the
number of MDR-TB sufferers is more
than half a million or around 520,000-
640,000 with the number of patients
dying around 250,000 people.6–8 In 2016
around 540,000-660,000 people with
MDR-TB.9–11 Meanwhile, in 2017 WHO
reported the number of MDR-TB sufferers
was around 483,000-639,00012 and in
2018 there were around 417,000-556,000
people with MDR-TB with cases of death
around 133,000-295,000. There is a slight
tendency for MDR-TB cases to increase
from year to year.13
MDR-TB is tuberculosis that is
resistant to the two most potent anti-TB
drugs, namely Isoniazid and Rifamficin
through Drug Susceptibility Testing
(DST).13-17 Resistant TB can occur during
first-line treatment of anti-TB drugs
called secondary MDR-TB or due to
transmission of resistant strains from an
already infected patient to susceptible
patients or called primary MDR-TB.18,19
From a health economics perspective,
MDR-TB is a heavy burden on the health
care system with treatment costs 20 times
higher and more expensive than TB
treatment that is susceptible to anti-TB
drugs.20 MDR-TB is a problem in low to
middle income countries.1,21–23 WHO 2018
data reports that MDR-TB in Indonesia
in 2018 was around 17,000-32,000 cases
assuming an incidence of 6-12 per
100,000 population and this greatly affects
community productivity.13
In the findings of the previous literature
review, the factors associated with previous
TB treatment as a significant cause of
MDR-TB were adherence to the treatment
process.20,24 Other factors are adverse side
effects and discontinuation of treatment/
incomplete or failed.20,25 Other findings
from Asgedom et al include inappropriate
drug regimens, inadequate drug supply;
inappropriate or irregular, and lack of
drug control are other factors causing
MDR-TB.24 Feng et al added that another
factor was withdrawal from treatment
and TB treatment which was more than 2
times the cause of the increasing number
of MDR-TB sufferers.25 From the various
literatures reviewed, it can be concluded
that previous tuberculosis treatment was
the most common causative factor in all

