Prevalence of extensively drug-resistant tuberculosis and drug resistance patterns in Asia and Africa (2000-2025): systematic review and meta-analysis
Abstract
Background: Extensively drug-resistant tuberculosis (XDR-TB) remains a significant global health issue, especially in areas with high incidence like Asia and Africa. XDR-TB is characterized by resistance to rifampicin, fluoroquinolones, and at least one Group A drug such as bedaquiline or linezolid, making treatment difficult and raising the risk of death. Although concern about XDR-TB is increasing, there is still limited data on its prevalence and resistance trends in Asia and Africa.
Methods: A systematic review and meta-analysis were conducted following PRISMA guidelines, with the protocol registered in PROSPERO. Four electronic databases, which are PubMed, Scopus, ProQuest and Science Direct, were systematically searched for studies published between 2000 and 2025. Twenty-two studies met the inclusion criteria and were assessed for quality using the Joanna Briggs Institute tool. Meta-analysis using a random-effects model was performed in RStudio to estimate pooled prevalence rates of XDR-TB, as well as resistance to key anti-tuberculosis drugs. Given the evolution of the XDR-TB definition in 2021, studies were evaluated for definitional consistency. Where necessary, differences between pre-2021 and post-2021 definitions were acknowledged and addressed through subgroup interpretation.
Results: The pooled prevalence of XDR-TB was estimated at 16.5% (95% CI: 5.8-27.1), with substantial regional variation. Higher prevalence was observed in Asia (12.3%) compared to Africa…
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Evidence Hub reads this as a meta-analysis. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid.
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