Prevalence and determinants of post-tuberculosis lung disease in Sub-Saharan Africa: A systematic review and meta-analysis

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Only a few studies have reported the burden of PTLD globally, and the determinants of PTLD have been understudied. This systematic review and meta-analysis aimed to estimate the pooled prevalence and determinants of PTLD in sub-Saharan African countries. Methods: This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines for systematic review and meta-analysis. We included studies reporting the prevalence and determinants of PTLD among individuals with a history of pulmonary TB in sub-Saharan Africa. A comprehensive literature search was conducted via PubMed, Embase, Google Scholar, and African Journal Online databases. The pooled prevalence of PTLD was estimated using a random-effects model, and associated factors were analyzed using crude odds ratios (ORs). Results: A total of 21 studies, consisting of 4,463 participants, were included. The overall pooled prevalence of PTLD in sub-Saharan Africa was 43.26% (95% CI: 34.17%–52.34%). The key determinants significantly associated with PTLD included: female sex (OR: 1.57, 95% CI: 1.16, 2.11), smoking (OR: 1.64, 95% CI: 1.09, 2.46), Presence of cough (OR: 1.73, 95% CI: 1.03, 2.9) and fibrotic pattern (OR:3.94 (95% CI: 1.96, 7.92). Conclusion: Nearly half of tuberculosis patients in sub-Saharan Africa develop post-tuberculosis lung disease. Being female, smoking, fibrosis, and posttreatment cough were key determinants associated with PTLD. To effectively manage PTLD in sub-Saharan Africa, it is important to implement targeted interventions for high-risk groups, strengthen screening and chronic care services, enhance healthcare system capacity, and integrate PTLD management into national TB control programs. Prevalence Determinants Risks Post-tuberculosis (PTLD) lung disease Lung impairment Chronic lung disease Sub-Saharan Africa Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Figure 8 Figure 9 Figure 10 Figure 11 Figure 12 Figure 13 Figure 14 Figure 15 Background Post-Tuberculosis Lung Disease (PTLD) is a chronic respiratory abnormality that persists in individuals after microbiological cure of pulmonary tuberculosis (TB), and can be attributed at least in part to previous tuberculosis[1]. PTLD encompasses a range of structural, functional, and symptomatic pulmonary impairments, including airflow obstruction, bronchiectasis, fibrosis, and reduced quality of life [2, 3]. Globally, TB has led to approximately 1.25 million deaths in 2024, with 10.8 million new cases reported in the same year[4]. Although effective TB treatment is widely available through national TB programs with reported treatment success rates of 88% for drug-susceptible TB and 68% for multidrug-resistant TB in 2022, the long-term consequences of TB, including post-treatment lung impairment, are increasingly recognized [4]. Post-tuberculosis lung disease (PTLD) is a major public health challenge, particularly in sub-Saharan Africa, where the burden of tuberculosis (TB) remains high [1, 5]. An estimated 4.5–5.8% of the population in the region is affected by chronic respiratory disease [4, 6, 7]. In response to this growing concern, the first International Post-Tuberculosis Symposium (2019) defined PTLD as “evidence of chronic respiratory abnormality, with or without symptoms, attributable at least in part to previous tuberculosis”[8]. A systematic review and meta-analysis published in December 2022 assessed the magnitude of post-tuberculosis lung disease (PTLD) in low- and middle-income countries (LMICs), revealing a high magnitude of PTLD among TB survivors [9]. In addition, a meta-analysis published in 2015 revealed that individuals with prior TB were approximately three times more likely to develop chronic obstructive pulmonary disease (COPD) than those without a TB history [9]. Existing studies in SSA vary widely in their definitions, methods, and populations, making it difficult to draw generalizable conclusions about PTLD in the region. Moreover, there is a considerable gap in evidence on the determinants of PTLD, such as HIV co-infection, TB severity, smoking, nutritional status, delayed diagnosis, and clinical characteristics, which leads to fragmented and inconsistent reports within the region. Recent TB treatment guidelines acknowledge the importance of evaluating the long-term health impacts of pulmonary TB [2]. Nevertheless, the lack of targeted studies involving African populations continues to hinder the development of context-specific policies, clinical guidelines, and interventions [10, 11]. This gap is further heightened by the limited quality of evidence available to support robust recommendations. In response to the growing recognition of post-tuberculosis lung disease (PTLD) as a significant but underexplored public health issue in sub-Saharan Africa (SSA), this systematic review and meta-analysis aims to synthesize available evidence to estimate the pooled prevalence of PTLD and identify its key determinants among individuals previously treated for TB in the region. By addressing current evidence gaps, this study seeks to generate reliable, context-specific data that will inform policymakers in developing clinical guidelines, enhancing post-TB care strategies, and supporting evidence-based health policy development in SSA. Methods A preliminary search was conducted in the PROSPERO database and the Database of Abstracts of Reviews of Effects (DARE) to identify any existing or ongoing systematic reviews related to the prevalence and determinants of post-tuberculosis lung disease (PTLD), to avoid duplication and ensure the novelty of the study. We performed a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines 2020 [12]. The study protocol has been registered on PROSPERO, ID CRD42025636215. Eligibility criteria PTLD has gained increasing recognition as a significant post-treatment sequela of tuberculosis, particularly since 2015 [13]. Therefore, studies conducted in SSA, published from 2015 onwards and reporting on both a history of pulmonary tuberculosis (TB) and the prevalence of post-tuberculosis lung disease (PTLD) were considered eligible for inclusion in the review. Specifically, observational studies using cross-sectional, cohort, or case-control designs were included. To ensure accessibility and accurate interpretation, only studies published in English were considered. Studies were excluded if they focused exclusively on extrapulmonary TB without reference to PTLD. Reviews, editorials, or conference abstracts lacking primary data. Additionally, any studies conducted before 2015 and outside of SSA were excluded to maintain the geographical and time scope of the review. Literature search and study selection The literature search was performed via PubMed, Embase, Google Scholar, and African Journal Online databases, from February 25, 2025 to March 20, 2025. Boolean operators such as “OR” and “AND” were used with search terms such as "post-tuberculosis lung disease," "PTLD," "chronic respiratory disease after TB," "sub-Saharan Africa," and "determinant factors associated with PTLD". The full search for each database is available in S 1. The identified research articles were screened to ensure that all relevant studies were included. The literature was downloaded and imported into Mendeley reference software to maintain and manage citations and facilitate the review process. Two reviewers (ATG and YAF) reviewed the articles, and a third reviewer (MTB) resolved any discrepancies. Research articles were subsequently screened based on their titles and abstracts to exclude studies that were irrelevant to the topic, such as those not addressing PTLD. The titles and abstracts of the selected studies were reviewed for full text by two authors (ATG, MTB). These processes were conducted independently, and discrepancies were resolved by the third author (HTA) to decide whether the study was included. Outcome measurement The primary outcome was the prevalence of post-tuberculosis lung disease (PTLD) among individuals with a history of tuberculosis. This was calculated by dividing the number of participants diagnosed with PTLD by the total number of individuals with prior TB included in the final analysis. The secondary outcome focused on the determinants associated with PTLD, which were assessed via odds ratios (ORs) derived from 2×2 contingency tables, as reported in the original studies. Data extraction The data extraction was conducted by MYT and YA via a data extraction tool that consists of demographic information, including Author, year of publication, country, income status, and study setting. Independent variables, such as participant residence, age, sex, HIV status and nutritional status, were also extracted. Smoking, severity markers of tuberculosis such as fibrosis and cough, overall PTLD prevalence, spirometry findings, and radiologic findings were extracted via a format created in a Microsoft Excel spreadsheet S2. Inconsistency due to data discrepancy was resolved by discussion with the reviewers. The overall PTLD prevalence data were extracted based on symptoms, spirometry, and radiologic findings as a benchmark. Risk of bias The methodological quality of the included articles was assessed via the Joanna Briggs