1294 Bali Medical Journal 2021; 10(3) Special Issue ICONURS: Open
1294-1303
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| doi:
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studies. Seeing the increasing MDR-TB
cases where the author works and there are
many things experienced by patients in the
MDR-TB treatment process such as feelings
of boredom, anxiety, depression, isolation,
rejection, feelings of worthlessness,
nausea, vomiting, heartburn, hearing loss.
decreased, decreased vision, lost hope of
recovery even the feeling of wanting to
die. The things above can be avoided to
not happen because in addition to causing
very heavy suffering for the sufferer, at the
same time the family also experiences a
great burden. With the reasonings above,
the authors were interested in exploring
factors related to previous TB treatment
as the cause of MDR-TB using the scoping
review method from the Joana Briggs
Institute (JBI).
METHODS
The research method uses a scoping review
design by looking for articles related to the
purpose of the study and then summarizing
the results of further research articles that
are presented comprehensively in the
hope that it can be useful for handling
tuberculosis cases, more specifically drug
resistance tuberculosis.
Search technique
A systematic approach and selection
process was used in this literature review.
International databases such as Ebsco
Host, Google Scholar, Proquest, Science
Direct, Scopus are searched as library
sources. Further searches were carried out
on previous literature review articles to be
used as reference material to strengthen
the findings in this literature review. The
amount of data on the number of TB
and MDR-TB patients in the world was
searched on the WHO website. The article
search technique uses keywords that are
specific to the research question. The
keywords or phrases used are described in
table 1.
Inclusion and exclusion criteria
This literature review aims to examine
what factors are associated with previous
TB treatment as a predisposing cause
of the increasing number of MDR-TB
sufferers globally in adults. Therefore, in
determining whether an article is eligible
or not to be included in the review, the
Bali Medical Journal 2021; 10(3) Special Issue ICONURS: 1294-1303 | doi: 10.15562/bmj.v10i3.2901
inclusion criteria are as follows:
• Full text article
• All research articles published from
2015 to 2020
• Adults as respondents
• Research on all health services
• All studies about predisposing factor
MDR-TB
• Articles in English and Indonesian
• Open access articles
• Case control study and cross sectional
study articles
• All kinds of articles related to MDR-TB
The eksclussion criteria:
• TB pada HIV dan DM
• Literature review articles
RESULTS
Schematic Diagram (PRISMA)
The presentation of the results in this
scoping review refers to the PRISMA
flowchart adapted from the statement of
Moher et al (2009). Consists of several
steps, namely Identification, Screening,
Eligibility and Included. An initial search
of databases and journals by entering
keywords resulted in a number of articles
as shown in the chart below.
List of reviewed articles
The steps taken after selecting and
extracting the article data obtained are
detailed descriptions of the researcher’s
name, title, research design, sample and
respondent characteristics, instruments,
findings related to previous treatment
factors, factors that can be modified or
controlled and factors that cannot be
modified or controlled. All of which are
summarized in table 2.
Table 1. List of keywords and their possible synonyms.
Keywords
Multi Drug resistant Tuberculosis
Predisposing factor
Previously treatment
Adult
REVIEW
History of tuberculosis treatment is
the most significant predisposition to the
incidence of drug resistance tuberculosis.
The definition of previous tuberculosis
treatment is a patient who has previously
taken first-line anti-tuberculosis drugs,
namely isoniazid and ripamficin for at
least a month or more.44 Several research
articles reviewed showed that previous TB
treatment was a predisposing factor for the
increasing number of MDR-TB patients.26
In the previous treatment process,
various possibilities can occur that cause
tuberculosis treatment to be unsuccessful
and become resistant
There are several possibilities that
can occur or be experienced by patients
while undergoing previous TB treatment.
These possible occurrences are identified
as factors that can be controlled or
modified and which cannot be controlled
or modified according to the research
objectives. Factors that can be modified
or controlled include; treatment failure
or discontinuation,27-29,4,8,16,23,45 loss to
follow up,29,25 disobedient,30 lack of
supervision31,32 and unclear or inadequate
instructions.8 Meanwhile, factors that
cannot be modified or controlled are
experiencing drug side effects,5,33 and
relapse.29,4 This confirms that previous TB
treatment predisposes to MDR-TB.
Nurses as one of the elements of health
workers have a very important role to
control the factors that cause resistance and
support the global tuberculosis elimination
program. Direct supervision of patients
undergoing treatment is very influential
to avoid things that can cause resistance.
Medication monitoring program or
DOTS (directly-observed treatment short
Synonym
Tuberculosis drug resistance
Multi drug resistance
Rifampicin and isoniazid resistant
Risk factor
Related Factor
Risk factor
Associated factor
Previous TB treatment
Prior tb treatment
Adult
> 18 year
1295
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Figure 1. Flowchart of the article selection process.
course) very important to improve31,30 and
of course to improve the DOTS program
requires further involvement of nurses and
a bigger role because it greatly affects the
success of other programs for tuberculosis
elimination.
DISCUSSION
Multi-drug resistance tuberculosis (MDR-
TB) is drug-resistant tuberculosis in which
the patient is resistant to at least two first-
line tuberculosis drugs, namely isoniazid
and rifampicin.46 Drug-resistant TB is
the resistance of M. Tuberculosis bacteria
where the bacteria can no longer be killed
with the currently used anti-tuberculosis
drugs (OAT).47 Multi-drug resistance
continues to increase so that it becomes
a global problem with the number
of increases varying in each country.
Identifying resistance risk factors is very
important because it will contribute to the
development of the right strategy48 and
need to get priority in the tuberculosis
control program.5 Patients undergoing
treatment for tuberculosis resistance will
1296
suffer greatly, involve a larger treatment
team and the hope of recovery is less
than 50%.49 The duration of TB drug
resistance treatment also becomes longer
with more expensive costs, more severe
side effects and drugs with more toxic
regimensk. Resistance to rifampicin and
isoniazid is a resistance that often occurs
when undergoing tuberculosis treatment,
this resistance allows for a wider and
more difficult resistance called XDR-TB
(Extensively drug resisten tuberculosis).50
Previous tuberculosis treatment was
the most significant predisposing factor
causing resistance, this was stated by
Mesfin et al in a study conducted in
Ethiopia,27 the same thing was stated by
Arora et al in an article discussing drug
resistance tuberculosis tuberculosis;49
similar findings in a study in western
France,37 northern part of Iran,21 Henan
Province China,5 Malaysia32 and research
in Espírito Santo, Brazil.40 The results of
this study are somewhat different from
the research conducted in Serbia by
Stosic et al which stated that a significant
Bali Medical Journal 2021; 10(3) Special Issue ICONURS: 1294-1303 | doi: 10.15562/bmj.v10i3.2901
predisposing factor for drug resistance
was an economic factor.26 This difference
in findings is because researchers differ
in including predisposing factors or risk
factors for resistance and the focus of the
researchers. Previously treated patients
often constitute a highly significant group
of resistance,29 This finding is in line with
the results of the study in Bamako Mali by
Baya et al,51 similar results in the study in
Zimbabwe,9 research conducted in Lahore
Pakistan,38 and also in India on research
on drug resistance,33 a different finding
was put forward by Desmukh et al which
stated that the risk factor for resistance was
the decision to adhere to treatment,52 This
difference is due to the focus of research
on certain risk factors in accordance with
the objectives of the researcher.
Very important to identify matters
related to the success of treatment in
order to avoid resistance.21 Risk factors
for resistance include those who relapse
after receiving successful treatment,
those who return after failure, and those
who start receiving a treatment regimen
after experiencing previous treatment
failure.5 Some of the things that cause
failure are drugs used to treat TB are
not used as prescribed. This can happen
when: the patient missed a dose or did
not complete the treatment completely;
health care provider prescribes the wrong
medication, wrong dose, or wrong time to
take medication; effective drugs are not
available; and the medicines are of poor
quality.28,43,53
In the previous history of tuberculosis
treatment, things could actually be
prevented from causing resistance.
Things that can be prevented, modified
or controlled require the participation
of health workers so that resistance can
be minimized or reduced in incidence.
Resistance in previously treated cases is
an indicator of poor adherence, lack of
monitoring of treatment and ineffective
Tuberculosis control programs.30 Failure or
discontinuation of treatment is one of the
factors that can be controlled. Treatment
can fail and be interrupted when the
patient misses a dose or does not complete
the treatment completely, which will make
the bacteria resistant.5 Other factors, such
as the patient feeling better or feeling
better during treatment, make the patient

