Prevalence of extra‐pulmonary tuberculosis in Africa: A systematic review and meta‐analysis

Author:

Hailu Semira1,Hurst Cameron2,Cyphers Griffin3,Thottunkal Stefan4,Harley David1,Viney Kerri456,Irwin Adam17,Dean Judith38,Nourse Clare17

Affiliation:

1. UQ Centre for Clinical Research The University of Queensland Brisbane Australia

2. Molly Wardaguga Research Centre Charles Darwin University Brisbane Australia

3. Faculty of Medicine, School of Public Health The University of Queensland Brisbane Australia

4. ANU College of Health and Medicine Australian National University Canberra Australia

5. School of Public Health, University of Sydney Camperdown Australia

6. Department of Global Public Health Karolinska Institutet Stockholm Sweden

7. Infection Management and Prevention Service, Queensland Children's Hospital Brisbane Australia

8. UQ Poche Centre for Indigenous Health The University of Queensland Brisbane Australia

Abstract

AbstractObjectiveThe burden of extra‐pulmonary tuberculosis (EPTB) is not well quantified in TB endemic countries such as those in sub‐Saharan Africa. This study aimed to quantify that burden via a systematic review of the prevalence of EPTB in African countries.MethodsStudies were retrieved by searching five databases; 105 studies published between 1990 and 2023 were included. The studies described the prevalence of EPTB among the general population (4 studies), TB patients (68) and patients with other conditions, including HIV (15), meningitis (3), renal failure (3) and other comorbidities, some of which are cancer (12). Due to the low number of studies reporting EPTB in patients with conditions other than TB, the meta‐analysis was performed on studies reporting on EPTB among TB patients (68 studies). Meta‐analysis was performed on the 68 studies (271,073 participants) using a random‐effects model to estimate the pooled prevalence of EPTB. Meta‐regression was used to explore possible explanations for heterogeneity according to regions and time periods.ResultsThe pooled prevalence of EPTB among TB patients was 26% (95% CI 23–29%). There was substantial heterogeneity of prevalence for the five African regions. The Eastern region had the highest prevalence of 32% (95% CI 28–37%) and the lowest in Western Africa, 16% (95% CI 10–24%). There was no significant difference in the prevalence of EPTB between the 3 eleven‐year time periods.ConclusionsOur systematic review and meta‐analysis give insight into the burden of EPTB in Africa. This review could inform clinical and programmatic practices–a higher suspicion index for clinicians and more effort for better services. This could contribute to efforts aiming to end TB, which have historically been focused on PTB.Coordinated efforts that target both EPTB and PTB are needed.

Publisher

Wiley

Reference46 articles.

1. World Health Organization.Global tuberculosis report 2022. Geneva: World Health Organization2022.

2. World Health Organization. Global tuberculosis control: epidemiology planning financing: WHO report 2009. Geneva: World Health Organization.2009.

3. The mechanisms and consequences of the extra-pulmonary dissemination of Mycobacterium tuberculosis

4. Mycobacterium tuberculosis Dissemination Plays a Critical Role in Pathogenesis

5. HIV‐TB co‐infection: epidemiology, diagnosis & management;Sharma SK;Indian J Med Res,2005

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