Institute Critical Appraisal Tool [19]. This scale has 9 items with possible responses of "Yes", "No", and "Unclear". The quality score presented in Table 1 was determined by considering "Yes" as one point and "No" and "Unclear" as zero points, meaning that the higher the score is, the lower the risk of bias. Statistical analysis The extracted data were cleaned and exported to STATA V17.0 and used to determine the pooled prevalence of PTLD with a 95% confidence interval and the pooled association of determinants of PTLD. The I 2 statistic of the forest plots was computed to assess heterogeneity among the included studies. I 2 statistics range from 0 to 100%, with I 2 statistic values of 0, 25, 50, and 75% indicating no, low, moderate, and high degrees of heterogeneity, respectively. A random-effects model was used to determine the pooled prevalence of PTLD and the pooled associations of determinants of PTLD. To determine the source of potential random variation, subgroup analysis was performed depending on the WHO African region, World Bank income classification, study setting, and residency/study site. To assess the presence of publication bias, a combination of methods was employed, including visual inspection of the funnel plot and statistical tests, Egger’s test, and Begg’s test, which were performed at a significance threshold of 5%. Results Selection of studies A total of 2487 studies were identified by the search. Following the removal of 250 duplicate articles, 2237 articles were eligible for title and abstract screening. Reviewing titles and abstracts resulted in the exclusion of 1960 articles. After the full texts were assessed, 247 studies that did not meet the eligibility criteria were excluded. Finally, 21 studies were included in the final systematic review and meta-analysis[14–34] (Fig. 1). Characteristics of the included studies This study consists of 4463 individuals Table 1. The sample size ranges from 18 in Tanzania and Uganda [19, 29] to 798 reported from Uganda [17]. Fifteen studies were cross-sectional [14–20, 22, 24–27, 29, 30, 32]. Four studies were prospective cohort studies [15, 19, 21, 28, 34], and the other two studies were longitudinal [31] and comparative [23] studies by study design. In the included studies, participants were within all age groups, with a median age range between 8.9 and 52 years. We observed that the majority of the study participants were adults and adolescents. A slight predominance of males was observed in the study population, with approximately 52% male and 48% female participants. Prevalence of post-tuberculosis lung disease (PTLD) in sub-Saharan Africa The pooled prevalence of PTLD from 21 studies in SSA was 43.26% (95% CI: 34.17–52.34; I2 2: 97.7% p<0.001) (Fig. 2). The pooled prevalence of spirometry findings was 41.01% (95% CI: 31.58–50.45; I2 2: 96% p<0.001) (Fig. 3). The percentage of symptoms was 41.77% (95% CI: 29.25–54.28; I2 2: 97.8% p<0,001) (Fig. 4). The prevalence of radiologic evidence of PTLD was 60.92% (95% CI: 38.57–83.27; I2 2: 99.2% p<0.001) (Fig. 5). Publication bias Publication bias was assessed both graphically by a funnel plot (Fig. 6) and statistically by Egger’s (p = 0.9076) and Begg’s (p = 0.6077) tests. The results indicated no evidence of publication bias. Risk of bias In the assessment of the risk of bias, more than 85% of the studies met the key quality criteria, including the use of adequate sample sizes, subjects, and settings described in detail; the use of comprehensive and validated methods for the identification of PTLD; and reliable measurements. Sub-group Analysis Sub-group analysis was performed to determine PTLD prevalence in terms of the SSA region, study setting, and residency. In the WHO sub-Saharan Africa region, the highest 50.87% (95% CI 40.49, 61.26) and lowest 38.05% (95% CI 23.34, 52.77) pooled prevalence of post-TB lung disease were reported in Central Africa (Cameroon and the Democratic Republic of Congo) [18, 26] and West Africa [22, 23, 25, 33] respectively (Fig. 7 ). The pooled prevalence of PTLD for patients diagnosed at the TB clinic was 54.99% (95% CI 31.77, 78.2) [20, 22, 23]. The pooled prevalence of PTLD in a hospital setting was 38.12% (95% CI 27.28, 48.97) [14–16, 19, 21, 24–28, 30, 32–34] (Fig. 8 ). According to the residency/study site, the highest prevalence of PTLD was 53.66% (95% CI 28.38, 78.95) reported from a mixed rural-urban area[17, 30] reported from a mixed rural-urban area, and the lowest prevalence was 40.12% (95% CI 18.35, 61.88) reported from a rural area [16, 18, 19, 29] (Fig. 9). Determinants of post-tuberculosis lung disease in sub-Saharan Africa The determinants of post-tuberculosis lung disease included in the pooled analysis were sex, smoking, HIV status, nutritional status, fibrotic pattern and cough (Table 2). The pooled analysis of six studies revealed that the association between being female and PTLD was statistically significant, OR = 1.57 (95% CI: 1.16, 2.11; I2 = 21.3%, P-value = 0.273) [22, 23, 25–27, 34] (Fig. 10). The pooled association between cigarette smoking and PTLD was statistically significant with an OR of 1.64 (95% CI: 1.09–2.46; I² = 39.5%, p = 0.192) [20, 23, 30] (Fig. 11). The pooled analysis of two studies revealed that underweight individuals were 2.19 times more likely to develop post-tuberculosis lung disease (PTLD) than normal-weight individuals were. However, this association was not statistically significant, with an odds ratio (OR) of 2.19 (95% CI: 0.63–7.59; I² = 68.3%, p = 0.076)[22, 23] (Fig. 12). The pooled association between cough and PTLD was OR= 1.73 (95% CI: 1.03–2.90; I² = 0.0%, p = 0.919) [22, 23, 26] (Fig. 13). The pooled association between the presence of a fibrotic pattern and PTLD from two studies was an OR of 3.94 (95% CI: 1.96–7.92; I² = 0.0%, p = 0.804) [22, 26] (Fig. 14). The pooled association between HIV and PTLD from four studies was OR = 0.75 (95% CI: 0.54–1.04; I² = 14.9%, p = 0.318) [20, 25, 26, 30] (Fig. 15). Discussion Post-tuberculosis lung disease (PTLD) is a major public health challenge, particularly in sub-Saharan Africa, where the burden of tuberculosis (TB) remains high. This systematic review and meta-analysis summarized the prevalence and determinants of post-tuberculosis lung disease (PTLD) in sub-Saharan Africa (SSA). Following TB treatment, it is important to estimate the total prevalence and determinants of PTLD for an appropriate follow-up strategy and intervention. The results of this systematic review and meta-analysis revealed that the pooled prevalence of PTLD was 43.26% in SSA. These finding indicates that approximately 44 out of every 100 patients who complete TB treatment are likely to develop post-TB lung sequelae. This finding underscores the long-term pulmonary consequences faced by TB survivors and is consistent with previous global estimates, which suggest that over 40% of individuals recovering from pulmonary TB will develop chronic respiratory sequelae [7, 35]. Similarly, a systematic review and meta-analysis conducted in low- and middle-income countries (LMICs) reported that the magnitude of PTLD was 42.7% [36]. However, our estimate is lower than that of a recent global study, which reported that approximately 59.1% of TB survivors experience PTLD [5]. This variation may be attributed to disparities in socioeconomic status and differences in health system contexts between global and sub-Saharan African (SSA) countries. The findings of this study are also consistent with those of clinical reviews, indicating that PTLD affects a broad range of respiratory functions, including obstructive lung disease, bronchiectasis, and pulmonary vascular damage [37]. It is estimated that up to half of TB survivors globally suffer from some form of PTLD[1]. This highlights the importance of comprehensive assessments that include both spirometry and symptom evaluations to capture the full extent of PTLD. In this study, a higher prevalence of radiologic abnormalities was observed (60.92%), which aligns with findings from other meta-analyses that reported a prevalence of 64.6% [36] but was lower than that reported in a review that noted radiologic abnormalities in up to 86% of patients [38]. The greater prevalence of radiologic findings than spirometry-based impairments highlight the importance of thorough imaging in post-TB care, as structural damage may be present even when pyrometric tests appear normal. In this review, there were marked differences in the prevalence of post-TB lung disease (PTLD) across sub-Saharan Africa. The highest prevalence was observed in Central Africa (50.87%), whereas the lowest was reported in West Africa (38.05%), which aligns with previous findings that regional disparities in PTLD are often driven by variations in healthcare access, diagnostic capacity, and TB management quality across African regions [39]. Similarly, the significantly higher PTLD prevalence in TB clinic attendees (54.99%) than in hospital-based studies (38.12%) may reflect a more chronic disease trajectory among those engaged in follow-up TB services. Moreover, the finding that mixed rural-urban settings had a higher PTLD prevalence (53.66%) than did purely rural areas (40.12%) suggests that environmental and occupational exposures are highest in peri-urban zones [37]. Determinants of post-tuberculosis lung disease (PTLD) Post-tuberculosis