Prevalence and determinants of post-tuberculosis lung disease in Sub-Saharan Africa: A systematic review and meta-analysis

Background: Post-tuberculosis lung disease (PTLD) is a major public health challenge in sub-Saharan Africa, where the burden of tuberculosis (TB) remains high. Only a few studies have reported the burden of PTLD globally, and the determinants of PTLD have been understudied. This systematic review and meta-analysis aimed to estimate the pooled prevalence and determinants of PTLD in sub-Saharan African countries. Methods: This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines for systematic review and meta-analysis. We included studies reporting the prevalence and determinants of PTLD among individuals with a history of pulmonary TB in sub-Saharan Africa. A comprehensive literature search was conducted via PubMed, Embase, Google Scholar, and African Journal Online databases. The pooled prevalence of PTLD was estimated using a random-effects model, and associated factors were analyzed using crude odds ratios (ORs). Results: A total of 21 studies, consisting of 4,463 participants, were included. The overall pooled prevalence of PTLD in sub-Saharan Africa was 43.26% (95% CI: 34.17%–52.34%). The key determinants significantly associated with PTLD included: female sex (OR: 1.57, 95% CI: 1.16, 2.11), smoking (OR: 1.64, 95% CI: 1.09, 2.46), Presence of cough (OR: 1.73, 95% CI: 1.03, 2.9) and fibrotic pattern (OR:3.94 (95% CI: 1.96, 7.92). Conclusion: Nearly half of tuberculosis patients in sub-Saharan Africa develop post-tuberculosis lung disease. Being female, smoking, fibrosis, and posttreatment cough were key determinants associated with PTLD. To effectively manage PTLD in sub-Saharan Africa, it is important to implement targeted interventions for high-risk groups, strengthen screening and chronic care services, enhance healthcare system capacity, and integrate PTLD management into national TB control programs.