Abstract
Background: Drug-resistant tuberculosis (DR-TB) remains a significant global public health challenge, particularly in regions with a high burden of TB. Nepal, one such country, has been witnessing a rise in DR-TB cases, posing serious challenges to TB control efforts. Despite this growing concern, there is a lack of localized data on the risk factors contributing to DR-TB, especially in urban areas like Pokhara. This study aims to fill that gap by assessing the prevalence of DR-TB and identifying associated demographic, behavioral, and clinical factors among TB patients in Pokhara Metropolitan City, Gandaki Province, Nepal. Methods: A retrospective cross-sectional analysis was conducted using 617 TB patient records from the Pokhara Metropolitan Health Office for the fiscal year 2078/79 (July 2021 to July 2022). Data on demographic characteristics, clinical history, treatment regimens, and behavioral factors such as smoking and alcohol consumption were extracted. Descriptive statistics were used to determine the prevalence of DR-TB, and bivariate logistic regression was applied to identify statistically significant risk factors associated with DR-TB. Results: Among the 617 TB patients, the prevalence of DR-TB was 2.6%. Most patients were male (57.4%) and within the 21-30 age group (26.9%). Pulmonary bacteriologically confirmed TB was the most common type (53.6%), predominantly affecting adults (98.1%). The primary treatment regimen administered was 2HRZE + 4HR (78.8%). TB-HIV co-infection was found in 1.9% of cases, with all co-infected patients receiving antiretroviral therapy. In a bivariate analysis, individuals with current smoking status (UOR: 9.384; CI: 3.342-26.351), exposure to smoking (UOR: 8.550: CI: 2.916-25.064), and current alcohol consumption (UOR: 4.553, CI: 1.406-14.745) had a higher likelihood of DR-TB. In a multivariate analysis, exposure to smoking (AOR: 5.317; CI: 1.394-20.274) and current alcohol consumption (AOR: 6.84; CI: 2.071-22.58) emerged as independent predictors associated with an increased risk of DR-TB. Conclusion: The study revealed a relatively low prevalence of DR-TB among TB patients in Pokhara, with strong associations between DR-TB and lifestyle factors such as smoking and alcohol use. These findings underscore the need for targeted public health interventions addressing behavioral risk factors to reduce DR-TB incidence. Enhanced surveillance, public awareness, and preventive strategies should be integrated into TB control programs to mitigate the spread of DR-TB in this region. Moreover, targeted behavioral interventions may be crucial in curbing the emergence of DR-TB, particularly in high-burden urban centers.