A review of drug-resistant tuberculosis in Northern Region of Zambia


By : N Monde 1,2 , M Zulu3 , M Tembo, 3 , R Handema 3 , G Chongwe 1 , M Munyeme 4 , S Malama.

1 Department of Disease control, School of Veterinary Medicine, University of Zambia, Lusaka, Zambia;

2 Department of Pathology and Microbiology, School of Medicine, University of Zambia, Lusaka, Zambia;

3 Tropical Diseases Research Center, Ndola, Zambia;

4 Department of Biological Sciences. School of Natural Science University of Zambia, Lusaka, Zambia

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Zambia is one of the countries in sub-Saharan Africa affected by multi-drug/Rifampicin-resistant tuberculosis (TB). However, the drug-resistant TB situation over the years has not been described in various regions of the country. Consequently, this review aims to describe the multi-drug resistant TB situation in the Northern region of Zambia over a four-year period to establish gaps in the diagnosis and management of tuberculosis in this region. This is based on data generated from a Regional TB Reference Laboratory.


Data was retrospectively reviewed on 248 GeneXpert Rifampicin resistant TB samples at diagnosis referred for culture at the Regional tuberculosis reference Laboratory over a four-year period (2016-2019). The regional TB Reference laboratory is the only laboratory in the Northern Region of Zambia that provides Mycobacterium culture and drug susceptibility-testing services. The Region comprises three provinces namely; Copperbelt, Luapula, and North-western. All clinical samples from the various health facilities in this region which by Xpert MTB/RIF test shows the presence of Mycobacterium tuberculosis resistant to Rifampicin are referred to this laboratory for culture and drug susceptibility testing to first-line and second-line TB drugs. Data was entered into a pre-tested standardized checklist and later entered into Excel software. Double-blinded checking was done by two independent data clerks to minimize duplication of cases. Cleaned data was then exported to SPSS version 25 for analysis. Descriptive statistics were performed and reported as frequencies and graphs.


Out of 248 Xpert/MTB Rifampicin resistant samples, 224 cases were confirmed as drug-resistant tuberculosis, and of these 71(31%) were from female patients and177(79%) were from male patients. Their ages ranged from 9 months to 64 years with a mean age of 35years. Sixty percent (135/224) of these were multi-drug resistant tuberculosis and 35.8% (78/224) were confirmed as Rifampicin Mono-resistant. Only 1.3% (3/224) of the Multi-drug resistant Tuberculosis patients were Pre-extensively drug-resistant. Copperbelt province had the largest proportion (56%) of multi-drug resistant tuberculosis patients followed by Luapula (48%) and North-Western (30%) provinces.


This current study has indicated that despite a slight downward trend in terms of multi-drug resistant Tuberculosis cases, a high incidence of Multi-drug resistant tuberculosis among Rifampicin-resistant diagnosed patients was observed with high rates being recorded on the Copperbelt Province. We, therefore, recommend strengthened routine surveillance and improved case management of multi-drug resistant TB patients in the region. This should include the incorporation of Next-Generation sequencing in the diagnosis and clinical management of all MDR/RR TB cases.