Tropical Medicine and Infectious Disease

Research

16 pages, 386 KB

Open AccessArticle

Evaluating Treatment and Safety Outcomes of a Shorter Regimen for Drug-Resistant TB in Nigeria: An Implementation Research Study

by Victor Babawale, Clement Adesigbin, Corinne S. Merle, Vanessa Veronese, Fatimata Bintou Sall, Benjamin Seydou Sombie, Eunice Nnaisa Jiya-Chitumu, Chizaram Onyeaghala, Adegboyega Moses Oyefabi, Rotimi Samuel Owolabi, Osman Eltaye, Olusoji Ige, Ogiri Sam, Obioma Akaniro, Adebola Lawanson, Victor Ombeka and Muse Fadeyi

Trop. Med. Infect. Dis. 2026, 11(3), 84; https://doi.org/10.3390/tropicalmed11030084 - 21 Mar 2026

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Abstract

The introduction of significantly shorter, all-oral regimens has significantly shifted the management of drug-resistant tuberculosis (DR-TB) towards a more tolerable and patient-centred therapeutic approach that aims to enhance treatment adherence, clinical outcomes, and quality of life among patients. Nigeria has gradually adopted this [...] Read more.

The introduction of significantly shorter, all-oral regimens has significantly shifted the management of drug-resistant tuberculosis (DR-TB) towards a more tolerable and patient-centred therapeutic approach that aims to enhance treatment adherence, clinical outcomes, and quality of life among patients. Nigeria has gradually adopted this all-oral, shorter regimen, but the impact of this regimen in programmatic settings has not yet been studied. In 2022, a longitudinal, two-armed cohort study was conducted to explore the effectiveness, safety, and feasibility of the all-oral shorter regimen in the programmatic management of RR/MDR-TB in Nigeria. Consenting and eligible RR/MDR-TB patients receiving the all-oral regimen (intervention group) in four states were consecutively enrolled and compared to those receiving the standard of care (SOC). Treatment effectiveness, proportion, and 95% confidence intervals of favourable and unfavourable outcomes were measured at the end of treatment and during follow-up (six and 12 months post-treatment). In total 383 Participants were followed monthly throughout the 9–12-month treatment phase and then reassessed at 6 and 12 months after treatment completion, giving a total possible observation period of up to 24 months (185 received the intervention and 198 the standard of care). At the end of follow-up, there was a higher but non-significant proportion of favourable outcomes among the intervention vs. SOC group (80% vs. 69.7%); a higher proportion of favourable outcomes was also noted at the end of treatment among intervention participants (81.1 vs. 76.8%). Around one third of patients reported at least one serious adverse event (SAE), with no significant differences between arms, and none were deemed related to the use of medication. Intervention participants reported greater improvements in health-related quality of life between baseline and four months compared to those receiving the SOC. These findings support the programmatic use of all-oral shorter treatment for RR/MDR-TB as a regimen that is effective, tolerable, safe, and associated with enhanced health-related quality of life for patients in Nigeria. Full article

(This article belongs to the Special Issue Tuberculosis Control in Africa and Asia)

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12 pages, 1018 KB

Open AccessArticle

Programmatic Results of Integrating Systematic TB Screening Across Diverse Outpatient Health System Entry Points in the Democratic Republic of the Congo

by Romain Kibadi Lungoy, Jean Ngoy Kitenge, Nuccia Saleri, Stephane Mbuyi Tshikunga, Papy Pululu, Emmanuelle Papot, Corinne Simone Merle, Anna Scardigli and Jean Pierre Malemba Tshibuyi

Trop. Med. Infect. Dis. 2026, 11(3), 83; https://doi.org/10.3390/tropicalmed11030083 - 17 Mar 2026

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Abstract

The Democratic Republic of the Congo faces a high tuberculosis (TB) burden. In 2022, 61% of an estimated 402,000 TB cases were reported (World Health Organization Global tuberculosis report). To enhance case detection, the national TB program (NTP) introduced a program quality and [...] Read more.

