Tuberculosis Treatment Outcomes in Tanzania: A Systematic Review on nutritional approach to enhance TB Outcomes

Background Tuberculosis (TB) remains a major cause of illness and death worldwide, and Tanzania continues to be among the high-burden countries. Malnutrition plays a dual role in TB: it increases the risk of developing the disease and also undermines recovery during treatment. Although nutritional support is widely recommended as part of TB care, evidence on how effective different nutritional interventions are in improving treatment outcomes is scattered and inconsistent. This systematic review aimed to synthesize existing evidence on the impact of nutritional support on TB outcomes in Tanzania and comparable sub-Saharan African settings. Methods This systematic review followed PRISMA 2020 guidelines. We searched PubMed, Embase, Scopus, Web of Science, CINAHL, the Cochrane Library, and African Journals Online (AJOL) for studies published between 2000 and June 2025, alongside relevant grey literature from international agencies and government sources. Search terms included subject headings and keywords related to tuberculosis, nutrition, malnutrition, dietary interventions, Tanzania, and sub-Saharan Africa. Two reviewers independently screened titles, abstracts, and full texts, with disagreements resolved by a third reviewer. Eligible studies included randomized controlled trials and observational designs assessing nutritional interventions and reporting TB outcomes. Risk of bias was assessed using standard tools, and findings were synthesized narratively, with meta-analysis conducted where appropriate. Results Eighteen studies involving approximately 5,007 participants met the inclusion criteria. Most studies reported positive effects of nutritional interventions, including higher treatment completion rates, greater weight gain, and lower mortality. Food-based and macronutrient interventions showed the most consistent benefits. In contrast, results for micronutrient supplementation were mixed and less conclusive. Several operational studies also highlighted practical challenges related to implementation, cost, and long-term sustainability in resource-limited settings. Conclusion Overall, this review shows that nutritional support can meaningfully improve TB treatment outcomes in Tanzania and similar contexts. The evidence supports the integration of food-based and macronutrient interventions into routine TB care, while also pointing to important gaps in knowledge around micronutrients and sustainable program delivery. These findings offer timely guidance for strengthening Tanzania’s National TB Program and promoting more holistic, patient-centred approaches to TB management.