lung disease (PTLD) is affected by multiple factors, including older age, as reported in many studies [30, 37]. Prior TB disease severity, recurrent TB, smoking, malnutrition, and HIV co-infection. Identifying these determinants is essential for improving post-TB care in high-burden settings. The current systematic review and meta-analysis revealed that females were 1.57 times more likely to develop PTLD than males were. This finding aligns with a study conducted in Zimbabwe and South Africa, suggesting that sex specific factors may influence disease severity and outcomes [28, 36, 40, 41]. Global studies often reported a greater incidence of tuberculosis among men than among women, with a male-to-female ratio of 2:1 in many regions[42–44]. However, women may experience worse long-term outcomes, such as PTLD or extra-pulmonary manifestations, potentially due to delayed diagnosis, social stigma, or biological differences in immune responses [40, 41]. The pooled analysis revealed that patients classified as underweight were 2.19 times more likely to develop PTLD than their normal-weight counterparts. This finding underscores the impact of nutritional status on the long-term respiratory health of individuals who have previously suffered from tuberculosis. Underweight individuals often experience compromised immune function, which can hinder recovery from tuberculosis and increase susceptibility to chronic lung conditions such as PTLD. The severity of undernutrition has been linked to poorer treatment outcomes in tuberculosis patients. Underweight patients are at increased risk of treatment failure and relapse [45, 46]. For example, one study conducted in Ethiopia indicated that underweight patients had a greater prevalence of severe symptoms and complications during TB treatment, which was associated with increased risks of long-term respiratory problems [45]. The other important factor in this study was cigarette smoking, which indicates that smokers were 1.64 times more likely to develop PTLD than non-smokers were. This underscores the importance of including smoking cessation interventions in TB control practices, especially in reducing post-TB treatment complications. For example, a study conducted at 18 TB clinics in Hong Kong reported that both current and ex-smokers were significantly less likely to achieve treatment completion and had higher rates of treatment failure, with smoking contributing to approximately 16.7% of unsuccessful treatment outcomes attributed to defaulting on treatment and mortality among ex-smokers [47]. Furthermore, smoking is associated with a slower bacteriological response during tuberculosis treatment, which means that smokers are more likely to remain sputum-positive after two months of therapy. This delayed response not only increases the risk of transmission but also raises concerns about the persistence of Mycobacterium tuberculosis in the lungs, leading to potential complications like PTLD [48, 49]. The other factor assessed in this study was the association b/n HIV and post-tuberculosis lung disease (PTLD). Tuberculosis infection is known to be strongly associated with HIV, and individuals living with HIV are often hypothesized to be more susceptible to developing PTLD. However, findings from the current study indicate that the pooled association between HIV status and PTLD was not statistically significant, with an odds ratio (OR) of 0.75. This suggests that while HIV is a known risk factor for tuberculosis, its impact on the development of PTLD may not be as pronounced as previously thought. Interestingly, other studies also suggest that individuals living with HIV may experience less severe forms of PTLD than their HIV-negative counterparts do [50]. This could be attributed to factors such as immunosuppression leading to less cavitary disease at the time of TB diagnosis, which may result in lower rates of lung damage [21]. Clinical presentations such as cough and fibrotic patterns are among the known features associated with post-tuberculosis lung disease (PTLD). The results from the present study indicates that patients with a history of tuberculosis who present with a cough after completing TB treatment are 1.73 times more likely to develop PTLD. This association increases the need for post-treatment follow-up and structured lung health assessments, particularly in resource-limited settings where PTLD often remains undiagnosed or misclassified [8, 21]. Fibrotic patterns observed on chest radiographs or CT scans are a common finding and are strongly associated with irreversible lung tissue damage, contributing to reduced lung function and diminished quality of life. In this study, patients presenting with fibrotic patterns were 3.94 times more likely to develop PTLD than those without fibrotic patterns. A prospective cohort study from Malawi revealed that fibrotic patterns were strongly associated with persistent respiratory symptoms and reduced spirometry measurements among TB survivors [13, 21, 35] One study from the DR Congo reported that anti-TB treatment for more than 6 months was significantly associated with PTLD [18]. This might be due to delayed bacterial clearance and prolonged inflammation, which can lead to irreversible lung damage. Extended treatment may also indicate more severe or drug-resistant TB, which is independently linked to a greater risk of structural lung complications such as fibrosis and bronchiectasis [51]. The persistent burden of PTLD calls for integrated care models that extend beyond microbiological cure, emphasizing pulmonary rehabilitation, spirometry-based evaluations, and long-term symptom monitoring. Moreover, further research is needed to define standardized diagnostic criteria and evidence-based interventions for PTLD. Implications for evidence-informed policy and clinical practice Given the high prevalence of PTLD in sub-Saharan Africa, it is essential to integrate PTLD management policies and practices into existing TB control programs. National TB programs should broaden their focus beyond cure to include post-treatment rehabilitation, aiming to increase the quality of life for TB survivors. Strengthening healthcare systems by training workers, providing diagnostic tools, and establishing referral pathways is crucial for better PTLD diagnosis and management [52, 53]. Collaboration among TB programs, specialists, researchers, and community organizations is vital [53]. Strengths and limitations This systematic review and meta-analysis comprehensively searched multiple databases for both published and unpublished studies. Relevant studies were included following a rigorous quality assessment process, which included determinants of PTLD in the analysis. We used the crude odds ratio for analyzing determinant of PTLD. The other major limitation of this study was the underrepresentation of pediatric data, and only a few studies have reported on the determinants of PTLD. Additionally, key factors such as treatment non-adherence were not addressed due to data limitations. Conclusion This systematic review and meta-analysis highlights the prevalence and determinants of post-tuberculosis lung disease (PTLD) in sub-Saharan Africa, emphasizing that nearly half of TB survivors are at risk of developing PTLD. Therefore, it is crucial to integrate routine PTLD screening, spirometry, imaging, and targeted interventions into national TB programs. Additionally, strengthening health systems through enhanced diagnostic capacity, provider training, and community awareness creation is essential for developing evidence-based policies that address the full spectrum of TB-related morbidity and mortality. Furthermore, the absence of an association between HIV and PTLD observed in the included studies permits further research to explain the underlying mechanisms and potential modifying factors. Abbreviations BMI: Body mass index CI: Confidence interval COPD: Chronic Obstructive Pulmonary Disease DBAE: Database of Abstract of Effect HIV: Human Immunodeficiency Virus LMICS: Low- and Middle-Income Countries OR: Odds Ratio PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analysis PTLD: Post-tuberculosis lung disease SSA: Sub-Saharan Africa TB: Tuberculosis UQAT; Université du Québec en Abitibi-Témiscamingue WHO: World Health Organization Declarations Acknowledgements We would like to thank all authors of the studies included in this systematic review and meta-analysis. Author contributions ATG, KBA, YAF, MYT, TAB ZA, SD, AT, MTB, and HTA were involved in the design, statistical analysis, and manuscript writing, and participated in the selection of articles and data extraction. All authors were involved in developing the initial drafts of the manuscript, revising subsequent drafts, and preparing the final draft of the manuscript. All authors read and approved the final manuscript. Funding No funding was obtained for this study. Data availability The datasets used and/or analyzed during the current study are available from the corresponding author and can be made available upon reasonable request. Ethics approval and consent to participate This study used secondary data; therefore, no ethical approval was required. Consent for publication Not applicable References Yarbrough C, Miller M, Zulu M, et al. Post-tuberculosis lung disease: Addressing the policy gap. PLOS Glob Public Heal 2024; 4: 6–13. Johnston JC, Cooper R, Menzies D. Chapter 5: Treatment of tuberculosis disease. Can J Respir Crit Care, Sleep Med 2022; 6: 66–76. Ivanova O, Hoffmann VS, Lange C, et al. Post-tuberculosis lung impairment: systematic review and meta-analysis of spirometry data from 14 621 people. Eur Respir Rev ; 32. Epub ahead of print 2023. DOI: 10.1183/16000617.0221-2022. World health organization W. https://www.who.int/teams/global-tuberculosis-programme/tb-reports/global-tuberculosis-report-2024 . 