Tuberculosis related disability: a systematic review and meta-analysis

Abstract

Background The sustainable development goals aim to improve health for all by 2030. They incorporate ambitious goals regarding tuberculosis (TB), which may be a significant cause of disability, yet to be quantified. Therefore, we aimed to quantify the prevalence and types of TB-related disabilities. Methods We performed a systematic review of TB-related disabilities. The pooled prevalence of disabilities was calculated using the inverse variance heterogeneity model. The maps of the proportions of common types of disabilities by country income level were created. Results We included a total of 131 studies (217,475 patients) that were conducted in 49 countries. The most common type of disabilities were mental health disorders (23.1%), respiratory impairment (20.7%), musculoskeletal impairment (17.1%), hearing impairment (14.5%), visual impairment (9.8%), renal impairment (5.7%), and neurological impairment (1.6%). The prevalence of respiratory impairment (61.2%) and mental health disorders (42.0%) was highest in low-income countries while neurological impairment was highest in lower middle-income countries (25.6%). Drug-resistant TB was associated with respiratory (58.7%), neurological (37.2%), and hearing impairments (25.0%) and mental health disorders (26.0%), respectively. Conclusions TB-related disabilities were frequently reported. More uniform reporting tools for TB-related disability and further research to better quantify and mitigate it are urgently needed. Prospero registration number CRD42019147488

TB morbidity estimates overlook the contribution of post-TB disability: evidence from urban Malawi

“…These values are in line with those estimated by Menzies et al, whonotably also taking conservative assumptions-estimated a mean increase of 383% (95% CI 154 to 755) in TB-related YLD globally, once morbidity experienced in the post-TB period had been added to that experienced during active disease. 35 While the degree of TB disability will vary between countries-particularly associated to their income 13 -our results point towards a vast amount of post-TB disability being overlooked among the 155 million TB survivors worldwide. 19 Our data suggest that post-TB morbidity is borne by a minority, with 94% of YLD faced by 20% of participants.…”

“…1 Those who survive TB disease face a considerable but under-recognised burden of ongoing morbidity including respiratory impairment, 2-5 psychosocial challenges and reduced health-related quality of life (HRQoL) after treatment completion. [6][7][8][9][10][11][12][13][14] Guidelines for TB management define 'treatment success' using microbiological outcomes and survival only, and measures of TB-associated morbidity remain solely focused on the period prior to and during treatment. 15 The most widely used measure of disease burdenassociated morbidity is the disability-adjusted life year (DALY).…”

A 360-Degree View: An Autobiographical Case Report

“…What seems to be underreported is the impact of TB on the mental health of patients. According to a study by Alene et al [16], the prevalence of mental health impairment is found to be significantly high and they reported an incidence of 21.9% for mental disorders, second after respiratory impairment which was reported by 33.1% of patients. Depression, anxiety, post-traumatic stress disorder, and psychosis were seen among TB patients.…”

Estimating the contribution of subclinical tuberculosis disease to transmission – an individual patient data analysis from prevalence surveys

“…An estimated 1.5-million people died from tuberculosis (TB) disease in 2020, and TB is on course to retake its position as the largest cause of death by a single infectious agent [1]. Fuelled by ongoing transmission through exhaled or expectorated Mycobacterium tuberculosis ( Mtb ) bacteria, TB incidence is declining at a rate of 1-2% per annum, which is too slow given the risk and scale of mortality [1,2], lifelong impairment [3,4], poverty [5] and macro-economic consequences [6]. Problematically, most Mtb transmission in high incidence settings remains unaccounted for [3], with less than one-in-ten occurrences of TB explained by transmission from a known contact [7].…”