Epidemiology, Drug Resistance Patterns, Treatment Outcomes, and Predictors of Death among Mycobacterium tuberculosis patients in Northern Malawi

Background The World Health Organisation (WHO) recognises Tuberculosis (TB) as one of the most lethal infectious diseases worldwide. TB is a disease associated with poverty, disproportionately impacting the poorest, most vulnerable, and marginalised populations across various regions. This study was conducted to thoroughly examine the current trends, patterns of drug resistance, treatment outcomes, and predictors of mortality related to TB in Malawi. Methods This was a retrospective cross-sectional study conducted in Malawi's northern region. All laboratory-, radiology-, and clinically confirmed TB patients were enrolled in treatment across all five districts, including Karonga, Rumphi, Nkhatabay, and Chitipa. The study employed a census sampling method. Records with missing key variables, such as diagnosis, gender, age, and outcome, were excluded. Data were collected using the KOBOToolbox application and analysed with SPSS, STATA, and R. Results A total of 3,439 tuberculosis (TB) cases were analysed, revealing that over half of the patients (50.4%) were HIV positive, while 29.2% had an unknown HIV status. The RHZE regimen was the most prescribed treatment, accounting for 98.37% (3,378 of 3,434) of cases. The trend in TB cases in Northern Malawi from 2019 to 2023 demonstrates a fluctuating pattern with notable peaks and declines. Most patients (3,354 cases; 98.36%) exhibited no drug resistance. Mzuzu Central Hospital accounted for the highest proportion of TB-related mortality and loss to follow-up (LTFU), at 33.94% and 71.21%, respectively. The findings suggest that mortality was significantly associated with various sociodemographic, clinical, and facility-level factors. Conclusions This study offers comprehensive evidence regarding the epidemiology, treatment outcomes, drug resistance patterns, and predictors of mortality among patients with TB in Northern Malawi. Overall, the findings demonstrate a relatively high success rate in treatment but also indicate a persistently significant mortality burden, with fatalities strongly influenced by sociodemographic, clinical, and health system factors. These results emphasise the ongoing vulnerability of population subgroups and underscore structural challenges within Malawi’s tuberculosis care delivery system.