2024. Taylor J, Bastos ML, Lachapelle-Chisholm S, et al. Residual respiratory disability after successful treatment of pulmonary tuberculosis: a systematic review and meta-analysis. eClinicalMedicine 2023; 59: 101979. Dodd PJ, Yuen CM, Jayasooriya SM, et al. Quantifying the global number of tuberculosis survivors : a modelling study. 21. Byrne AL, Marais BJ, Mitnick CD, et al. Tuberculosis and chronic respiratory disease : a systematic review. Int J Infect Dis 2015; 32: 138–146. Allwood BW, van der Zalm MM, Amaral AFS, et al. Post-tuberculosis lung health: perspectives from the First International Symposium. Int J Tuberc lung Dis Off J Int Union against Tuberc Lung Dis 2020; 24: 820–828. World Health Organization Executive Board. Global strategy and targets for tuberculosis prevention , care and control after 2015, November 2013, pp. 1–23, 2015. 2015; 1–23. Tripathi D. HSV. ADSADP. S. CLINICORADIOLOGICAL PROFILE OF POST- TUBERCULOSIS LUNG DISEASE: AN OBSERVATIONAL STUDY IN PATIENTS AT A TERTIARY CARE HOSPITAL IN INDORE, MADHYA PRADESH. India J Res 1991; 13: 137–138. Egere U, Shayo E, Ntinginya N, et al. Management of chronic lung diseases in Sudan and Tanzania: how ready are the country health systems? BMC Health Serv Res 2021; 21: 1–11. Page MJ, McKenzie JE, Bossuyt P, et al. The prisma 2020 statement: An updated guideline for reporting systematic reviews. Med Flum 2021; 57: 444–465. Allwood BW, Van Der Zalm MM, Amaral AFS, et al. Post-tuberculosis lung health: Perspectives from the First International Symposium. Int J Tuberc Lung Dis 2020; 24: 820–828. Binegdie AB, Parekh M, Tolessa TB, et al. SEQUELAE OF PATIENTS TREATED FOR PULMONARY TUBERCULOSIS IN CHEST CLINIC , TIKUR ANBESSA SPECIALIZED HOSPITAL ( TASH ),. 2015; 53: 167–171. Chin AT, Rylance J, Makumbirofa S, et al. Chronic lung disease in adult recurrent tuberculosis survivors in Zimbabwe : a cohort study. 2019; 23: 203–211. Kayongo A, Wosu AC, Naz T, et al. Chronic Obstructive Pulmonary Disease Prevalence and Associated Factors in a Setting of Well-Controlled HIV, A Cross-Sectional Study. COPD 2020; 17: 297–305. Kampen SC Van, Jones R, Kisembo H, et al. Chronic Respiratory Symptoms and Lung Abnormalities Among People With a History of Tuberculosis in Uganda : A National Survey. 2019; 68: 1919–1925. Katoto PDMC, Murhula A, Kayembe-kitenge T, et al. Household Air Pollution Is Associated with Chronic Cough but Not Hemoptysis after Completion of Pulmonary Tuberculosis Treatment in Adults , Rural Eastern Democratic Republic of Congo. Epub ahead of print 2018. DOI: 10.3390/ijerph15112563. North CM, Allen JG, Okello S, et al. HIV Infection , Pulmonary Tuberculosis , and COPD in Rural Uganda : A Cross-Sectional Study. Lung 2017; 0: 0. Manji M, Shayo G, Mamuya S, et al. Lung functions among patients with pulmonary tuberculosis in Dar es Salaam - A cross-sectional study. BMC Pulm Med 2016; 16: 1–9. Meghji J, Lesosky M, Joekes E, et al. Patient outcomes associated with post-tuberculosis lung damage in Malawi: A prospective cohort study. Thorax 2020; 75: 269–278. Nkereuwem E, Agbla S, Njai B, et al. Post-tuberculosis respiratory impairment in Gambian children and adolescents: A cross-sectional analysis. Pediatr Pulmonol 2024; 59: 1912–1921. Nkereuwem E, Agbla S, Sallahdeen A, et al. Reduced lung function and health-related quality of life after treatment for pulmonary tuberculosis in Gambian children: a cross-sectional comparative study. Thorax 2023; 78: 281–287. Ddungu A, 1, 2*, Fred C. Semitala3, 4, 5, Barbara Castelnuovo1, Christine Sekaggya- Wiltshire1, 5, William Worodria2, 3, 5, Bruce J. Kirenga2 3. Chronic obstructive pulmonary disease prevalence and associated factors in an urban HIV clinic in a low income country. 2021; 2: 1–12. A. A. Fiogbe,*† G. Agodokpessi,* J. F. Tessier,‡ D. Affolabi,* D. M. Zannou,§ G. Ad´e,* S. Anagonou,* C. Raherison-Semjen # O. Marcy. Prevalence of lung function impairment in cured pulmonary tuberculosis patients in Cotonou , Benin. 2019; 23: 195–202. Hugo B, Ngahane M, Nouyep J, et al. Post-tuberculous lung function impairment in a tuberculosis reference clinic in Cameroon. Respir Med 2016; 114: 67–71. Attia EF, Maleche-obimbo E, West TE, et al. Adolescent age is an independent risk factor for abnormal spirometry among people living with HIV in Kenya. Epub ahead of print 2018. DOI: 10.1097/QAD.0000000000001815. Auld SC, Kornfeld H, Maenetje P, et al. Pulmonary restriction predicts long ‑ term pulmonary impairment in people with HIV and tuberculosis. BMC Pulm Med 2021; 1–10. Magitta F, Walker RW, Apte K, et al. Prevalence , risk factors and clinical correlates of COPD in a rural setting in Tanzania. DOI: 10.1183/13993003.00182-2017. Mpagama SG, Msaji KS, Kaswaga O, et al. The burden and determinants of post-TB lung disease. Int J Tuberc lung Dis Off J Int Union against Tuberc Lung Dis 2021; 25: 846–853. van der Zalm MM, Jongen VW, Swanepoel R, et al. Impaired lung function in adolescents with pulmonary tuberculosis during treatment and following treatment completion. eClinicalMedicine 2024; 67: 102406. Osman M, Welte A, Dunbar R, et al. Morbidity and mortality up to 5 years post tuberculosis treatment in South Africa: A pilot study. Int J Infect Dis 2019; 85: 57–63. Akanbi MO, Taiwo BO, Achenbach CJ, et al. AIDS & Clinical Research HIV Associated Chronic Obstructive Pulmonary Disease in Nigeria. 6. Epub ahead of print 2015. DOI: 10.4172/2155-6113.1000453. Khosa C, Bhatt N, Massango I, et al. Development of chronic lung impairment in Mozambican TB patients and associated risks. 2020; 1–11. Silva DR, Freitas AA, Guimarães AR, et al. Post-tuberculosis lung disease: a comparison of Brazilian, Italian, and Mexican cohorts. J Bras Pneumol 2022; 48: 6–11. Id EM, Atieno M, Id O, et al. PLOS GLOBAL PUBLIC HEALTH Magnitude and factors associated with post- tuberculosis lung disease in low- and middle- income countries : A systematic review and. 2022; 1–26. Allwood BW, Byrne A, Meghji J, et al. Post-Tuberculosis Lung Disease: Clinical Review of an Under-Recognised Global Challenge. Respiration 2021; 100: 751–763. Meghji J, Simpson H, Squire SB, et al. A Systematic Review of the Prevalence and Pattern of Imaging Defined Post-TB Lung Disease. PLoS One 2016; 11: e0161176. Meghji J, Mortimer K, Agusti A, et al. Improving lung health in low-income and middle-income countries: from challenges to solutions. Lancet (London, England) 2021; 397: 928–940. Humayun M, Chirenda J, Ye W, et al. Effect of Gender on Clinical Presentation of Tuberculosis (TB) and Age-Specific Risk of TB, and TB-Human Immunodeficiency Virus Coinfection. Open Forum Infect Dis 2022; 9: 1–9. Lin CY, Chen TC, Lu PL, et al. Effects of Gender and Age on Development of Concurrent Extrapulmonary Tuberculosis in Patients with Pulmonary Tuberculosis: A Population Based Study. PLoS One ; 8. Epub ahead of print 2013. DOI: 10.1371/journal.pone.0063936. Peer V, Schwartz N, Green MS. Gender differences in tuberculosis incidence rates—A pooled analysis of data from seven high-income countries by age group and time period. Front Public Heal ; 10. Epub ahead of print 2023. DOI: 10.3389/fpubh.2022.997025. Marçôa R. Tuberculosis and gender – Factors influencing the risk of tuberculosis among men and women by age group. Pulmonology 2018; 24: 199–202. Nhamoyebonde S, Leslie A. Biological differences between the sexes and susceptibility to tuberculosis. J Infect Dis ; 209. Epub ahead of print 2014. DOI: 10.1093/infdis/jiu147. Sahile Z, Tezera R, Mariam DH, et al. Nutritional status and TB treatment outcomes in Addis Ababa, Ethiopia: An ambi-directional cohort study. PLoS One 2021; 16: 1–14. Yen YF, Tung FI, Ho BL, et al. Underweight increases the risk of early death in tuberculosis patients. Br J Nutr 2017; 118: 1052–1060. Leung CC, Yew WW, Chan CK, et al. Smoking adversely affects treatment response, outcome and relapse in tuberculosis. Eur Respir J 2015; 45: 738–745. Ganderia B. The association between asthma and tuberculosis. J Allergy 1962; 33: 112–129. Alavi-Naini R, Sharifi-Mood B, Metanat M. Association Between Tuberculosis and Smoking. Int J High Risk Behav Addict 2012; 1: 71–4. Mkoko P, Naidoo S, Mbanga LC, et al. Chronic lung disease and a history of tuberculosis (post-tuberculosis lung disease): Clinical features and in-hospital outcomes in a resource-limited setting with a high HIV burden. S Afr Med J 2019; 109: 169–173. Hnizdo E, Singh T, Churchyard G. Chronic pulmonary function impairment caused by initial and recurrent pulmonary tuberculosis following treatment. Thorax 2000; 55: 32–38. Id AG, Juneja S, Sahu S, et al. PLOS GLOBAL PUBLIC HEALTH Lifesaving , cost-saving : Innovative simplified regimens for drug-resistant tuberculosis. 