stop treatment.16 Likewise with regard to
patient compliance, if the patient does not
comply, it can cause failure, because the
patient will stop taking medication and no
longer want to control health services. If
the patient does not comply, the patient will
easily quit the treatment program. Patient
compliance is something that can be
controlled by means of tighter supervision
and stronger support from both families
and health workers. Another factor that
can also avoid the occurrence of resistance
is unclear or inadequate instructions.8
Due to unclear or inadequate instructions,
it causes confusion for patients and their
families so that patients can take the wrong
medicine in both the amount and dose and
time. The most important effort to prevent
the spread of drug-resistant TB is to use
all drugs according to the advice of health
workers (doctors, nurses or pharmacists).
All drugs must be taken according to the
schedule and instructions, there should be
no missed doses or early discontinuation
of treatment.54
Tuberculosis treatment according
to WHO standards requires patients to
consume drugs in large quantities and
for a long time.44 Most TB patients can
complete treatment without experiencing
significant OAT (anti-tuberculosis
drugs) side effects, but some patients can
experience adverse or severe side effects,
side effects ranging from mild to severe44
This will result in the patient being able
to stop treatment at any time without
notifying the health care provider.48
Mild symptoms ranging from vomiting,
headaches, dizziness, decreased hearing,
heartburn, and many other symptoms
can occur during the treatment process
and definitely require the participation
of very strong health workers to educate
patients who experience drug side effects
so as not to stop treatment, because it can
cause resistance. Drug side effects are one
of the factors that cannot be controlled or
modified.
Patient compliance is something that
can be controlled by means of tighter
supervision and stronger support from
both families and health workers. The next
factor that can also avoid the occurrence
of resistance is unclear or inadequate
instructions.8 Due to unclear or inadequate
instructions, it causes confusion for
Bali Medical Journal 2021; 10(3) Special Issue ICONURS: 1294-1303 | doi: 10.15562/bmj.v10i3.2901
patients and their families so that patients
can take the wrong drug in both the
amount and dose and time. An important
action to suppress the increase in resistant
TB is the use of drugs according to the
advice of doctors, pharmacists or nurses
who hold the program. The schedule for
taking medication must be according to
the instructions, the dose should not be
missed, let alone stop taking the drug at an
early stage.54
Relapse patients in tuberculosis
treatment is when the patient has been
declared cured and finished the program
then symptoms appear and TB is re-
diagnosed with examination.44 Relapse
is one of the causes of resistance with
unknown causes, and this cannot be
controlled or modified according to the
purpose of this literature review because
relapse is one thing that occurs without
the patient, family or even health workers
realizing it. Relapse patients are a risk
factor or predisposition to tuberculosis
drug resistance according to the findings in
the study in Tigray Ethopia4 and research
conducted in Adisababa Ethiopia.43
CONCLUSION
Factors causing resistance are related to
previous treatment history. Modifiable
factors related to previous tuberculosis
treatment include treatment failure or
discontinuation, non-adherence, lack
of supervision, unclear or inadequate
instructions and non modifiable factors
are adverse reaction or side effects and
relapse. Side effects of TB treatment
can be minimized and controlled not to
become resistant by providing education
and support so that patients do not stop
treatment. Patients who recover can be
given education to check themselves in
health facilities when they experience
symptoms again so that they are diagnosed
more quickly if the patient experiences a
relapse.
CONFLICT OF INTEREST
The authors declare there is no conflict of
interest regarding this article.
FUNDING
This research did not receive a specific
grant from a funding agency in the public,
REVIEW
commercial, or not-for-profit sector.
ETHIC APPROVAL
Ethical approval does not apply.
AUTHOR CONTRIBUTION
AM: searching articles, critical appraisal,
drafting reports.
NC: re-check the writings that have been
made, conduct analysis reviews and
compile publications.
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 Table 2. List of research articles in the literature review on risk factors for increasing MDR-TB rates

