New Publication: Sex differences in tuberculosis burden and notifications in low- and middle-income countries

Sex differences in tuberculosis burden and notifications in low- and middle-income countries: a systematic review and meta-analysis

Tuberculosis (TB) remains a major public health priority and is now the leading cause of death from an infectious disease worldwide. Over the past twenty years, TB case notifications among men have exceeded those among women in most countries and global regions. However, a focus on men is often absent from discussions and policy addressing gender and TB, partly because it is unknown whether these data reflect gender differences in burden of disease or in seeking and accessing TB care.


TB prevalence surveys offer a robust measure of disease burden in the community, reducing or eliminating the care-seeking biases that affect case notification rates. Gender-specific differences between TB prevalence and notification rates can provide insight into the relative importance of disease burden and access to care.


To determine gender-specific TB prevalence ratios and investigate whether differences in case notification rates could be attributed to disproportionate disease burdens or access to care, we conducted a systematic review and meta-analysis of national and sub-national TB prevalence surveys conducted among adult populations in low- and middle-income countries between 1993 and 2015. We used meta-regression to identify factors associated with high male-to-female prevalence ratios. In total, 86 TB prevalence surveys with at least 3.1 million participants from 28 countries were included in analysis.


Our main findings were that, in low- and middle-income countries, men have a substantially higher prevalence of TB than women and, in many settings, remain infectious in the community for a longer period of time. Addressing men’s burden of disease and disadvantage in seeking or accessing care is therefore an issue not only for men’s health but for broader TB prevention and care.


Our results have strong policy implications, as strategies to prevent and treat TB should acknowledge men as an underserved risk group and improve men’s access to diagnostic and screening services. Improving TB care among men is essential to ensure gender equity and to achieve the ambitious targets of the End TB Strategy.

See the full paper here