2022; 10–13. Academy of Medical Sciences. Improving the prevention and management of multimorbidity in sub-Saharan Africa, https://acmedsci.ac.uk/file-download/65601508 (2019). Tables Tables 1 and 2 are available in the Supplementary Files section. Additional Declarations No competing interests reported. Supplementary Files Tables.xlsx S1.docx S2.xlsx Cite Share Download PDF Status: Published Journal Publication published 23 Dec, 2025 Read the published version in BMC Pulmonary Medicine → Version 1 posted Editorial decision: Revision requested 12 Jun, 2025 Reviewers agreed at journal 10 Jun, 2025 Reviews received at journal 07 Jun, 2025 Reviewers agreed at journal 06 Jun, 2025 Reviewers agreed at journal 05 Jun, 2025 Reviews received at journal 04 Jun, 2025 Reviewers agreed at journal 04 Jun, 2025 Reviewers agreed at journal 04 Jun, 2025 Reviewers agreed at journal 03 Jun, 2025 Reviewers agreed at journal 03 Jun, 2025 Reviewers agreed at journal 03 Jun, 2025 Reviewers invited by journal 03 Jun, 2025 Editor assigned by journal 03 Jun, 2025 Editor invited by journal 03 Jun, 2025 Submission checks completed at journal 02 Jun, 2025 First submitted to journal 02 Jun, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6727961","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":466645560,"identity":"20a9ec8c-a553-4155-bd74-6861e7e006e2","order_by":0,"name":"Abraham 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PTLD encompasses a range of structural, functional, and symptomatic pulmonary impairments, including airflow obstruction, bronchiectasis, fibrosis, and reduced quality of life [2, 3].\u003c/p\u003e \u003cp\u003eGlobally, TB has led to approximately 1.25\u0026nbsp;million deaths in 2024, with 10.8\u0026nbsp;million new cases reported in the same year[4]. Although effective TB treatment is widely available through national TB programs with reported treatment success rates of 88% for drug-susceptible TB and 68% for multidrug-resistant TB in 2022, the long-term consequences of TB, including post-treatment lung impairment, are increasingly recognized [4]. Post-tuberculosis lung disease (PTLD) is a major public health challenge, particularly in sub-Saharan Africa, where the burden of tuberculosis (TB) remains high [1, 5]. An estimated 4.5\u0026ndash;5.8% of the population in the region is affected by chronic respiratory disease [4, 6, 7]. In response to this growing concern, the first International Post-Tuberculosis Symposium (2019) defined PTLD as \u0026ldquo;evidence of chronic respiratory abnormality, with or without symptoms, attributable at least in part to previous tuberculosis\u0026rdquo;[8].\u003c/p\u003e \u003cp\u003eA systematic review and meta-analysis published in December 2022 assessed the magnitude of post-tuberculosis lung disease (PTLD) in low- and middle-income countries (LMICs), revealing a high magnitude of PTLD among TB survivors [9]. In addition, a meta-analysis published in 2015 revealed that individuals with prior TB were approximately three times more likely to develop chronic obstructive pulmonary disease (COPD) than those without a TB history [9]. Existing studies in SSA vary widely in their definitions, methods, and populations, making it difficult to draw generalizable conclusions about PTLD in the region. Moreover, there is a considerable gap in evidence on the determinants of PTLD, such as HIV co-infection, TB severity, smoking, nutritional status, delayed diagnosis, and clinical characteristics, which leads to fragmented and inconsistent reports within the region. Recent TB treatment guidelines acknowledge the importance of evaluating the long-term health impacts of pulmonary TB [2]. Nevertheless, the lack of targeted studies involving African populations continues to hinder the development of context-specific policies, clinical guidelines, and interventions [10, 11]. This gap is further heightened by the limited quality of evidence available to support robust recommendations.\u003c/p\u003e \u003cp\u003eIn response to the growing recognition of post-tuberculosis lung disease (PTLD) as a significant but underexplored public health issue in sub-Saharan Africa (SSA), this systematic review and meta-analysis aims to synthesize available evidence to estimate the pooled prevalence of PTLD and identify its key determinants among individuals previously treated for TB in the region. By addressing current evidence gaps, this study seeks to generate reliable, context-specific data that will inform policymakers in developing clinical guidelines, enhancing post-TB care strategies, and supporting evidence-based health policy development in SSA.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eA preliminary search was conducted in the PROSPERO database and the Database of Abstracts of Reviews of Effects (DARE) to identify any existing or ongoing systematic reviews related to the prevalence and determinants of post-tuberculosis lung disease (PTLD), to avoid duplication and ensure the novelty of the study. We performed a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines 2020 [12]. The study protocol has been registered on PROSPERO, ID CRD42025636215.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eEligibility criteria\u003c/h2\u003e \u003cp\u003ePTLD has gained increasing recognition as a significant post-treatment sequela of tuberculosis, particularly since 2015 [13]. Therefore, studies conducted in SSA, published from 2015 onwards and reporting on both a history of pulmonary tuberculosis (TB) and the prevalence of post-tuberculosis lung disease (PTLD) were considered eligible for inclusion in the review. Specifically, observational studies using cross-sectional, cohort, or case-control designs were included. To ensure accessibility and accurate interpretation, only studies published in English were considered. Studies were excluded if they focused exclusively on extrapulmonary TB without reference to PTLD. Reviews, editorials, or conference abstracts lacking primary data. Additionally, any studies conducted before 2015 and outside of SSA were excluded to maintain the geographical and time scope of the review.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eLiterature search and study selection\u003c/h3\u003e\n\u003cp\u003eThe literature search was performed via PubMed, Embase, Google Scholar, and African Journal Online databases, from February 25, 2025 to March 20, 2025. Boolean operators such as \u0026ldquo;OR\u0026rdquo; and \u0026ldquo;AND\u0026rdquo; were used with search terms such as \"post-tuberculosis lung disease,\" \"PTLD,\" \"chronic respiratory disease after TB,\" \"sub-Saharan Africa,\" and \"determinant factors associated with PTLD\". The full search for each database is available in S 1. The identified research articles were screened to ensure that all relevant studies were included. The literature was downloaded and imported into Mendeley reference software to maintain and manage citations and facilitate the review process. Two reviewers (ATG and YAF) reviewed the articles, and a third reviewer (MTB) resolved any discrepancies. Research articles were subsequently screened based on their titles and abstracts to exclude studies that were irrelevant to the topic, such as those not addressing PTLD. The titles and abstracts of the selected studies were reviewed for full text by two authors (ATG, MTB). These processes were conducted independently, and discrepancies were resolved by the third author (HTA) to decide whether the study was included.\u003c/p\u003e\n\u003ch3\u003eOutcome measurement\u003c/h3\u003e\n\u003cp\u003eThe primary outcome was the prevalence of post-tuberculosis lung disease (PTLD) among individuals with a history of tuberculosis. This was calculated by dividing the number of participants diagnosed with PTLD by the total number of individuals with prior TB included in the final analysis. The secondary outcome focused on the determinants associated with PTLD, which were assessed via odds ratios (ORs) derived from 2\u0026times;2 contingency tables, as reported in the original studies.\u003c/p\u003e\n\u003ch3\u003eData extraction\u003c/h3\u003e\n\u003cp\u003eThe data extraction was conducted by MYT and YA via a data extraction tool that consists of demographic information, including Author, year of publication, country, income status, and study setting. Independent variables, such as participant residence, age, sex, HIV status and nutritional status, were also extracted. Smoking, severity markers of tuberculosis such as fibrosis and cough, overall PTLD prevalence, spirometry findings, and radiologic findings were extracted via a format created in a Microsoft Excel spreadsheet S2. Inconsistency due to data discrepancy was resolved by discussion with the reviewers. The overall PTLD prevalence data were extracted based on symptoms, spirometry, and radiologic findings as a benchmark.\u003c/p\u003e\n\u003ch3\u003eRisk of bias\u003c/h3\u003e\n\u003cp\u003eThe methodological quality of the included articles was assessed via the Joanna Briggs Institute Critical Appraisal Tool [19]. This scale has 9 items with possible responses of \"Yes\", \"No\", and \"Unclear\". The quality score presented in Table\u0026nbsp;1 was determined by considering \"Yes\" as one point and \"No\" and \"Unclear\" as zero points, meaning that the higher the score is, the lower the risk of bias.