1300
Sample / Findings regarding Factors that
Author / year / Research / site Modifiable
No Title Characteristics of Instruments previous treatment cannot be
time design factors
respondents factors as predisposing modified
REVIEW

1 Desissa et al., Risk factors for the occurrence of Case-control study / 73 cases and 146 P a t i e n t Previous TB treatment was incomplete or -
20182 multidrug-resistant tuberculosis East Shoa, Ethiopia controls interviews, statistically associated with i n appropr i at e
among patients undergoing questionnaires MDR-TB development TB treatment
multidrug-resistant tuberculosis and clinical notes perkembangan regimen
treatment
2 Babure et al., Risk factors for multi drug- Case control study 21 cases, 44 controls Interviews, Multiple tuberculosis drug adherence to -
20193 resistant tuberculosis among / Referral Hospital questionnaires resistance is significantly taking anti-
tuberculosis patients Nekemte, West and patient associated with a history of tuberculosis
Ethopia medical records previous TB treatment drugs
3 Zereabruk et al, Determinants Of Multidrug Case control study / 254 Participants, Interview, History of previous Coming Relapsed
20204 Resistant Tuberculosis Among Tigray, Ethiopia 85 cases and 169 Review patient’s tuberculosis treatment back after no
Adults undergoing Treatment controls medical record, follow-up and
For Tuberculosis Questionnaire treatment failure
4 Zhang et al, 20165 Determinants of multidrug- Case control study / 287 cases and 291 Questionnaire Previous tuberculosis Drug-resistant -
resistant tuberculosis Henan, China controls treatment has been strongly TB can occur
associated with multiple when the drugs
drug resistance used to treat TB
are not taken as
prescribed
5 Gobena et al., Predictor of multidrug resistant Case control study / 61 cases and 61 Questionnaire, Previous tuberculosis inadequate
20188 tuberculosis in southwestern Southwest Ethiopia controls registration book treatment predisposes to instructions on
part of Ethiopia: a case control resistance anti-TB drugs,
study discontinuing
previous first-
line anti-TB
treatment for at
least one day
6 Muchena et al, Determinants of multidrug Case-control study / 80 cases and 240 Interview, History of previous No follow-up
20179 resistance among previously Zimbabwe controls questionnaire tuberculosis treatment and treatment
treated tuberculosis patients failure

7 Elduma et al, Assessment of the risk factors case-control study / 430 cases and 860 Questionnaire, The main risk factor for Discontinuation -
201916 associated with multidrug- Sudan controls Interview tuberculosis drug resistance of tuberculosis
resistant tuberculosis is a history of previous treatment
tuberculosis treatment
8 Baya et al, 201917 Clinical risk factors associated Cross-sectional study 214 patients with Tu b e r c u l o s i s Previous tuberculosis Tre at m e nt -
with multidrug-resistant /Bamako, Mali suspected multiple- patient register treatment program failure
tuberculosis (MDR-TB) drug resistance
tuberculosis

