The incidence and mortality of COVID-19 related TB disease in Sub-Saharan Africa: A systematic review and meta-analysis

  1. Jacques L Tamuzi
  2. Gomer Lulendo
  3. Patrick Mbuesse
  4. Peter S. Nyasulu

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Abstract

Background

Coronavirus disease 2019 (COVID-19) is also associated with other co-morbidities in people who have previously or currently have pulmonary tuberculosis (PTB). PTB is a risk factor for COVID-19, both in terms of severity and mortality, regardless of HIV status. However, there is less information available on COVID-19 and PTB in terms of incidence and mortality rates in Sub-Saharan Africa (SSA), a high-burden TB region. This systematic review provided a data synthesis of available evidence on COVID-19/PTB incidence and case fatality rates, as well as mortality rates found in clinical and post-mortem COVID-19/PTB diagnostics in SSA.

Methods

We conducted an electronic search in the PubMed, Medline, Google Scholar, Medrxix, and COVID-19 Global literature on coronavirus disease databases for studies involving COVID-19 and PTB in Sub-Saharan Africa. The primary outcomes were the incidence proportion of people with COVID-19 who had current or previous PTB, as well as the case fatality rate associated with COVID-19/PTB. Based on methodological similarities in the included random effect model studies, the combination method was developed using Stata version 16 and Prometa 3 software. We also performed sensitivity analysis and meta-regression.

Results

From the 548 references extracted by the literature search, 25 studies were selected and included in the meta-analysis with a total of 191, 250 COVID-19 infected patients and 11, 480 COVID-19 deaths. The pooled COVID-19/PTB incidence was 3% [2%-5%] and a case fatality rate of 13% [4%-23%]. The pooled estimates for case fatality rate among COVID-19/PTB were 7% [1%-12%] for clinical PTB diagnostic and 25% [3%-47%] for post-mortem PTB diagnostic. Previous TB had the highest incidence and fatality rates with 46 [19-73] per 1, 000 population and 8% [3%-19%], respectively. Meta-regression model including the effect sizes and cumulative COVID-19 cases (P= 0.032), HIV prevalence (P= 0.041), and TB incidence (P= 0.002) to explain high heterogeneity between studies.

Conclusion

To summarize, the incidence of TB associated with COVID-19 is higher in SSA, as are the case fatality rates, when compared to the rest of the world. However, because the post-mortem TB diagnostic was higher, COVID-19 associated with TB may have been underreported in studies conducted in SSA. To confirm COVID-19/TB incidence and case fatality rates in SSA, large-scale cohort studies that adequately clear tools on previous and/or current TB diagnostic tools are required.

Review registration

PROSPERO (CRD42021233387)

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  1. Version published to 10.1101/2022.01.11.22269065v2 on medRxiv
  2. ScreenIT

    SciScore for 10.1101/2022.01.11.22269065: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Ethicsnot detected.
    Sex as a biological variablenot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Search strategy and eligibly criteria: A search of the literature was systematically conducted using Pubmed, Medline, Google Scholar, Medrxix and COVID-19 Global literature on coronavirus disease.
    Pubmed
    suggested: (PubMed, RRID:SCR_004846)
    Medline
    suggested: (MEDLINE, RRID:SCR_002185)
    Google Scholar
    suggested: (Google Scholar, RRID:SCR_008878)
    The search was restricted to studies related to the incidence and case fatality rates of COVID-19 related to TB in SSA since December 2019 to November 2021 including the key words and term as follows: “Covid-19 or 2019-nCoV or coronavirus disease 2019 or Novel coronavirus or SARS-CoV-2 “ and “tuberculosis or PTB or TB or Mycobacterium tuberculosis infection” and “mortality rate or death rate or case fatality rate” and “incidence or Incidence proportions or Incidence rate or incidence rate or attack rate” and “Angola or Benin or Botswana or Burkina Faso or Burundi or Cameroon or Cape Verde or “Central African republic” or Chad or Congo or “Democratic Republic of Congo” or DRC or Djibouti or Equatorial guinea or Eritrea or Ethiopia or Gabon or Gambia or Ghana or Guinea or Bissau or Ivory coast or ““Cote d’ ivoire” or Kenya or Lesotho or Liberia or Madagascar or Malawi or Mali or Mayotte or Mozambique or Namibia or Niger or Nigeria or Principe or Reunion or Rhodesia or Rwanda or “Sao Tome” or Senegal or “Sierra Leone” or Somalia or “South Africa” or Swaziland or Tanzania or Togo or Uganda or Zambia or Zimbabwe or “Central Africa” or “Sub-Saharan Africa” or “East Africa” or “Southern Africa” or “South Africa”, without language restrictions to identify citations from prior to January 2020.
    Madagascar
    suggested: (Madagascar, RRID:SCR_003274)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: An explicit section about the limitations of the techniques employed in this study was not found. We encourage authors to address study limitations.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    Results from scite Reference Check: We found no unreliable references.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  3. Version published to 10.1101/2022.01.11.22269065v1 on medRxiv