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eThe extracted data were cleaned and exported to STATA V17.0 and used to determine the pooled prevalence of PTLD with a 95% confidence interval and the pooled association of determinants of PTLD. The I\u003csup\u003e2\u003c/sup\u003e statistic of the forest plots was computed to assess heterogeneity among the included studies. I\u003csup\u003e2\u003c/sup\u003e statistics range from 0 to 100%, with I\u003csup\u003e2\u003c/sup\u003e statistic values of 0, 25, 50, and 75% indicating no, low, moderate, and high degrees of heterogeneity, respectively. A random-effects model was used to determine the pooled prevalence of PTLD and the pooled associations of determinants of PTLD. To determine the source of potential random variation, subgroup analysis was performed depending on the WHO African region, World Bank income classification, study setting, and residency/study site. To assess the presence of publication bias, a combination of methods was employed, including visual inspection of the funnel plot and statistical tests, Egger\u0026rsquo;s test, and Begg\u0026rsquo;s test, which were performed at a significance threshold of 5%.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eSelection of studies\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 2487 studies were identified by the search. Following the removal of 250 duplicate articles, 2237 articles were eligible for title and abstract screening. Reviewing titles and abstracts resulted in the exclusion of 1960 articles. After the full texts were assessed, 247 studies that did not meet the eligibility criteria were excluded. Finally, 21 studies were included in the final systematic review and meta-analysis[14\u0026ndash;34] (Fig. 1).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCharacteristics of the included studies\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study consists of 4463 individuals Table 1. The sample size ranges from \u0026nbsp;18 in Tanzania and Uganda \u0026nbsp;[19, 29] to 798 reported from \u0026nbsp;Uganda \u0026nbsp; [17]. Fifteen studies were cross-sectional [14\u0026ndash;20, 22, 24\u0026ndash;27, 29, 30, 32]. Four studies were prospective cohort studies [15, 19, 21, 28, 34], and the other two studies were longitudinal [31] and comparative [23] studies by study design. \u0026nbsp;In the included studies, participants were within all age groups, with a median age range between 8.9 and 52 years. We observed that the majority of the study participants were adults and adolescents. A slight predominance of males was observed in the study population, with approximately 52% male and 48% female participants.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePrevalence of post-tuberculosis lung disease (PTLD) in sub-Saharan Africa\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe pooled prevalence of PTLD from 21 studies in SSA was 43.26% (95% CI: 34.17\u0026ndash;52.34; I2 2: 97.7% p\u0026lt;0.001) (Fig. 2). The pooled prevalence of spirometry findings was 41.01% (95% CI: 31.58\u0026ndash;50.45; I2 2: 96% p\u0026lt;0.001) (Fig. 3). The percentage of symptoms was 41.77% (95% CI: 29.25\u0026ndash;54.28; I2 2: 97.8% p\u0026lt;0,001) (Fig. 4). The prevalence of radiologic evidence of PTLD was 60.92% (95% CI: 38.57\u0026ndash;83.27; I2 2: 99.2% p\u0026lt;0.001) (Fig. 5).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePublication bias\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePublication bias was assessed both graphically by a funnel plot (Fig. 6) and statistically by Egger\u0026rsquo;s (p = 0.9076) and Begg\u0026rsquo;s (p = 0.6077) tests. The results indicated no evidence of publication bias.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRisk of bias\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn the assessment of the risk of bias, more than 85% of the studies met the key quality criteria, including the use of adequate sample sizes, subjects, and settings described in detail; the use of comprehensive and validated methods for the identification of PTLD; and reliable measurements.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSub-group Analysis\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSub-group analysis was performed to determine PTLD prevalence in terms of the SSA region, study setting, and residency. In the WHO sub-Saharan Africa region, the highest 50.87% (95% CI 40.49, 61.26) and \u0026nbsp;lowest 38.05% (95% CI 23.34, 52.77) pooled prevalence of post-TB lung disease were reported in Central Africa (Cameroon and the Democratic Republic of Congo) [18, 26] and West Africa [22, 23, 25, 33] respectively (Fig. \u003cem\u003e7\u003c/em\u003e). The pooled prevalence of PTLD \u0026nbsp;for patients diagnosed at the TB clinic was 54.99% (95% CI 31.77, 78.2) [20, 22, 23]. The pooled prevalence of PTLD in a hospital setting was 38.12% (95% CI 27.28, 48.97) [14\u0026ndash;16, 19, 21, 24\u0026ndash;28, 30, 32\u0026ndash;34] (Fig. \u003cem\u003e8\u003c/em\u003e). According to the residency/study site, the highest prevalence of PTLD was 53.66% (95% CI 28.38, 78.95) reported from a mixed rural-urban area[17, 30] reported from a mixed rural-urban area, and the lowest prevalence was 40.12% (95% CI 18.35, 61.88) reported from a rural area [16, 18, 19, 29] (Fig. 9).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDeterminants of post-tuberculosis lung disease in sub-Saharan Africa\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe determinants of post-tuberculosis lung disease included in the pooled analysis were sex, smoking, HIV status, nutritional status, fibrotic pattern and cough (Table 2).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe pooled analysis of six studies revealed that the association between being female and PTLD was statistically significant, OR = 1.57 (95% CI: 1.16, 2.11; I2 = 21.3%, P-value = 0.273) [22, 23, 25\u0026ndash;27, 34] (Fig. 10).\u003c/p\u003e\n\u003cp\u003eThe pooled association between cigarette smoking and PTLD was \u0026nbsp;statistically significant with an OR of 1.64 (95% CI: 1.09\u0026ndash;2.46; I\u0026sup2; = 39.5%, p = 0.192) [20, 23, 30] (Fig. 11). \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe pooled analysis of two studies revealed that underweight individuals were 2.19 times more likely to develop post-tuberculosis lung disease (PTLD) than normal-weight individuals were. However, this association was not statistically significant, with an odds ratio (OR) of 2.19 (95% CI: 0.63\u0026ndash;7.59; I\u0026sup2; = 68.3%, p = 0.076)[22, 23] (Fig. 12).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe pooled association between \u0026nbsp;cough \u0026nbsp; and PTLD was OR= 1.73 (95% CI: 1.03\u0026ndash;2.90; I\u0026sup2; = 0.0%, p = 0.919) [22, 23, 26] (Fig. 13).\u003c/p\u003e\n\u003cp\u003eThe pooled association between the presence of a fibrotic pattern and PTLD from two studies was an OR of 3.94 (95% CI: 1.96\u0026ndash;7.92; I\u0026sup2; = 0.0%, p = 0.804) [22, 26] (Fig. 14).\u003c/p\u003e\n\u003cp\u003eThe pooled association between HIV and PTLD from four studies was OR = 0.75 (95% CI: 0.54\u0026ndash;1.04; I\u0026sup2; = 14.9%, p = 0.318) \u0026nbsp;[20, 25, 26, 30] (Fig. 15).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003ePost-tuberculosis lung disease (PTLD) is a major public health challenge, particularly in sub-Saharan Africa, where the burden of tuberculosis (TB) remains high. This systematic review and meta-analysis summarized the prevalence and determinants of post-tuberculosis lung disease (PTLD) in sub-Saharan Africa (SSA). Following TB treatment, it is important to estimate the total prevalence and determinants of PTLD for an appropriate follow-up strategy and intervention. The results of this systematic review and meta-analysis revealed that the pooled prevalence of PTLD was 43.26% in SSA. These finding indicates that approximately 44 out of every 100 patients who complete TB treatment are likely to develop post-TB lung sequelae. This finding underscores the long-term pulmonary consequences faced by TB survivors and is consistent with previous global estimates, which suggest that over 40% of individuals recovering from pulmonary TB will develop chronic respiratory sequelae [7, 35]. Similarly, a systematic review and meta-analysis conducted in low- and middle-income countries (LMICs) reported that the magnitude of PTLD was 42.7% [36]. However, our estimate is lower than that of a recent global study, which reported that approximately 59.1% of TB survivors experience PTLD [5]. This variation may be attributed to disparities in socioeconomic status and differences in health system contexts between global and sub-Saharan African (SSA) countries. The findings of this study are also consistent with those of clinical reviews, indicating that PTLD affects a broad range of respiratory functions, including obstructive lung disease, bronchiectasis, and pulmonary vascular damage [37]. It is estimated that up to half of TB survivors globally suffer from some form of PTLD[1]. This highlights the importance of comprehensive assessments that include both spirometry and symptom evaluations to capture the full extent of PTLD. In this study, a higher prevalence of radiologic abnormalities was observed (60.92%), which aligns with findings from other meta-analyses that reported a prevalence of 64.6% [36] but was lower than that reported in a review that noted radiologic abnormalities in up to 86% of patients [38]. The greater prevalence of radiologic findings than spirometry-based impairments highlight the importance of thorough imaging in post-TB care, as structural damage may be present even when pyrometric tests appear normal.