Thorax doi:10.1136/thoraxjnl-2011-200018
  • Tuberculosis
  • Original article

Factors contributing to the high prevalence of multidrug-resistant tuberculosis: a study from China

  1. Liyuan Han1
  1. 1Department of Social Medicine, School of Public Health, Harbin Medical University, Harbin, Heilongjiang, People's Republic of China
  2. 2School of Public Health, La Trobe University, Victoria, Australia
  3. 3Heilongjiang Provincial Center for STD Prevention and Control, Harbin, Heilongjiang, People's Republic of China
  4. 4Heilongjiang Provincial Center for Tuberculosis Prevention and Control, Harbin, Heilongjiang, People's Republic of China
  5. 5School of Public Health, Peking University, Beijing, People's Republic of China
  1. Correspondence to Professor Qunhong Wu, School of Public Health, Harbin Medical University, 157 Baojian Road, Nangang District, Harbin, Heilongjiang 10081, People's Republic of China; wuqunhong{at}
  1. Contributors QW, LG, YX and YH designed and planned this study; YX, LG, HS, XY, FL, HL and HF undertook the fieldwork and data collection; LL, NN, LH and YC performed statistical analysis; LL, QW, YH and CL integrated data analysis and wrote a first draft; QW, LL and CL revised the paper.

  • Received 12 February 2011
  • Accepted 4 January 2012
  • Published Online First 8 March 2012


Background The rapid spread of multidrug-resistant tuberculosis (MDR-TB) has attracted global concerns. This study aimed to identify factors contributing to the high prevalence of MDR-TB in China's Heilongjiang province.

Methods A cross-sectional survey following the WHO/International Union Against Tuberculosis and Lung Disease guidelines was conducted with consecutive recruitment of patients with TB in 30 counties selected at random in Heilongjiang in 2004. A total of 1995 patients were tested for MDR-TB. Factors associated with MDR-TB were identified through multilevel models and traditional logistic regression analysis, along with in-depth interviews with nine patients, five healthcare managers and four doctors.

Results 241 patients (12%) were identified with MDR-TB. The retreatment patients were 5.48 times (95% CI 4.04 to 7.44) more likely to have MDR-TB than newly diagnosed patients. The patients who were treated with isoniazid and rifampin for >180 days were 4.82 times (95% CI 2.97 to 7.81) more likely to develop MDR-TB than those treated <180 days. Age and delay in initiating TB treatment were associated with MDR-TB. Financial burden, poor knowledge and side effects of TB treatment were perceived by the interviewees as influencing factors. Lack of coordination of services, unsatisfactory supervision of treatment and infection control jeopardised the control of MDR-TB.

Conclusions Inappropriate treatment is the most important influencing factor of MDR-TB. Increasing people's awareness of TB, early detection and appropriate treatment of patients with TB should become a priority, which requires strong commitment and collaboration among health organisations and greater compliance with TB treatment guidelines by service providers and patients.


  • Libo Liang, Lijun Gao, Yanguang Xie contributed equally to this article.

  • Funding Funding was provided in part by the China Medical Board and the China Global Fund TB Programme 08-929.

  • Competing interests None.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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