The Democratic Republic of the Congo faces a high tuberculosis (TB) burden. In 2022, 61% of an estimated 402,000 TB cases were reported (World Health Organization Global tuberculosis report). To enhance case detection, the national TB program (NTP) introduced a program quality and efficiency approach (PQE), integrating systematic TB screening into outpatient departments (OPDs). Observational data of the PQE on the TB care cascade (from screening to treatment) across 70 sites in Kinshasa that initiated PQE during the first quarter of 2023 are presented. Data were collected monthly and validated during supervision visits, and disaggregated by sex, healthcare facility type (public, private, or faith-based), facility level (primary or secondary), and OPD within each facility. In 2024, 639,464 individuals were consulted in various OPDs in the participating facilities, 57% of which were female. The median number needed to screen (NNS) was 22.1, with an interquartile range of [9.5–104.3]. There was a significantly lower NNS observed in general practice and human immunodeficiency virus departments. Throughout the TB care cascade, women were less likely than men to be screened, tested, or treated. These findings, to be interpreted within the context of Kinshasa pilot facilities, provide insights to the NTP for developing PQE implementation research aimed at understanding the reasons for these discrepancies and informing NTP scale-up at the national level. Full article

(This article belongs to the Special Issue Tuberculosis Control in Africa and Asia)

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10 pages, 3332 KB

Open AccessArticle

Incidence and Spatial Mapping of Tuberculosis and Multidrug-Resistant Tuberculosis in Libreville, Republic of Gabon, in 2022

by Casimir Manzengo, Nlandu Roger Ngatu, Stredice Manguinga-Guitouka, Fleur Lignenguet, Ghislaine Nkone-Asseko, Marie Nsimba-Miezi, Nobuyuki Miyatake, Jose Lami-Nzunzu and Tomohiro Hirao

Trop. Med. Infect. Dis. 2026, 11(1), 8; https://doi.org/10.3390/tropicalmed11010008 - 27 Dec 2025

Cited by 1 | Viewed by 895

Abstract

Background: Tuberculosis (TB) remains a major global health problem, and the WHO central Africa region continues to bear the heaviest disease burden. Gabon is one of the high-TB-burden countries in the world; however, its national TB program performance remains weak despite financial support [...] Read more.

Background: Tuberculosis (TB) remains a major global health problem, and the WHO central Africa region continues to bear the heaviest disease burden. Gabon is one of the high-TB-burden countries in the world; however, its national TB program performance remains weak despite financial support from international health agencies. Identifying and mapping high-TB- and multi-drug-resistant-TB (MDR-TB)-burden areas for targeted public health interventions was the objective of this study. Methods: A region-wide mixed method study was carried out, comprising ecological design and a desk review, with the use of medical records from TB diagnosis and care units in 12 health facilities located across the capital Libreville, Republic of Gabon, from 1 January through December 2022. Libreville is the region that bears the heaviest TB burden in Gabon. With the collaboration of the Agency for Space Studies and Observations (AGEOS, Gabon), collected data were transferred to and analyzed using QGIS software in order to develop satellite images. Results: In the Libreville health region, there were 4560 cases diagnosed in 2022, representing 77.9% of all cases in the country, with an annual incidence of 509 per 100,000. Spatial mapping of incident cases by county of residence showed that a large majority of the TB cases diagnosed at the CHUL care center in 2022 were from Nzeng-Ayong (range: 36–50 cases) and Owendo (26–35 cases), whereas higher TB incidence at the Nkembo care center was from Nzeng-Ayong (range: 356–455 cases) and Owendo (256–355 cases), followed by Nkembo, Akebe ville, Akebe Baraka, Akebe Plaine/plateau, Angondje, Angondje village, Charbonnages, Bikele, Pk11, Pk12, Pk9, Mindoube I, Mindoube II (66–255 cases), Sotega, and Nkok (46–65 cases). Other counties accounted for less than 45 TB cases. Considering MDR-TB cases, higher incidence was observed in Pk9 county, which accounted for six cases (14.6%), followed by Owendo, accounting for four (9.7%). Discussion: Findings suggest that Nzeng-Ayong and Owendo are high-TB-burden counties in Libreville, whereas Pk9 and Owendo counties are counties categorized as high-MDR-TB-incidence areas. They should be subject to targeted to public health interventions to enhance TB control in Libreville. Full article

(This article belongs to the Special Issue Tuberculosis Control in Africa and Asia)

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24 pages, 29797 KB

Open AccessArticle

Predictors of Tuberculous Meningitis Mortality Among Persons with HIV in Mozambique

by Edy Nacarapa, Isabelle Munyangaju, Dulce Osório and Jose-Manuel Ramos-Rincon

Trop. Med. Infect. Dis. 2025, 10(10), 276; https://doi.org/10.3390/tropicalmed10100276 - 24 Sep 2025

Viewed by 2721

Abstract

Background: Tuberculous meningitis (TBM) is the most severe form of tuberculosis and is associated with high morbidity and mortality, especially in resource-limited settings. In Mozambique, where both tuberculosis and HIV are highly prevalent, TBM poses significant diagnostic and therapeutic challenges. This study [...] Read more.

