Does the risk factor assessment help to reduce drug-resistant tuberculosis?

Dear Editor, The global burden of tuberculosis (TB) is not hidden from everyone. Every year, national and international annual reports show the prevalence, disease burden, and mortality of TB nationally and Worldwide.[1] However, there is a lack of adequate knowledge and understanding are not in common people regarding various categories of drug-resistant TB (DRTB).[2] They don’t have awareness and differentiation about mono-resistant, multidrug-resistant (MDR), poly-drug-resistant (pDR), pre-extensive drug resistance (Pre-XDR), extensive drug resistance (XDR), and total drug Resistant (TDR) types of category of TB. To understand about the risk factors and their prevalence is also very difficult for them. Recently published an article where the author team has assessed the risk factors of DRTB. After reading the article, we thought there was some information missing. They selected the bacteriologically confirmed cases of TB, though they did not reveal how those cases were called bacteriologically confirmed cases. Either those cases were confirmed by Cartridge Base Nucleic Acid Amplification Technology (CBNAAT), Line probe assay (LPA) type molecular testing methods, or solid/liquid culture type conventional gold standard methods.[1] Confirming the cases using CBNAAT or LPA can’t be called confirmed as they detect only genetic material and do not tell whether it’s active or past infection. Due to that limitation, those molecular methods are not used as a gold standard for TB diagnosis.[3] Another point, we noted is that they have selected DRTB cases only, but there is no clarification regarding DRTB categories. Are all cases mono-drug-resistant TB, MDR TB, or any other category of DRTB? Also, how those cases were confirmed drug-resistance, either by molecular methods or conventional methods, is not mentioned.[1] The above points are not clear in the article as the author doesn’t have that information. When taking the data from any national program database, try to take a bifurcation of it too. A similar type of study was conducted and published in another journal where they assessed the Maharashtra data on various 14 risk factors. They have concluded that low economic status, low weight, low Body Mass Index, and Tobacco addiction are statistically significant in developing DRTB. The same results are shown in this study. In a previous study, they did the logistic regression to determine the major culprit of DRTB development and found Tobacco addiction.[4] In current times, addiction to tobacco and alcohol is increasing in our country as well as globally. Prevention of DRTB needs to avoid the necessary risk factors. We know that there are several other things (including some hidden factors) that play an important role in developing DRTB in patients. There is no full proof assurance regarding the prevention of DRTB even after avoiding all suggested risk factors, though we can try to reduce the risk of DRTB development in drug-sensitive T patients. Providing proper nutrition to TB patients will help to get a successful recovery rate as well as prevent DRTB development. The government has provided financial support to TB patients to get a good nutritious diet during the treatment phase by Nikshay Mitra and Nikshay Poshan Yojana.[5] We are still far away from reaching our goal to END TB till 2030 but risk factor avoidance will help to reach the goal very soon. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.