The burden of tuberculosis and drug resistance in 22 Sub-Saharan African countries, 1990–2021: a GBD 2021 analysis and progress towards WHO 2035 targets with projections to 2050

作者：Shirong Li, Emmanuel Mensah, Min Liu, Lingling Pan, Wei Lu, Susheng Zhou, Liqin Zhang, Yusheng Cheng, Hui Zhao, Shuoshuo Wei, Lei Zha · 发表于：Frontiers in Microbiology · 年份：2025 · DOI：10.3389/fmicb.2025.1695592 · 被引用次数：8 · 研究领域：Tuberculosis Research and Epidemiology、Malaria Research and Control、Diagnosis and treatment of tuberculosis

Background: Tuberculosis (TB) remains a major public health challenge in Sub-Saharan Africa (SSA), compounded by rising multidrug-resistant (MDR-TB), and extensively drug-resistant tuberculosis (XDR-TB) strains. This study aimed to quantify the burden, temporal trends, and subregional heterogeneity of TB across 22 selected SSA countries; project future trends to 2050; and evaluate the alignment of national TB policies with WHO End TB 2035 targets. Methods: We conducted a mixed-methods analysis using Global Burden of Disease (GBD) 2021 data. Age- and sex-specific TB incidence, prevalence, mortality, and disability-adjusted life years (DALYs) were analyzed across 22 SSA countries from 1990 to 2021. BAPC model projected disease burden to 2050. National TB policy alignment with WHO targets was assessed qualitatively. Drug-susceptible (DS-TB), MDR-TB, and XDR-TB forms were evaluated alongside key attributable risk factors. Results: Between 1990 and 2021, absolute TB incidence in SSA increased by 25.6% and prevalence by 44.2%, while mortality and DALYs declined by 14.0 and 24.8%, respectively. Age-standardized rates declined significantly across all metrics; incidence (-46.2%), prevalence (-35.2%), mortality (-56.4%), and DALYs (-60.9%). Progress varied substantially by region: Western SSA showed the greatest improvement, while Southern and Central SSA continued to face high burdens, with rising mortality in some areas. MDR-TB incidence surged by 743.2%, with XDR-TB also increasing...