\u003c/p\u003e \u003cp\u003eIn this review, there were marked differences in the prevalence of post-TB lung disease (PTLD) across sub-Saharan Africa. The highest prevalence was observed in Central Africa (50.87%), whereas the lowest was reported in West Africa (38.05%), which aligns with previous findings that regional disparities in PTLD are often driven by variations in healthcare access, diagnostic capacity, and TB management quality across African regions [39]. Similarly, the significantly higher PTLD prevalence in TB clinic attendees (54.99%) than in hospital-based studies (38.12%) may reflect a more chronic disease trajectory among those engaged in follow-up TB services. Moreover, the finding that mixed rural-urban settings had a higher PTLD prevalence (53.66%) than did purely rural areas (40.12%) suggests that environmental and occupational exposures are highest in peri-urban zones [37].\u003c/p\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eDeterminants of post-tuberculosis lung disease (PTLD)\u003c/h2\u003e \u003cp\u003ePost-tuberculosis lung disease (PTLD) is affected by multiple factors, including older age, as reported in many studies [30, 37]. Prior TB disease severity, recurrent TB, smoking, malnutrition, and HIV co-infection. Identifying these determinants is essential for improving post-TB care in high-burden settings. The current systematic review and meta-analysis revealed that females were 1.57 times more likely to develop PTLD than males were. This finding aligns with a study conducted in Zimbabwe and South Africa, suggesting that sex specific factors may influence disease severity and outcomes [28, 36, 40, 41]. Global studies often reported a greater incidence of tuberculosis among men than among women, with a male-to-female ratio of 2:1 in many regions[42\u0026ndash;44]. However, women may experience worse long-term outcomes, such as PTLD or extra-pulmonary manifestations, potentially due to delayed diagnosis, social stigma, or biological differences in immune responses [40, 41].\u003c/p\u003e \u003cp\u003eThe pooled analysis revealed that patients classified as underweight were 2.19 times more likely to develop PTLD than their normal-weight counterparts. This finding underscores the impact of nutritional status on the long-term respiratory health of individuals who have previously suffered from tuberculosis. Underweight individuals often experience compromised immune function, which can hinder recovery from tuberculosis and increase susceptibility to chronic lung conditions such as PTLD. The severity of undernutrition has been linked to poorer treatment outcomes in tuberculosis patients. Underweight patients are at increased risk of treatment failure and relapse [45, 46]. For example, one study conducted in Ethiopia indicated that underweight patients had a greater prevalence of severe symptoms and complications during TB treatment, which was associated with increased risks of long-term respiratory problems [45].\u003c/p\u003e \u003cp\u003eThe other important factor in this study was cigarette smoking, which indicates that smokers were 1.64 times more likely to develop PTLD than non-smokers were. This underscores the importance of including smoking cessation interventions in TB control practices, especially in reducing post-TB treatment complications. For example, a study conducted at 18 TB clinics in Hong Kong reported that both current and ex-smokers were significantly less likely to achieve treatment completion and had higher rates of treatment failure, with smoking contributing to approximately 16.7% of unsuccessful treatment outcomes attributed to defaulting on treatment and mortality among ex-smokers [47]. Furthermore, smoking is associated with a slower bacteriological response during tuberculosis treatment, which means that smokers are more likely to remain sputum-positive after two months of therapy. This delayed response not only increases the risk of transmission but also raises concerns about the persistence of Mycobacterium tuberculosis in the lungs, leading to potential complications like PTLD [48, 49]. The other factor assessed in this study was the association b/n HIV and post-tuberculosis lung disease (PTLD). Tuberculosis infection is known to be strongly associated with HIV, and individuals living with HIV are often hypothesized to be more susceptible to developing PTLD. However, findings from the current study indicate that the pooled association between HIV status and PTLD was not statistically significant, with an odds ratio (OR) of 0.75. This suggests that while HIV is a known risk factor for tuberculosis, its impact on the development of PTLD may not be as pronounced as previously thought. Interestingly, other studies also suggest that individuals living with HIV may experience less severe forms of PTLD than their HIV-negative counterparts do [50]. This could be attributed to factors such as immunosuppression leading to less cavitary disease at the time of TB diagnosis, which may result in lower rates of lung damage [21]. Clinical presentations such as cough and fibrotic patterns are among the known features associated with post-tuberculosis lung disease (PTLD). The results from the present study indicates that patients with a history of tuberculosis who present with a cough after completing TB treatment are 1.73 times more likely to develop PTLD. This association increases the need for post-treatment follow-up and structured lung health assessments, particularly in resource-limited settings where PTLD often remains undiagnosed or misclassified [8, 21]. Fibrotic patterns observed on chest radiographs or CT scans are a common finding and are strongly associated with irreversible lung tissue damage, contributing to reduced lung function and diminished quality of life. In this study, patients presenting with fibrotic patterns were 3.94 times more likely to develop PTLD than those without fibrotic patterns. A prospective cohort study from Malawi revealed that fibrotic patterns were strongly associated with persistent respiratory symptoms and reduced spirometry measurements among TB survivors [13, 21, 35]\u003c/p\u003e \u003cp\u003eOne study from the DR Congo reported that anti-TB treatment for more than 6 months was significantly associated with PTLD [18]. This might be due to delayed bacterial clearance and prolonged inflammation, which can lead to irreversible lung damage. Extended treatment may also indicate more severe or drug-resistant TB, which is independently linked to a greater risk of structural lung complications such as fibrosis and bronchiectasis [51]. The persistent burden of PTLD calls for integrated care models that extend beyond microbiological cure, emphasizing pulmonary rehabilitation, spirometry-based evaluations, and long-term symptom monitoring. Moreover, further research is needed to define standardized diagnostic criteria and evidence-based interventions for PTLD.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003eImplications for evidence-informed policy and clinical practice\u003c/h2\u003e \u003cp\u003eGiven the high prevalence of PTLD in sub-Saharan Africa, it is essential to integrate PTLD management policies and practices into existing TB control programs. National TB programs should broaden their focus beyond cure to include post-treatment rehabilitation, aiming to increase the quality of life for TB survivors. Strengthening healthcare systems by training workers, providing diagnostic tools, and establishing referral pathways is crucial for better PTLD diagnosis and management [52, 53]. Collaboration among TB programs, specialists, researchers, and community organizations is vital [53].\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eStrengths and limitations\u003c/strong\u003e \u003cp\u003eThis systematic review and meta-analysis comprehensively searched multiple databases for both published and unpublished studies. Relevant studies were included following a rigorous quality assessment process, which included determinants of PTLD in the analysis. We used the crude odds ratio for analyzing determinant of PTLD. The other major limitation of this study was the underrepresentation of pediatric data, and only a few studies have reported on the determinants of PTLD. Additionally, key factors such as treatment non-adherence were not addressed due to data limitations.\u003c/p\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis systematic review and meta-analysis highlights the prevalence and determinants of post-tuberculosis lung disease (PTLD) in sub-Saharan Africa, emphasizing that nearly half of TB survivors are at risk of developing PTLD. Therefore, it is crucial to integrate routine PTLD screening, spirometry, imaging, and targeted interventions into national TB programs. Additionally, strengthening health systems through enhanced diagnostic capacity, provider training, and community awareness creation is essential for developing evidence-based policies that address the full spectrum of TB-related morbidity and mortality. Furthermore, the absence of an association between HIV and PTLD observed in the included studies permits further research to explain the underlying mechanisms and potential modifying factors.