Background: Tuberculous meningitis (TBM) is the most severe form of tuberculosis and is associated with high morbidity and mortality, especially in resource-limited settings. In Mozambique, where both tuberculosis and HIV are highly prevalent, TBM poses significant diagnostic and therapeutic challenges. This study aimed to describe the clinical characteristics and to identify predictors of TBM mortality among persons living with HIV (PLWH) in a rural hospital in Mozambique. Methods: We conducted a retrospective cohort study at Carmelo Hospital of Chokwe (CHC) between 2015 and 2020. We included 372 PLWH diagnosed with TBM (PTBM); data on demographics, clinical presentation, and laboratory findings were extracted from patient records. TBM diagnosis was considered for confirmed cases based on a hospital-adapted algorithm incorporating clinical features, cerebrospinal fluid (CSF) analysis, TB-LAM, and Xpert MTB/RIF testing. Cox proportional hazard models were used to identify independent predictors of mortality, and Kaplan–Meier survival curves with log-rank tests were used to assess survival differences across clinical subgroups. Significance was considered at a p value ≤ 0.05 with an adjusted hazard ratio (AHR) 95% CI in the multivariate analysis. Results: Overall, 372 PTBM contributed to a total of 3720 person-months (PM) of treatment follow-up, corresponding to a mortality incidence of 3.76 deaths per 100 person-months. Factors independently associated with increased mortality included male sex (adjusted hazard ratio [aHR]: 1.80; 95% CI: 1.21–2.68; p = 0.004), BMI < 18.5 kg/m² (aHR: 2.84; 95% CI: 1.46–5.55; p = 0.002), Immunovirological failure to ART (aHR: 2.86; 95% CI: 1.56–5.23; p = 0.001), CSF opening pressure >40 cmH₂O (aHR: 2.67; 95% CI: 1.46–4.86; p = 0.001), and TBM severity grading III (aHR: 4.59; 95% CI: 1.79–11.76; p = 0.001). TBM involving other organs also significantly worsened survival (aHR: 2.03; 95% CI: 1.27–3.25; p = 0.003). Conclusions: TBM mortality in PLWH was driven by ART failure, high CSF pressure, and malnutrition. Male sex and severe neurology also increased risk. Urgent interventions are proposed: optimize ART, manage intracranial pressure, provide nutritional support, and use corticosteroids. An integrated care approach is essential to improving survival in resource-limited settings. Full article

(This article belongs to the Special Issue Tuberculosis Control in Africa and Asia)

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16 pages, 383 KB

Open AccessArticle

Alcohol Consumption of Male Tuberculosis Index Cases and Tuberculosis Transmission Among Social Contacts in Puducherry, India: A Cross-Sectional Analytical Study

by Charutha Retnakumar, Palanivel Chinnakali, Balaji Bharadwaj, Karikalan Nagarajan and Sonali Sarkar

Trop. Med. Infect. Dis. 2025, 10(9), 248; https://doi.org/10.3390/tropicalmed10090248 - 30 Aug 2025

Viewed by 1917

Abstract

We aimed to compare the proportion of tuberculosis infection among social contacts of male tuberculosis Index case with and without alcohol use in the Puducherry district. A cross-sectional study using ego-centric approach was conducted between November 2023 and May 2024. A total of [...] Read more.

We aimed to compare the proportion of tuberculosis infection among social contacts of male tuberculosis Index case with and without alcohol use in the Puducherry district. A cross-sectional study using ego-centric approach was conducted between November 2023 and May 2024. A total of 713 social contacts of 106 male pulmonary tuberculosis index cases were enrolled, stratified by alcohol-use (AUDIT ≥ 8): 358 contacts from 45 alcohol-using cases and 355 from 61 non-alcohol-use cases. Social contacts were defined based on the frequency and duration of shared indoor exposure with index cases within the past three months. Tuberculosis infection was screened with Cy-Tb skin test (≥5 mm induration) at the third month of index case treatment. Univariate and multivariable analysis were conducted to identify factors associated with tuberculosis transmission. Among the 358 social contacts of alcohol-use index cases, 33.8% (n = 121; 95% CI, 29.1–38.8%) tested positive for tuberculosis infection, significantly higher than 21.7% (n = 77; 95% CI, 17.7–26.3%) among 355 contacts of non-alcohol-use cases. Regression analysis revealed that contacts of alcohol-using index cases (aOR = 1.6, p < 0.05), were significantly associated with tuberculosis infection. Alcohol-use among tuberculosis patients significantly increases the risk of tuberculosis infection in their social networks. Full article