9 Alene et al., 201919 Risk factors for multidrug‐ Case–control study / 242 cases, 210 Patient medical History of previous TB Inadequate -
resistant tuberculosis Northwest Ethiopia controls records, and treatment is strongly treatment
laboratory associated with MDR-TB
records

Bali Medical Journal 2021; 10(3) Special Issue ICONURS: 1294-1303 | doi: 10.15562/bmj.v10i3.2901
 Sample / Findings regarding Factors that
Author / year / Research / site Modifiable
No Title Characteristics of Instruments previous treatment cannot be
time design factors
respondents factors as predisposing modified
10 Afshari et al, Determinant factors of drug a case control study / 22 cases and 88 Data on the Previous treatment history - -
201921 resistant tuberculosis North Iran controls patient’s medical is significantly associated
record with resistance to several
tuberculosis drugs
11 Ali et al., 201923 Predictors of Multidrug- Case-control study / 76 cases and 107 Interviews, Previous tuberculosis P r e v i o u s -
Resistant Tuberculosis (MDR- Sudan controls questionnaires treatment as a predisposing treatment
TB) in Sudan and patient factor for the development f a i l u r e ,
medical records. of resistance medication
adherence
12 Stosic et al., 201826 Risk factors for multidrug- Case-control study / 31 cases and 93 Interview, History of previous S k i p p i n g -
resistant tuberculosis among Serbia controls tuberculosis treatment treatment
tuberculosis patients

13 Mesfin et al, Drug-resistance patterns of Cross-sectional study 226 Participants Patient medical High prevalence of treatment Relapsed
201827 Mycobacterium tuberculosis / Addis Ababa, records, Check resistance among previously failure and loss
strains and associated risk Ethiopia list treated patients to follow-up,
factors discontinuation
among multi drug-resistant of anti-TB
tuberculosis suspected patients drugs during
treatment,
14 Okethwangu et Multidrug-resistant tuberculosis Case-control study 33 cases and 101 Medical records, History of previous Non-adherence
al., 201928 outbreak associated with poor / Arua district, controls interviews and tuberculosis treatment as to treatment
treatment adherence and delayed Uganda, questionnaires a predisposing factor for
treatment resistance
15 Mekonnen et al, Multidrug resistant tuberculosis: Cross-sectional study 124 pulmonary Semi-structural History of previous - -
201529 prevalence and risk factors / West Armachiho tuberculosis patients questionnaire. tuberculosis treatment as
and Metema district. with smear + a significant factor in the
(positive) development of multiple

Bali Medical Journal 2021; 10(3) Special Issue ICONURS: 1294-1303 | doi: 10.15562/bmj.v10i3.2901
drug resistance
16 Ullah et al., 201630 Pattern of Drug Resistance and Cross sectional 6006 Sample Interview The main risk factor is a Poor adherence, -
Risk Factors Associated with descriptive study history of previous TB lack of
Development of Drug Resistant / Lahore, Punjab, treatment monitoring
Mycobacterium tuberculosis Pakistan of treatment
and ineffective
TB Control
Programs
17 Rifat et al, 201531 Factors related to previous Case– control study / 250 MDR-TB Interview Patients who received Incomplete Adverse reactions
tuberculosis treatment of patients Bangladesh patients and 750 previous tuberculosis treatment or side effects
with multidrug- resistant non-MD patients treatment more than once of tuberculosis
tuberculosis treatment
18 Mohd Shariff et Previous treatment, sputum- Case-control study / 30 cases and 120 Patient medical History of TB treatment Treatment is -
al., 201632 smear non conversion, and Malaysia controls r e c o r d , nine times more likely to not according to
suburban living: The risk questionnaire develop MDR-TB schedule
factors of multidrug- resistant
tuberculosis among Malaysians
REVIEW

1301
 Sample / Findings regarding Factors that

1302
Author / year / Research / site Modifiable
No Title Characteristics of Instruments previous treatment cannot be
time design factors
respondents factors as predisposing modified
REVIEW

