Prevalence and determinants of drug-resistant pulmonary tuberculosis in the MENA region: a systematic review and meta-analysis
Clinical Snapshot
PICO Framework
| P — Population | Individuals with pulmonary tuberculosis living in the Middle East and North African (MENA) region |
| I — Intervention | Not applicable (observational systematic review) |
| C — Comparator | Not applicable (prevalence study) |
| O — Outcomes | Prevalence of multidrug-resistant tuberculosis (MDR-TB) and associated determinants/risk factors |
Bottom Line
This systematic review reports a pooled MDR-TB prevalence of 3.54% in the MENA region, but extremely high heterogeneity (I² = 95.6%) severely limits confidence in this estimate. The wide range (0% to 17.1%) across studies suggests substantial variation in study quality, populations, and healthcare settings. Key risk factors identified include previous TB treatment, HIV co-infection, smoking, and comorbidities. However, the absence of quality assessment and inadequate exploration of heterogeneity sources undermines the reliability of findings. While the review highlights persistent MDR-TB challenges in the MENA region, the high heterogeneity and methodological limitations prevent confident application of results to clinical practice or policy decisions. More rigorous systematic review methodology with quality assessment and heterogeneity exploration is needed.
Key Findings
P Value: Not reported
Effect Size: Wide range from 0% to 17.1% across studies
Primary Outcome: Pooled prevalence of MDR-TB in MENA region: 3.54% (95% CI 2.18% to 5.72%)
Nnt Or Sensitivity: Prevalence study - risk factors identified include previous TB treatment, HIV infection, smoking, and comorbidities
Confidence Interval: 95% CI 2.18% to 5.72% for pooled estimate
Clinical Application
High heterogeneity limits confidence in pooled estimates for clinical decision-making Limited direct relevance to Australian practice given different TB epidemiology, healthcare infrastructure, and population characteristics. Australian MDR-TB rates typically lower than reported MENA estimates Limited applicability beyond MENA region due to geographic and healthcare system differences
Abstract
BACKGROUND: Multidrug-resistant tuberculosis (MDR-TB) is a constraining challenge for tuberculosis (TB) control worldwide. The Middle East and North African (MENA) region represents a significant part of the global MDR-TB burden. AIM: To estimate the pooled prevalence of MDR-TB and its determinants in the MENA region. METHODS: We searched for studies published in English and French on the subject up to 31 January 2026 on Web of Science, PubMed, Scopus and Cochrane, without time restriction. Original studies reporting data on the prevalence of MDR-TB in individuals living in the MENA region were selected. The meta-analysis was done using the random effects model considering the heterogeneity among the included studies and I 2 statistic was used to assess the heterogeneity. RESULTS: A total of 1239 articles were identified and 25 studies from 6 countries were included in this review. The prevalence of MDR-TB in the MENA region ranged from 0% (95% CI 0% to 4.1%) to 17.1% (95% CI 10.6% to 25.4%). The pooled prevalence was 3.54% (95% CI 2.18% to 5.72%) with a high heterogeneity, I2 =95.6%; 95% CI 94.4% to 96.5%. Previous exposition to TB treatment, HIV infection, smoking and the presence of comorbidities were the most reported associated factors. CONCLUSION: This review underscores the persistence of MDR-TB in the MENA region, suggesting insufficiency in TB control. Multisectoral interventions integrating strong prevention measures, standardised treatment protocols and measures to enhance treatment adherence should be implemented.
References
- 1.Mahamed, O., Hounnoukon, N. S., Laraqui Houssaini, S., El Faziki, I., Kirat, M., & El Rhazi, K. (2026). Prevalence and determinants of drug-resistant pulmonary tuberculosis in the MENA region: a systematic review and meta-analysis. BMJ Open Respiratory Research, 13(1), e003887. https://doi.org/10.1136/bmjresp-2025-003887
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