(This article belongs to the Special Issue Tuberculosis Control in Africa and Asia)

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13 pages, 445 KB

Open AccessArticle

Unmasking the Determinants of Loss to Follow-Up in Pulmonary Tuberculosis: A Study in Selangor, Malaysia

by Sumarni Mohd Ghazali, Kee Chee Cheong, Mohamad Nadzmi Md Nadzri, Nur’Ain Mohd Ghazali, Lim Mei Cheng, Lonny Chen Rong Qi Ahmad, Mohd Kamarulariffin Kamarudin, Nur Ar Rabiah Ahmad, Asrul Anuar Zulkifli, Cheong Yoon Ling, Qistina Ruslan, Sarbhan Singh, Balvinder Singh Gill, Asmah Razali and Nuur Hafizah Md Iderus

Trop. Med. Infect. Dis. 2025, 10(8), 226; https://doi.org/10.3390/tropicalmed10080226 - 12 Aug 2025

Cited by 1 | Viewed by 2364

Abstract

Adherence to the 6-month tuberculosis (TB) treatment regimen is challenging due to its duration and side effects, with various factors influencing patient compliance. A retrospective cross-sectional study was conducted among newly diagnosed pulmonary TB (pTB) patients in Selangor, Malaysia, undergoing treatment in government [...] Read more.

Adherence to the 6-month tuberculosis (TB) treatment regimen is challenging due to its duration and side effects, with various factors influencing patient compliance. A retrospective cross-sectional study was conducted among newly diagnosed pulmonary TB (pTB) patients in Selangor, Malaysia, undergoing treatment in government primary care clinics and hospitals. Patients who were lost to follow-up (LTFU) within the first six months were determined by reviewing patient records and the national TB registry. Logistic regression analysis identified sociodemographic and clinical factors associated with LTFU. Of the 699 pTB patients, 55 (7.9%) were lost to follow-up. Factors significantly associated with LTFU included age (higher in 25–44-year-olds, adjusted odds ratio (aOR): 2.83), unmarried status (aOR: 2.17), lower education level (aOR: 6.13), being a smoker (aOR: 2.65), and unawareness of TB diagnosis (aOR: 38.14). A significant interaction was found between education level and awareness of diagnosis, with unawareness having a stronger association with LTFU among higher-educated patients. Young adults, those with a lower education level, unmarried individuals, smokers, and those unaware of their TB diagnosis are at higher risk of LTFU. These factors can be used for rapid risk assessment. Intensive counselling and health education at treatment initiation, particularly for at-risk patients, are crucial for preventing LTFU. Full article

(This article belongs to the Special Issue Tuberculosis Control in Africa and Asia)

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16 pages, 678 KB

Open AccessArticle

Evaluating the Gaps in the Diagnosis and Treatment in Extra-Pulmonary Tuberculosis Patients Under National Tuberculosis Elimination Programme (NTEP) Guidelines: A Multicentric Cohort Study

by Sanjeev Sinha, Renuka Titiyal, Prasanta R. Mohapatra, Rajesh K. Palvai, Itishree Kar, Baijayantimala Mishra, Anuj Ajayababu, Akanksha Sinha, Sourin Bhuniya and Shivam Pandey

Trop. Med. Infect. Dis. 2025, 10(8), 206; https://doi.org/10.3390/tropicalmed10080206 - 24 Jul 2025

Cited by 1 | Viewed by 2099

Abstract

Extra-pulmonary tuberculosis (EPTB) can affect any organ of the body, producing a wide variety of clinical manifestations that make the diagnosis and treatment of EPTB challenging. The optimum treatment varies depending on the site of EPTB, its severity, and response to treatment. There [...] Read more.

Extra-pulmonary tuberculosis (EPTB) can affect any organ of the body, producing a wide variety of clinical manifestations that make the diagnosis and treatment of EPTB challenging. The optimum treatment varies depending on the site of EPTB, its severity, and response to treatment. There is often uncertainty about the best management practices, with a significant departure from national guidelines. This study aims to identify gaps and barriers in adhering to the national guidelines for the diagnosis and treatment of EPTB. We included 433 patients having EPTB and followed up at predefined intervals of 2 months, 6 months, 9 months, and 12 months. Questionnaire-based interviews of the treating physician and the patients in different departments were conducted. For confirmatory diagnosis, heavy dependence on clinical-radiological diagnosis without microbiological support was observed, which is a deviation from National Tuberculosis Elimination Programme (NTEP) guidelines and raises concerns about the potential for misdiagnosis and overtreatment. Apart from patient delays, long health system delays in EPTB were observed. The median patient delay, health system delay, and total treatment delay times were 4.2, 4, and 10.1 weeks, respectively. To enhance EPTB diagnosis and management, there is a pressing need for improved access to microbiological testing, enhanced physician training on adherence to NTEP guidelines, and greater utilisation of imaging and histopathological techniques. Full article

