Trend of tuberculosis case notifications and their determinants in Africa and South-East Asia during 2000–2018: a longitudinal analysis of national data from 58 countries

Abstract

Background: The World Health Organization (WHO) regions of Africa and South-East Asia are the epicentres of the global tuberculosis (TB) epidemic. This study aimed at examining the trend and determinants of TB case notifications in the two regions during 2000–2018.

Methods: This was a retrospective analysis of yearly, new TB cases notified to the WHO. We obtained data on potential determinants for the 58 countries in the two regions during 2000–2018. Multivariable longitudinal fixed-effects regression analysis was used to quantify the association between the determinants and TB notifications.

Results: During 2000–2018, TB notifications and incidence declined in Africa. In South-East Asia, case notifications increased while the incidence declined, on average, by 2% per year during the same period. After controlling for health, socioeconomic indicators, country and year fixed-effects, each 1% increase in the antiretroviral therapy (ART) coverage and the TB treatment success was associated with a decrease per 100,000 population in the TB case notification rate of −1.62 (95% CI: −4.93, −1.90; p = .037) and −0.91(95% CI: −1.54, −0.28; p = .005) respectively. Similarly, each 1-year increase in the life expectancy at birth resulted in a decrease in TB case notification rates of −6.64 (95% CI: −12.32, −0.95; p = .037). By contrast, a 1% increase in the unemployment rate resulted in an increase in TB notification rate of 3.49 cases (95% CI: 0.19, 6.79; p = .039).

Conclusion: Improving population health and the broad scale-up of ART coverage could complement existing TB treatment coverage and cure programmes to drive down new cases in Africa and South-East Asia.

Keywords:

• Morbidity
• tuberculosis
• infectious diseases
• determinants
• case notifications

Disclosure statement

The authors report no conflicts of interest.