19 Asefa et al, 201733 Determinants of multidrug- Case–control study / 229 cases and 481 Q uest ionnaire A history of previous Tre at m e nt -
resistant tuberculosis Addis Ababa controls and interviews, tuberculosis treatment failure
is strongly associated
with resistance to several
tuberculosis drugs
20 Sharma et al., Factors Associated with the Case–control study 247 cases and 494 Live interview Resistant patients have Failure on -
201934 Development of Secondary / Madhya Pradesh, controls and review of had one or two previous p r e v i o u s
Multidrug‑ resistant Tuberculosis Middle part of India medical records tuberculosis treatments tuberculosis
treatment
21 Chuchottaworn et Risk Factors for Multidrug- Case−control study 145 cases, 145 Patient medical Patients on previous Tre at m e nt -
al., 201535 Resistant Tuberculosis among / Lung Center controls record treatment are more likely to failure
Patients with Pulmonary Institute, Thailand have MDR-TB
Tuberculosis
22 Dzeyie et al, Epidemiological and behavioral Cross-sectional study 250 Patients Interview, semi- Previous tuberculosis Failure of first- -
201936 correlates of drug-resistant / Delhi, India structured treatment has been strongly line therapy
tuberculosis in a Tertiary Care questionnaire associated with multiple
Centre drug resistance
23 Gaborit et al, Characteristics and outcome of case-control study / 134 tuberculosis Questionnaire, Previous tuberculosis Tre at m e nt -
201837 multidrug-resistant tuberculosis West France patients, 44 Patient medical treatment is a factor failure
in a low-incidence area diagnosed with record associated with multiple
multidrug resistance drug resistance
and 90 patients
susceptible to
tuberculosis drugs
24 Hameed et al, Drug resistance profile of Cross sectional study / 863 Sample Inter v ie w, Previous tuberculosis - -
201938 Mycobacterium tuberculosis and Lahore, Pakistan patient medical treatment was significantly
predictors associated with the record associated with the
development of drug resistance development of multiple
drug resistance
25 Dessalegn et al., Predictors of multidrug resistant Case-control study / 103 cases and 103 Interviews, Previous tuberculosis unsuccessful -
201639 tuberculosis among adult Saint Peter Hospital, controls questionnaires, treatment predisposes to treatment,
patients Addis Ababa, medical records/ multiple tuberculosis drug i n appropr i at e
Ethiopia registration resistance treatment
books r e g i m e n ,
inadequate or
irregular drug
supply, erratic
and infrequent
consumption of
anti-TB drugs,
unsatisfactor y
patient or doctor
compliance, lack
of medication
supervision,

Bali Medical Journal 2021; 10(3) Special Issue ICONURS: 1294-1303 | doi: 10.15562/bmj.v10i3.2901
 Sample / Findings regarding Factors that
Author / year / Research / site Modifiable
No Title Characteristics of Instruments previous treatment cannot be
time design factors
respondents factors as predisposing modified
26 Fregona et al., Risk factors associated with Cross-sectional study 1,669 people M a i n Previous tuberculosis Leave or stop -
201740 multidrug-resistant tuberculosis / Espírito Santo, underwent anti- information treatment predisposes to treatment
Brazil tuberculosis drug system multiple tuberculosis drug unilaterally
susceptibility testing resistance
27 Workicho et al., Risk factors for multidrug- Case-control study / 180 (90 cases and 90 Interviews, Respondents with a history wrong way to
201741 resistant tuberculosis among St. Peter TB hospital, controls) questionnaires of previous TB treatment take medicine -
tuberculosis patients Addis Ababa, and medical were 21 times more likely to
Ethiopia records develop MDR-TB
28 Fambirai, 201542 Factors associated with Case control study / 42 cases and 84 Semi-structured A very significant risk factor S t o p p i n g -
occurrence of multi drug harare controls, interviews, is previous tuberculosis tuberculosis
resistant tuberculosis questionnaires. treatment treatment
Check list
29 Huai et al., 201643 Proportions and Risk Factors Case–Control Study / 61 cases and 110 Questionnaire, MDR-TB among previously Long-term -
of Developing Multidrug China controls interview treated patients was much TB treatment
Resistance Among Patients with higher than in new patients provides more
Tuberculosis opportunity for
interruption and
irregular and
non-standard
therapy.

Bali Medical Journal 2021; 10(3) Special Issue ICONURS: 1294-1303 | doi: 10.15562/bmj.v10i3.2901
REVIEW

1303