(This article belongs to the Special Issue Tuberculosis Control in Africa and Asia)

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16 pages, 782 KB

Open AccessArticle

Impact of Nutritional Counselling and Support on Body Mass Index Recovery and Treatment Outcomes Among Tuberculosis Patients in the Lao People’s Democratic Republic

by Donekham Inthavong, Hend Elsayed, Phonesavanh Keonakhone, Vilath Seevisay, Somdeth Souksanh, Sakhone Suthepmany, Misouk Chanthavong, Xaysomvang Keodavong, Phonesavanh Kommanivanh, Phitsada Siphanthong, Phengsy Sengmany, Buahome Sisounon, Jacques Sebert, Manami Yanagawa, Fukushi Morishita, Nobuyuki Nishikiori and Takuya Yamanaka

Trop. Med. Infect. Dis. 2025, 10(7), 198; https://doi.org/10.3390/tropicalmed10070198 - 15 Jul 2025

Cited by 1 | Viewed by 1595

Abstract

Tuberculosis (TB) and undernutrition are intricately linked, significantly impacting health outcomes. However, nutritional support for TB patients is not systematically implemented in Lao People’s Democratic Republic (Lao PDR). This study evaluated the effects of nutritional counselling and support on nutritional recovery and TB [...] Read more.

Tuberculosis (TB) and undernutrition are intricately linked, significantly impacting health outcomes. However, nutritional support for TB patients is not systematically implemented in Lao People’s Democratic Republic (Lao PDR). This study evaluated the effects of nutritional counselling and support on nutritional recovery and TB treatment outcomes. A longitudinal study involved 297 individuals with drug-susceptible TB, 39.4% of whom had a body mass index (BMI) below 18.5 kg/m². Participants were divided into an observation group and an intervention group, the latter receiving nutritional support. Nutritional support included ready-to-use therapeutic food and therapeutic milk products, tailored to patients’ nutritional status. Data collection was conducted at four intervals during treatment. By the end of treatment, 84.3% of participants improved their nutritional status to a BMI of 18.5 kg/m² or higher. The intervention group showed early nutritional recovery, particularly during the intensive phase of TB treatment, although the p-value (p = 0.067) should be interpreted with caution. The overall treatment success rate was high at 90.6%, with no significant difference between groups. Factors associated with treatment success included age under 45, HIV-negative status, a BMI of 18.5 kg/m² or higher, and clinically diagnosed pulmonary TB. Further assessment is required for the operational feasibility to provide systematic nutritional assessment and counselling for people with TB in Lao PDR. Full article

(This article belongs to the Special Issue Tuberculosis Control in Africa and Asia)

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15 pages, 1092 KB

Open AccessArticle

Qualitative Study of Nutritional Support-Related Perceptions and Preferences Among Persons Affected by TB, Family Caregivers, and Healthcare Providers in India

by Balaji Ramraj, Karikalan Nagarajan, Debjani Ram Purakayastha, Major Madhukar, Makesh Kumar, Neha Raj, Sarath Kumar, Banappa S. Unger, Nithin Rajamani, Sampada Dipak Bangar, Murugesan Periyasamy, Hansraj Choudhary, Yasaswany Santhoshkumar, Ramesh Kumar, Seema Sahay, Nivedita Gupta and Chandrasekaran Padmapriyadarsini

Trop. Med. Infect. Dis. 2025, 10(4), 114; https://doi.org/10.3390/tropicalmed10040114 - 21 Apr 2025

Cited by 2 | Viewed by 2943

Abstract

Evidence on the implementation aspects of nutritional support interventions for persons with TB in India is limited. This qualitative study employed focus group discussions with persons with TB (n = 71), their family caregivers (n = 17), and healthcare providers (n = 18). [...] Read more.

