Gender disparities in multidrug-resistant tuberculosis notifications in Uganda: evidence from national surveillance data, 2014-2023

Background Globally, tuberculosis and drug-resistant tuberculosis are more frequently reported among men than women. However, sex-specific patterns in multidrug-resistant and rifampicin-resistant tuberculosis (MDR/RR-TB) notifications may vary across settings and may be influenced by surveillance and health system factors. Evidence describing gender differences in MDR/RR-TB in Uganda remains limited. This study examined gender-specific patterns and temporal trends in MDR/RR-TB notifications in Uganda over a ten-year period. Methods We conducted a national ecological analysis of routinely collected MDR/RR-TB surveillance data extracted from Uganda’s District Health Information System 2 (DHIS2) for the period 2014–2023. Sex-disaggregated notification data were summarised descriptively at national and regional levels. Annual proportions were calculated, and temporal trends were assessed using longitudinal descriptive analysis to evaluate stability and variation in gender distribution over time. Results Between 2014 and 2023, a total of 324,025 MDR/RR-TB cases were notified nationally. Females accounted for 178,861 cases (55.2%), while males accounted for 145,164 cases (44.8%). Female predominance was observed consistently throughout the ten-year period, with no sustained year in which male notifications exceeded female notifications. Notifications increased over time among both sexes, but the relative distribution remained stable. Female predominance was also observed across all regions, although the magnitude of the difference varied geographically. Conclusions MDR/RR-TB notification patterns in Uganda differ from commonly reported global trends of male predominance. The consistent female predominance observed over a decade likely reflects contextual and programmatic factors influencing case detection rather than biological susceptibility alone. Strengthening gender-disaggregated surveillance and investigating potential barriers to diagnosis and care remain essential for equitable tuberculosis control.