Environmental-demographic determinants associated with tuberculosis prevalence in seven African countries: an aggregated dataset analysis.
cross_sectional · Level IV
Where this comes from
- Record sourced from PubMed, PMID 41660366.
- Also identified by DOI 10.1016/j.eclinm.2026.103773 and PMC identifier 12874274.
- Licence recorded as CC BY.
- The licence permits redistribution, so the abstract is shown in full and the full text is available from the publisher.
Abstract
Knowledge about environmental and demographic determinants of tuberculosis is largely limited to studies with ecological designs. We explored the association between these determinants and tuberculosis prevalence in an individual participant dataset aggregated across seven African countries. Data of nationally representative tuberculosis prevalence surveys (2012-2019) from highly endemic countries were supplemented with publicly accessible data at district level. Associations between individual-level diagnosis of bacteriologically confirmed tuberculosis and district-level environmental-demographic variables were investigated in generalised linear mixed-effects models accounting for the multi-level structure of the data. Of 322,615 participants aged ≥15 years across 400 districts, 976 were newly diagnosed with tuberculosis (prevalence 183-638/100,000 across the countries). Living at latitude 7.6-14.6° (adjusted odds ratio, aOR 2.07, 95% confidence interval, 95% CI 1.48-2.90) or in higher population density (aOR 1.07 per percent increase in mean population density, 1.01-1.13), or urban districts (aOR 1.31, 1.11-1.54) were independently associated with higher prevalence. Living in distsricts above 900 m altitude (aOR 0.52, 0.32-0.84), with 50-100 mm precipitation (aOR 0.62, 0.46-0.84), or at higher temperature (aOR 0.93 per degree Celsius, 0.88-0.98) was independently associated with lower tuberculosis prevalence. No significant associations were observed with fine particulate matter (aOR 1.04, 0.70-1.54 for 20-40 μg/m<sup>3</sup>, 0.82, 0.44-1.53 for >40 μg/m<sup>3</sup>), solar radiation (aOR 1.04, 0.93-1.15) or International Wealth Index (aOR 1.01 (1.00-1.02). Our results suggest that in high-burden African countries, some of the variation in tuberculosis prevalence can be explained by environmental and demographic factors that merit further investigation. Mr Willem Bakhuys Roozeboom Foundation.