Evidence on the implementation aspects of nutritional support interventions for persons with TB in India is limited. This qualitative study employed focus group discussions with persons with TB (n = 71), their family caregivers (n = 17), and healthcare providers (n = 18). The study was conducted from August 2023 to April 2024 in five states in India. Participants’ knowledge, perceptions, and practices about nutritional intake, experiences, and expectations when accessing nutritional support were explored. Four nutrition-related themes emerged: (a) the experiences and perceptions of persons with tuberculosis and their caregivers, explained by their understanding of the importance of adequate nutrition and TB cures; (b) changes in food practices, explained by protein food adoption, alongside food insecurity experienced by those in poverty; (c) Direct Benefit Transfer (DBT)-related issues, explained by insufficiency and access-related gaps; and (d) preferred choices for nutrition support delivery, explained by less preference towards the involvement of intermediaries and a public distribution system alongside preference for the provision of nutrition through treatment facilities. Our findings underscore the importance of the provision of protein-rich food and an increase in financial support based on needs assessments. Mitigating the linkage and access gaps in DBT is needed. The delivery of ready-to-consume food through tuberculosis treatment facilities could be prioritized. Full article

(This article belongs to the Special Issue Tuberculosis Control in Africa and Asia)

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15 pages, 835 KB

Open AccessArticle

Community-Based Tuberculosis Preventive Treatment Among Child and Adolescent Household Contacts in Ethiopia

by Eshetu Abelti, Zewdu Dememew, Asfawesen Gebreyohannes, Yohannes Alemayehu, Tilay Terfassa, Taye Janfa, Degu Jerene, Pedro Suarez and Daniel Datiko

Trop. Med. Infect. Dis. 2025, 10(4), 102; https://doi.org/10.3390/tropicalmed10040102 - 9 Apr 2025

Cited by 5 | Viewed by 2879

Abstract

There are limited studies on the community-based outcomes of tuberculosis (TB) preventive treatment (TPT) among children and adolescent contacts <15 years in Ethiopia. Our objective was to assess TPT uptake and completion rates among eligible under-15-year-old TB household contacts through an enhanced community-based [...] Read more.

There are limited studies on the community-based outcomes of tuberculosis (TB) preventive treatment (TPT) among children and adolescent contacts <15 years in Ethiopia. Our objective was to assess TPT uptake and completion rates among eligible under-15-year-old TB household contacts through an enhanced community-based model of interventions. The study was conducted between July 2021 and June 2022 in twenty primary health care units in the Sidama and Southern Nations, Nationalities, and Peoples’ Region (SNNPR) regions. A total of 4367 (99.2%) household contacts of 1069 bacteriologically confirmed PTB index cases were symptomatically screened for TB by trained health extension workers (HEWs) at the community level. A total of 696 (15.9%) symptomatic contacts were identified, of which 694 (99.7%) were evaluated for TB, resulting in 60 (8.6%) TB cases. A total of 1567 (95.3%) asymptomatic children and adolescent contacts <15 years of age were initiated on TPT (88.8%) at health posts in the community. After the interventions, there was a significant increase in contact screening coverage (95.6% vs. 99.2%, Odds Ratio (OR), 5.54; 95% Confidence interval (CI), 2.93–10.13) and TPT uptake (81.7% vs. 95.4%; OR, 4.67; 95% CI, 2.54–8.23). The TPT completion rate was also 98.1% (of 1567). The TPT completion rate at health posts in the community was higher than the rate at health centers (99.4% vs. 88.0%; OR, 20.95; 95% CI, 8.97–52.71). TPT uptake and completion in children and adolescent contacts could be improved remarkably with the implementation of an enhanced community-based model of intervention in high-TB-burden districts. Full article

(This article belongs to the Special Issue Tuberculosis Control in Africa and Asia)

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15 pages, 1597 KB

Open AccessArticle

The Trend of Tuberculosis Case Notification Rates from 1995 to 2022 by Country Income and World Health Organization Region

by Kobto G. Koura and Anthony D. Harries

Trop. Med. Infect. Dis. 2024, 9(12), 294; https://doi.org/10.3390/tropicalmed9120294 - 2 Dec 2024

Cited by 7 | Viewed by 4593

Abstract

Over the past 27 years, three major global TB control strategies have been implemented, and it is important at this stage to evaluate their impact on tuberculosis (TB) case notification rates (CNRs). This study, therefore, analyzed TB CNR trends from 1995 to 2022 [...] Read more.

