Annual trends in Mycobacterium tuberculosis detection and rifampicin resistance at a regional referral hospital in Northern Ghana, 2019–2024
6 affiliations
- 1Department of Laboratory Technology, Faculty of Health Science, Kumasi Technical University, Kumasi, Ghana
- 2Medicare College of Applied Sciences, Kumasi, Ghana
- 3Upper East Regional Hospital, Bolgatanga, Ghana
- 4Department of Biochemistry and Biotechnology, College of Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- 5Department of Medical Laboratory Sciences, School of Allied Health Sciences, University of Health and Allied Sciences, Ho, Ghana
- 6Elite Research and Data Science Institute, Kumasi, Ghana
Abstract
Background Tuberculosis (TB) remains an important public health problem in Ghana, while rifampicin-resistant TB (RR-TB) poses an additional challenge to TB control. Routine molecular diagnostic data can provide useful information on temporal patterns of TB detection and drug resistance, particularly in regions where population-based surveillance data are limited. However, findings from referral facilities may be influenced by referral patterns and access to diagnostic services and should therefore be interpreted within their health-system context. We conducted a cross-sectional study using historical GeneXpert MTB/RIF data collected from January 2019 to December 2024 at the Upper East Regional Hospital (UERH), a regional referral facility in Bolgatanga, Ghana. Data were extracted from GeneXpert laboratory and TB programme registers for patients tested for presumptive TB. MTB detection and rifampicin resistance were determined from GeneXpert MTB/RIF results. Temporal differences in categorical outcomes were assessed using Pearson’s chi-square test of independence. Multivariable logistic regression was used to identify factors independently associated with rifampicin resistance. A total of 6,897 GeneXpert MTB/RIF tests were included. The mean age of the tested population was 44.6 ± 20.4 years, and 56.7% were male. MTB was detected in 1,083 tests (15.7%). MTB detection varied significantly across study years (χ² = 28.46, p < 0.001), with positivity ranging from 9.8% in 2022 to 20.9% in 2021. Among MTB-positive tests, 192/1,083 (17.7%) showed rifampicin resistance. The annual proportion of rifampicin resistance ranged from 9.5% in 2020 to 23.1% in 2023 and varied significantly across years (χ² = 27.13, p < 0.001). Low MTB bacterial load was significantly more frequent among rifampicin-resistant cases. In multivariable analysis, female sex was associated with higher odds of rifampicin resistance after adjustment for age and MTB bacterial-load category (aOR = 1.44, 95% CI: 1.02–2.02; p = 0.037), while low MTB bacterial load was independently associated with rifampicin resistance after adjustment for age and sex (aOR = 9.62, 95% CI: 5.77–16.04; p < 0.001). MTB detection and rifampicin resistance showed substantial year-to-year variation among patients tested at UERH during 2019–2024. The 17.7% rifampicin-resistance proportion represents a hospital-based estimate among MTB-positive GeneXpert-tested cases and should not be interpreted as the population prevalence of RR-TB in the Upper East Region. The observed pattern nevertheless warrants further investigation to determine the contribution of referral patterns, targeted testing, previous treatment, and other programme factors to the high proportion of rifampicin resistance observed at this referral facility.
Related
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- Rapid detection of non-rifampicin resistant drug-resistant tuberculosis using Xpert MTB/XDR testing: Findings from a multisite drug-resistant tuberculosis case detection surge in Zambia
- Clinical and laboratory determinants of treatment response and rifampicin resistance among Xpert MTB/RIF-confirmed extrapulmonary tuberculosis patients: A prospective study from Central India
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BibTeX
@article{wireko2026annual,
title = {{Annual trends in Mycobacterium tuberculosis detection and rifampicin resistance at a regional referral hospital in Northern Ghana, 2019–2024}},
author = {Solomon Wireko and Joseph Nyarko and Kristine Harley Arthur-Quayson and Osman Abu and Rebecca Appiah and Mina Ofosu and Alexander Kwarteng and John Gameli Deku and Ebenezer Senu},
journal = {PLOS One},
year = {2026},
month = sep,
doi = {10.1371/journal.pone.0346447},
url = {https://doi.org/10.1371/journal.pone.0346447},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Annual trends in Mycobacterium tuberculosis detection and rifampicin resistance at a regional referral hospital in Northern Ghana, 2019–2024
AU - Solomon Wireko
AU - Joseph Nyarko
AU - Kristine Harley Arthur-Quayson
AU - Osman Abu
AU - Rebecca Appiah
AU - Mina Ofosu
AU - Alexander Kwarteng
AU - John Gameli Deku
AU - Ebenezer Senu
PY - 2026
DA - 2026/09/18
JO - PLOS One
DO - 10.1371/journal.pone.0346447
UR - https://doi.org/10.1371/journal.pone.0346447
AB - Background Tuberculosis (TB) remains an important public health problem in Ghana, while rifampicin-resistant TB (RR-TB) poses an additional challenge to TB control. Routine molecular diagnostic data can provide useful information on temporal patterns of TB detection and drug resistance, particularly in regions where population-based surveillance data are limited. However, findings from referral facilities may be influenced by referral patterns and access to diagnostic services and should therefore be interpreted within their health-system context. We conducted a cross-sectional study using historical GeneXpert MTB/RIF data collected from January 2019 to December 2024 at the Upper East Regional Hospital (UERH), a regional referral facility in Bolgatanga, Ghana. Data were extracted from GeneXpert laboratory and TB programme registers for patients tested for presumptive TB. MTB detection and rifampicin resistance were determined from GeneXpert MTB/RIF results. Temporal differences in categorical outcomes were assessed using Pearson’s chi-square test of independence. Multivariable logistic regression was used to identify factors independently associated with rifampicin resistance. A total of 6,897 GeneXpert MTB/RIF tests were included. The mean age of the tested population was 44.6 ± 20.4 years, and 56.7% were male. MTB was detected in 1,083 tests (15.7%). MTB detection varied significantly across study years (χ² = 28.46, p < 0.001), with positivity ranging from 9.8% in 2022 to 20.9% in 2021. Among MTB-positive tests, 192/1,083 (17.7%) showed rifampicin resistance. The annual proportion of rifampicin resistance ranged from 9.5% in 2020 to 23.1% in 2023 and varied significantly across years (χ² = 27.13, p < 0.001). Low MTB bacterial load was significantly more frequent among rifampicin-resistant cases. In multivariable analysis, female sex was associated with higher odds of rifampicin resistance after adjustment for age and MTB bacterial-load category (aOR = 1.44, 95% CI: 1.02–2.02; p = 0.037), while low MTB bacterial load was independently associated with rifampicin resistance after adjustment for age and sex (aOR = 9.62, 95% CI: 5.77–16.04; p < 0.001). MTB detection and rifampicin resistance showed substantial year-to-year variation among patients tested at UERH during 2019–2024. The 17.7% rifampicin-resistance proportion represents a hospital-based estimate among MTB-positive GeneXpert-tested cases and should not be interpreted as the population prevalence of RR-TB in the Upper East Region. The observed pattern nevertheless warrants further investigation to determine the contribution of referral patterns, targeted testing, previous treatment, and other programme factors to the high proportion of rifampicin resistance observed at this referral facility.
SN - 1932-6203
ER -