Liyew Alemneh Mekuriaw, Gebreyohannes Eyob Alemayehu, Python Andre, Clements Archie C A, Gilmour Beth, Gething Peter W, Amratia Punam, Alene Kefyalew Addis
Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
School of Population Health, Faculty of Health Sciences, Curtin University, Perth, Australia.
Commun Med (Lond). 2025 May 27;5(1):194. doi: 10.1038/s43856-025-00831-9.
Worldwide, tuberculosis (TB) remains the leading cause of death from infectious diseases. Africa is the second most-affected region, accounting for a quarter of the global TB burden, but there is limited evidence whether there is subnational variation of TB prevalence across the continent. Therefore, this study aimed to estimate sub-national and local TB prevalence across Africa.
We compiled geolocated data from 50 population-based surveys across 14 African countries. A total of 212 data points were identified and linked to covariates assembled from publicly available sources. Bayesian geostatistical modelling was used to predict TB prevalence across Africa, and results were aggregated to estimate number of TB cases at national and subnational levels.
Here we estimate 1.28 million TB cases (95% uncertainty interval [UI] 0.14-4.87) across 14 countries, with marked spatial variations. The highest cases are estimated in Nigeria (460,247 95% UI 7954-1,783,106), and Mozambique (120,622 95%UI 20,027-321,177) while the lowest in Guinea-Bissau (1952 95%UI 154-7365) and Rwanda (2207 95% UI 1050-9225). National TB prevalence range from 0.25 to 7.32 per 1000 with significant variation at higher spatial resolution. Temperature (°C) (OR = 1.27; 95% CrI: 1.20-1.35), precipitation (mm) (OR = 1.34; 95% CrI: 1.26-1.40), and access to city (minute) (OR = 1.21; 95% CrI: 1.14-1.25) are positively associated with TB prevalence, while altitude (m) (OR = 0.83; 95% CrI: 0.78-0.87) is negatively associated.
We find substantial variations in TB prevalence at national, sub-national, and local levels in Africa. These considerable spatial variations suggest the need for geographically targeted interventions to control TB in Africa.
在全球范围内，结核病仍然是传染病致死的主要原因。非洲是受影响第二严重的地区，占全球结核病负担的四分之一，但关于非洲大陆各国结核病患病率是否存在差异的证据有限。因此，本研究旨在估算非洲各国及地方的结核病患病率。
我们汇总了来自14个非洲国家50项基于人群调查的地理位置数据。共识别出212个数据点，并将其与从公开来源收集的协变量相关联。采用贝叶斯地理统计模型预测非洲各地的结核病患病率，并汇总结果以估算国家和次国家层面的结核病病例数。
我们估计14个国家共有128万例结核病病例（95%不确定区间[UI]为0.14 - 487万），存在明显的空间差异。估计病例数最多的是尼日利亚（460247例，95% UI为7954 - 1783106例）和莫桑比克（120622例，95% UI为20027 - 321177例），而最低的是几内亚比绍（1952例，95% UI为154 - 7365例）和卢旺达（2207例，95% UI为1050 - 9225例）。各国结核病患病率范围为每1000人0.25至7.32例，在更高空间分辨率下存在显著差异。温度（℃）（OR = 1.27；95% CrI：1.20 - 1.35）、降水量（mm）（OR = 1.34；95% CrI：1.26 - 1.40）和到城市的距离（分钟）（OR = 1.21；95% CrI：1.14 - 1.25）与结核病患病率呈正相关，而海拔（米）（OR = 0.83；95% CrI：0.78 - 0.87）呈负相关。
我们发现非洲国家、次国家和地方层面的结核病患病率存在很大差异。这些显著的空间差异表明需要采取因地制宜的干预措施来控制非洲的结核病。