Over the past 27 years, three major global TB control strategies have been implemented, and it is important at this stage to evaluate their impact on tuberculosis (TB) case notification rates (CNRs). This study, therefore, analyzed TB CNR trends from 1995 to 2022 across 208 countries and islands, using data from the WHO Global TB Programme database. Countries were classified by income level and population size based on World Bank criteria. The analysis revealed significant disparities in TB CNRs across income groups: Low-income, lower-middle-income, and upper-middle-income countries consistently reported higher CNRs compared to high-income countries. Regional analysis further demonstrated notable variations influenced by both economic and geographical factors. These findings reaffirm the strong link between TB and poverty, underscoring the need for a holistic approach to combat the disease. Efforts must extend beyond enhancing health care access and delivery to addressing the social determinants that drive TB transmission and progression. Full article

(This article belongs to the Special Issue Tuberculosis Control in Africa and Asia)

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Review

Jump to: Research, Other

11 pages, 2557 KB

Open AccessReview

TB Data Improvement in Nkembo Health Treatment Center in Libreville, Gabon

by Casimir Manzengo, Farai Mavhunga, Nlandu Roger Ngatu, Fleur Lignenguet, Stredice Manguinga and Ghislaine Asseko Nkone

Trop. Med. Infect. Dis. 2026, 11(4), 90; https://doi.org/10.3390/tropicalmed11040090 - 27 Mar 2026

Viewed by 701

Abstract

Although the estimated tuberculosis (TB) incidence in Gabon is declining, there have been challenges with treatment coverage, HIV status and treatment outcome documentation. Thus, the National TB Program (NTP) conducted an innovative data review at the Nkembo Health Treatment Center in Libreville, which [...] Read more.

Although the estimated tuberculosis (TB) incidence in Gabon is declining, there have been challenges with treatment coverage, HIV status and treatment outcome documentation. Thus, the National TB Program (NTP) conducted an innovative data review at the Nkembo Health Treatment Center in Libreville, which manages more than 70% of Gabonese TB patients. Since our hypothesis was that the Nkembo treatment center was struggling with data mismanagement due to the workload, the objective was to perform a TB data quality review and triangulation exercise at the Nkembo health facility in Libreville, from January to August 2023, and propose recommendations for data improvement. Methods: The study used the data reconciliation method. This is a process that involves comparing and aligning data from multiple sources to ensure consistency, accuracy, and integrity. The primary purpose of data reconciliation is to identify and resolve discrepancies or differences between datasets and make them consistent. Using the “TB onion model”, analysis identified data mismanagement as a key contributor to underreporting. A data review compared TB records to TB registry data and patient folders from January to August 2023 for notification and to the 2022 cohort for treatment results. The study focused on notified TB cases, HIV status and TB treatment outcome documentation. Discrepancies were reconciled, and treatment outcomes re-evaluated. Results: After review, statistically significant increases were observed: +22% for total TB cases (p = 0.0003), +141% for the number of TB cases with known HIV status (p = 0.0017) and +104% for the number of TB cases successfully treated (p = 0.0001), as compared with the previous data. Discussion: This data reconciliation showed the usefulness of triangulation across data sources to improve the completeness of data. Also, current reported data underestimate the number of reported cases, documentation of HIV status, and treatment success. Conclusions: The study shows that data reconciliation can improve TB programmatic data completeness to better reflect program performance. Full article

(This article belongs to the Special Issue Tuberculosis Control in Africa and Asia)

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Other

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12 pages, 732 KB

Open AccessPerspective

Reframing TB Care: A Perspective on Multimorbidity-Centered Care for People with TB

by Alexa Tabackman, Sadie Cowan, Claire Calderwood and Pranay Sinha

Trop. Med. Infect. Dis. 2026, 11(2), 37; https://doi.org/10.3390/tropicalmed11020037 - 29 Jan 2026

Viewed by 1181

Abstract

Tuberculosis (TB) rarely occurs in isolation; most people with TB experience multiple coexisting conditions, including HIV, diabetes, undernutrition, depression, and substance use disorders, which worsen disease severity and compromise treatment outcomes. Although the World Health Organization has issued disease-specific guidance for managing key [...] Read more.

Tuberculosis (TB) rarely occurs in isolation; most people with TB experience multiple coexisting conditions, including HIV, diabetes, undernutrition, depression, and substance use disorders, which worsen disease severity and compromise treatment outcomes. Although the World Health Organization has issued disease-specific guidance for managing key comorbidities, TB care remains largely siloed and poorly equipped to address the growing burden of multimorbidity, particularly in African health systems. In this perspective article, we propose a phased framework for multimorbidity-centered TB care. The first phase emphasizes systematic screening for common comorbidities and establishment of basic referral pathways. The second phase focuses on strengthening coordination between TB programs and existing health and social services, including task sharing and longitudinal follow-up. The third phase advances toward fully integrated, co-located, multidisciplinary models of care that embed TB services within broader multimorbidity platforms. Together, this framework offers a pragmatic roadmap for TB programs to deliver more person-centered, equitable, and efficient care, strengthen primary care systems, and accelerate progress toward ending TB as a public health threat in Africa. Full article

