Predictive Factors Associated With Multidrug‐Resistant Tuberculosis Among Tuberculosis Patients in Southwest Ethiopia: An Unmatched Case‐Control Study

ABSTRACT Background Multidrug‐resistant tuberculosis (MDR‐TB) presents a significant public health challenge, particularly in resource‐limited settings like Ethiopia. Identifying factors associated with MDR‐TB is essential for designing effective control strategies. The objective of this study was to identify the determinants of multidrug‐resistant tuberculosis (MDR‐TB) in southwest Ethiopia, to inform targeted public health interventions, improve prevention and control strategies, and support evidence‐based planning in regions with limited resources and a high burden of drug‐resistant TB. Methods An unmatched case‐control study was conducted from October 2022 to February 2023 in Jimma and Illubabor zones, located in Southwest Ethiopia. A total of 201 participants were initially selected, of whom 200 (66 MDR‐TB cases and 134 drug‐susceptible TB controls) completed the study and were included in the final analysis. Data were collected through interviewer‐administered questionnaires and review of medical records. Variables with a p ‐value < 0.25 in bivariable analysis were entered into multivariable logistic regression to identify independent predictors of MDR‐TB. Adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were used, and statistical significance was declared at p < 0.05. Results Among the 200 participants included, several factors were significantly associated with MDR‐TB. Compared to those aged 15–24 years, participants aged 25–34 years (AOR = 3.8, 95% CI: 1.34–8.36) and 35–44 years (AOR = 3.3, 95% CI: 1.42–7.65) had higher odds of MDR‐TB. Other significant predictors included urban residence (AOR = 2.1), contact with TB or known MDR‐TB patients (AOR = 2.21), HIV infection (AOR = 1.9), substance use (alcohol, khat, illicit drugs), psychological illness (AOR = 9.4), previous TB treatment (AOR = 5.3), retreatment history (AOR = 13.9), low BMI (< 18.5 kg/m²; AOR = 3.9), living more than 25 km from treatment centers (AOR = 6.2), and perceived social stigma (AOR = 5.2). Conclusion This study identified multiple independent predictors of MDR‐TB, including previous TB treatment, retreatment history, substance use, HIV infection, psychological illness, malnutrition, and limited access to healthcare. Sociodemographic factors such as age, urban residence, and perceived stigma were also significant. These findings highlight the need for integrated TB control strategies addressing clinical management, behavioral and psychosocial support, and improved healthcare access to effectively reduce MDR‐TB in Southwest Ethiopia.