Background: It was estimated that China carried the highest number of multidrug-resistant tuberculosis (MDR-TB) cases in the world. Sichuan is a populous province located in the southwest of China, where the disastrous May 12th Wenchuan Earthquake (2008) broke out. Surveillance data showed that TB was most serious infectious diseases in Sichuan. No evidence of high quality about local magnitude of MDR-TB and the risk factors are available at present. Objectives: To investigate magnitude of MDR-TB in Sichuan against other provinces in China, and find out the risk factors to inform policy-making. Methods: Secondary study: systematic review procedure was applied to investigate the magnitude of MDR-TB. Primary study: logistic regression model was applied to analyze the risk factors. Results: The primary, acquired and combined MDR-TB prevalence of 2005 was 2.64, 6.20 and 3.84 times of 1985 respectively, all showing an upward trend (P ≤ 0.05). They were higher than the national average level in Sichuan (P ≤ 0.05), ranking 11th, 3rd and 6th respectively. Anti-TB treatment history was significantly correlated withMDR-TB (Odds Ratio, OR11.93, 95%CI 6.80-20.94), and the factors which hindered the whole course (at least 6 months), full dose and standard treatment process might contribute to the development of drug resistance, such as resources limitation, variations of DOTS implementation and children vaccination among different areas, floating population, incomplete supervision of medicine taking, unreasonable regimen, poor compliance, unavailable of anti-TB drug, and the National Essential Medicine List for Local Use not providing enough guidance because of the lack of drug combination and dosage. Conclusions: MDR-TB especially acquired MDR-TB in Sichuan should be paid special attention. It is necessary to increase financial support for local research and activities, and to provide high quality evidence to understand the crucial point of MDR-TB control, so as to enhance the relevance and sustainability of policy-making. Key words: Multidrug-resistant tuberculosis (MDR-TB); Epidemiology; Risk factors; Sichuan Province. This study is funded by project Evidence-based research of multidrugresistant tuberculosis prevention and control in Sichuan province (2008SG0017) from Science and Technology Bureau of Sichuan Province, Sichuan Provincial People s Government, China.