(This article belongs to the Special Issue Tuberculosis Control in Africa and Asia)

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7 pages, 622 KB

Open AccessCommentary

Ending the TB Crisis in Low- and Middle-Income Countries of the Eastern Mediterranean Region—Overcoming Inaction Through Strategical Leaps

by Santosha Kelamane, Ghada Muhjazi, Nevin Wilson and Martin van den Boom

Trop. Med. Infect. Dis. 2025, 10(12), 348; https://doi.org/10.3390/tropicalmed10120348 - 12 Dec 2025

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Abstract

Tuberculosis (TB) remains a public health threat in low- and middle-income countries (LMICs) of the World Health Organization (WHO) Eastern Mediterranean Region (EMR), driven by a combination of social determinants including undernutrition, fragile health systems, conflict-related disruptions, human mobility and displacement, sub-optimal programmatic [...] Read more.

Tuberculosis (TB) remains a public health threat in low- and middle-income countries (LMICs) of the World Health Organization (WHO) Eastern Mediterranean Region (EMR), driven by a combination of social determinants including undernutrition, fragile health systems, conflict-related disruptions, human mobility and displacement, sub-optimal programmatic implementation, and insufficient domestic investment. These programmatic and governance constraints operate within a broader geopolitical context marked by conflict, sanctions, protracted crises, and large-scale displacement, which further limit countries’ ability to deliver uninterrupted TB services. In 2023, the region’s TB incidence was estimated at 116 per 100,000 population, with Pakistan alone accounting for about 73% of the regional burden. Despite a multitude of efforts, progress in reducing the TB burden in the EMR remains slow, with high case detection and treatment coverage gaps, low uptake of TB preventive treatment (TPT), underutilization of WHO-recommended rapid diagnostics, and only 25% of drug-resistant TB (DR-TB) cases initiated on treatment. Vulnerable populations, including internally displaced persons, migrants, refugees, prisoners, and returnees, continue to face major access barriers, and cross-border TB collaboration remains limited. This commentary reasons that the slow pace of TB burden reduction in the region is not only a biomedical or resource issue but also a reflection of structural and governance shortcomings. It proposes a ten-point strategic vision focused on building a sustainable ecosystem, enhancing primary healthcare systems, adopting people-centered and rights-based approaches, leveraging artificial intelligence, and gradually reducing dependency on external donors where feasible. However, in highly fragile settings such as Yemen or Somalia, domestic financing remains limited, and sustained external support will continue to be indispensable. The commentary calls for stronger national leadership, inclusive stakeholder engagement, and increased domestic financing to deliver integrated and resilient TB services. Ending TB in the EMR is within reach, but it requires boldly committed, coordinated, and country-led action. Full article

(This article belongs to the Special Issue Tuberculosis Control in Africa and Asia)

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Open AccessCase Report

Tuberculous Meningitis in a Child: A Rare Presentation of Cytotoxic Lesion of the Corpus Callosum

by Ny Thi Hong Tran, Nhung Thi Hong Nguyen, Uyen Phuong Vo and Julie Huynh

Trop. Med. Infect. Dis. 2025, 10(4), 96; https://doi.org/10.3390/tropicalmed10040096 - 4 Apr 2025

Cited by 1 | Viewed by 1587

Abstract

Tuberculous meningitis (TBM) is the most severe form of tuberculosis, disproportionately affecting vulnerable populations such as young children and people living with human immunodeficiency virus (HIV). Major challenges to accurate and early diagnosis of TBM are the non-specific clinical features which overlap with [...] Read more.

Tuberculous meningitis (TBM) is the most severe form of tuberculosis, disproportionately affecting vulnerable populations such as young children and people living with human immunodeficiency virus (HIV). Major challenges to accurate and early diagnosis of TBM are the non-specific clinical features which overlap with other infectious syndromes and the lack of adequately sensitive tests to detect Mycobacterium tuberculosis in the cerebrospinal fluid (CSF). Diagnosis is, therefore, still dependent on clinical suspicion along with clinical features, cerebrospinal fluid (CSF) characteristics and, where facilities are available, neuroimaging. Typical neuroimaging features of TBM include hydrocephalus, infarcts, tuberculomas and basal exudates; however, less well described are very rare features such as cytotoxic lesion of the corpus callosum (CLOCC), otherwise known as transient splenic lesion. We describe the first case report of a child with confirmed TBM who had a very rare presentation of CLOCC with complete recovery and present a literature review on the pathophysiology and alternative aetiologies where CLOCC is more commonly seen. Full article

(This article belongs to the Special Issue Tuberculosis Control in Africa and Asia)

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