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eBMI: Body mass index\u003c/p\u003e\n\u003cp\u003eCI: Confidence interval\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eCOPD: Chronic Obstructive Pulmonary Disease\u003c/p\u003e\n\u003cp\u003eDBAE: Database of Abstract of Effect\u003c/p\u003e\n\u003cp\u003eHIV: Human Immunodeficiency Virus\u003c/p\u003e\n\u003cp\u003eLMICS: Low- and Middle-Income Countries\u003c/p\u003e\n\u003cp\u003eOR: Odds Ratio\u003c/p\u003e\n\u003cp\u003ePRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analysis\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ePTLD: Post-tuberculosis lung disease\u003c/p\u003e\n\u003cp\u003eSSA: Sub-Saharan Africa\u003c/p\u003e\n\u003cp\u003eTB: Tuberculosis\u003c/p\u003e\n\u003cp\u003eUQAT; Universit\u0026eacute; du Qu\u0026eacute;bec en Abitibi-T\u0026eacute;miscamingue\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWHO: World Health Organization\u0026nbsp;\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe would like to thank all authors of the studies included in this systematic review and meta-analysis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eATG, KBA, YAF, MYT, TAB ZA, SD, AT, MTB, and HTA were involved in the design, statistical analysis, and manuscript writing, and participated in the selection of articles and data extraction. All authors were involved in developing the initial drafts of the manuscript, revising subsequent drafts, and preparing the final draft of the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo funding was obtained for this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author and can be made available upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;This study used secondary data; therefore, no ethical approval was required.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eYarbrough C, Miller M, Zulu M, et al. Post-tuberculosis lung disease: Addressing the policy gap. \u003cem\u003ePLOS Glob Public Heal\u003c/em\u003e 2024; 4: 6\u0026ndash;13.\u003c/li\u003e\n\u003cli\u003eJohnston JC, Cooper R, Menzies D. Chapter 5: Treatment of tuberculosis disease. \u003cem\u003eCan J Respir Crit Care, Sleep Med\u003c/em\u003e 2022; 6: 66\u0026ndash;76.\u003c/li\u003e\n\u003cli\u003eIvanova O, Hoffmann VS, Lange C, et al. Post-tuberculosis lung impairment: systematic review and meta-analysis of spirometry data from 14 621 people. \u003cem\u003eEur Respir Rev\u003c/em\u003e; 32. Epub ahead of print 2023. DOI: 10.1183/16000617.0221-2022.\u003c/li\u003e\n\u003cli\u003e\u003cem\u003eWorld health organization W. https://www.who.int/teams/global-tuberculosis-programme/tb-reports/global-tuberculosis-report-2024\u003c/em\u003e. 2024.\u003c/li\u003e\n\u003cli\u003eTaylor J, Bastos ML, Lachapelle-Chisholm S, et al. Residual respiratory disability after successful treatment of pulmonary tuberculosis: a systematic review and meta-analysis. \u003cem\u003eeClinicalMedicine\u003c/em\u003e 2023; 59: 101979.\u003c/li\u003e\n\u003cli\u003eDodd PJ, Yuen CM, Jayasooriya SM, et al. Quantifying the global number of tuberculosis survivors : a modelling study. 21.\u003c/li\u003e\n\u003cli\u003eByrne AL, Marais BJ, Mitnick CD, et al. Tuberculosis and chronic respiratory disease : a systematic review. \u003cem\u003eInt J Infect Dis\u003c/em\u003e 2015; 32: 138\u0026ndash;146.\u003c/li\u003e\n\u003cli\u003eAllwood BW, van der Zalm MM, Amaral AFS, et al. Post-tuberculosis lung health: perspectives from the First International Symposium. \u003cem\u003eInt J Tuberc lung Dis Off J Int Union against Tuberc Lung Dis\u003c/em\u003e 2020; 24: 820\u0026ndash;828.\u003c/li\u003e\n\u003cli\u003eWorld Health Organization Executive Board. Global strategy and targets for tuberculosis prevention , care and control after 2015, November 2013, pp. 1\u0026ndash;23, 2015. 2015; 1\u0026ndash;23.\u003c/li\u003e\n\u003cli\u003eTripathi D. HSV. ADSADP. S. CLINICORADIOLOGICAL PROFILE OF POST- TUBERCULOSIS LUNG DISEASE: AN OBSERVATIONAL STUDY IN PATIENTS AT A TERTIARY CARE HOSPITAL IN INDORE, MADHYA PRADESH. \u003cem\u003eIndia J Res\u003c/em\u003e 1991; 13: 137\u0026ndash;138.\u003c/li\u003e\n\u003cli\u003eEgere U, Shayo E, Ntinginya N, et al. Management of chronic lung diseases in Sudan and Tanzania: how ready are the country health systems? \u003cem\u003eBMC Health Serv Res\u003c/em\u003e 2021; 21: 1\u0026ndash;11.\u003c/li\u003e\n\u003cli\u003ePage MJ, McKenzie JE, Bossuyt P, et al. The prisma 2020 statement: An updated guideline for reporting systematic reviews. \u003cem\u003eMed Flum\u003c/em\u003e 2021; 57: 444\u0026ndash;465.\u003c/li\u003e\n\u003cli\u003eAllwood BW, Van Der Zalm MM, Amaral AFS, et al. Post-tuberculosis lung health: Perspectives from the First International Symposium. \u003cem\u003eInt J Tuberc Lung Dis\u003c/em\u003e 2020; 24: 820\u0026ndash;828.\u003c/li\u003e\n\u003cli\u003eBinegdie AB, Parekh M, Tolessa TB, et al. SEQUELAE OF PATIENTS TREATED FOR PULMONARY TUBERCULOSIS IN CHEST CLINIC , TIKUR ANBESSA SPECIALIZED HOSPITAL ( TASH ),. 2015; 53: 167\u0026ndash;171.\u003c/li\u003e\n\u003cli\u003eChin AT, Rylance J, Makumbirofa S, et al. Chronic lung disease in adult recurrent tuberculosis survivors in Zimbabwe : a cohort study. 2019; 23: 203\u0026ndash;211.\u003c/li\u003e\n\u003cli\u003eKayongo A, Wosu AC, Naz T, et al. Chronic Obstructive Pulmonary Disease Prevalence and Associated Factors in a Setting of Well-Controlled HIV, A Cross-Sectional Study. \u003cem\u003eCOPD\u003c/em\u003e 2020; 17: 297\u0026ndash;305.\u003c/li\u003e\n\u003cli\u003eKampen SC Van, Jones R, Kisembo H, et al. Chronic Respiratory Symptoms and Lung Abnormalities Among People With a History of Tuberculosis in Uganda : A National Survey. 2019; 68: 1919\u0026ndash;1925.\u003c/li\u003e\n\u003cli\u003eKatoto PDMC, Murhula A, Kayembe-kitenge T, et al. Household Air Pollution Is Associated with Chronic Cough but Not Hemoptysis after Completion of Pulmonary Tuberculosis Treatment in Adults , Rural Eastern Democratic Republic of Congo. Epub ahead of print 2018. DOI: 10.3390/ijerph15112563.\u003c/li\u003e\n\u003cli\u003eNorth CM, Allen JG, Okello S, et al. HIV Infection , Pulmonary Tuberculosis , and COPD in Rural Uganda : A Cross-Sectional Study. \u003cem\u003eLung\u003c/em\u003e 2017; 0: 0.\u003c/li\u003e\n\u003cli\u003eManji M, Shayo G, Mamuya S, et al. Lung functions among patients with pulmonary tuberculosis in Dar es Salaam - A cross-sectional study. \u003cem\u003eBMC Pulm Med\u003c/em\u003e 2016; 16: 1\u0026ndash;9.\u003c/li\u003e\n\u003cli\u003eMeghji J, Lesosky M, Joekes E, et al. Patient outcomes associated with post-tuberculosis lung damage in Malawi: A prospective cohort study. \u003cem\u003eThorax\u003c/em\u003e 2020; 75: 269\u0026ndash;278.\u003c/li\u003e\n\u003cli\u003eNkereuwem E, Agbla S, Njai B, et al. Post-tuberculosis respiratory impairment in Gambian children and adolescents: A cross-sectional analysis. \u003cem\u003ePediatr Pulmonol\u003c/em\u003e 2024; 59: 1912\u0026ndash;1921.\u003c/li\u003e\n\u003cli\u003eNkereuwem E, Agbla S, Sallahdeen A, et al. Reduced lung function and health-related quality of life after treatment for pulmonary tuberculosis in Gambian children: a cross-sectional comparative study. \u003cem\u003eThorax\u003c/em\u003e 2023; 78: 281\u0026ndash;287.\u003c/li\u003e\n\u003cli\u003eDdungu A, 1, 2*, Fred C. Semitala3, 4, 5, Barbara Castelnuovo1, Christine Sekaggya- Wiltshire1, 5, William Worodria2, 3, 5, Bruce J. Kirenga2 3. Chronic obstructive pulmonary disease prevalence and associated factors in an urban HIV clinic in a low income country. 2021; 2: 1\u0026ndash;12.\u003c/li\u003e\n\u003cli\u003eA. A. Fiogbe,*\u0026dagger; G. Agodokpessi,* J. F. Tessier,\u0026Dagger; D. Affolabi,* D. M. Zannou,\u0026sect; G. Ad\u0026acute;e,* S. Anagonou,* C. Raherison-Semjen # O. Marcy. Prevalence of lung function impairment in cured pulmonary tuberculosis patients in Cotonou , Benin. 2019; 23: 195\u0026ndash;202.\u003c/li\u003e\n\u003cli\u003eHugo B, Ngahane M, Nouyep J, et al. Post-tuberculous lung function impairment in a tuberculosis reference clinic in Cameroon. \u003cem\u003eRespir Med\u003c/em\u003e 2016; 114: 67\u0026ndash;71.\u003c/li\u003e\n\u003cli\u003eAttia EF, Maleche-obimbo E, West TE, et al. Adolescent age is an independent risk factor for abnormal spirometry among people living with HIV in Kenya. Epub ahead of print 2018. DOI: 10.1097/QAD.0000000000001815.\u003c/li\u003e\n\u003cli\u003eAuld SC, Kornfeld H, Maenetje P, et al. Pulmonary restriction predicts long ‑ term pulmonary impairment in people with HIV and tuberculosis. \u003cem\u003eBMC Pulm Med\u003c/em\u003e 2021; 1\u0026ndash;10.\u003c/li\u003e\n\u003cli\u003eMagitta F, Walker RW, Apte K, et al. Prevalence , risk factors and clinical correlates of COPD in a rural setting in Tanzania. DOI: 10.1183/13993003.00182-2017.\u003c/li\u003e\n\u003cli\u003eMpagama SG, Msaji KS, Kaswaga O, et al. The burden and determinants of post-TB lung disease. \u003cem\u003eInt J Tuberc lung Dis Off J Int Union against Tuberc Lung Dis\u003c/em\u003e 2021; 25: 846\u0026ndash;853.\u003c/li\u003e\n\u003cli\u003evan der Zalm MM, Jongen VW, Swanepoel R, et al. Impaired lung function in adolescents with pulmonary tuberculosis during treatment and following treatment completion. \u003cem\u003eeClinicalMedicine\u003c/em\u003e 2024; 67: 102406.\u003c/li\u003e\n\u003cli\u003eOsman M, Welte A, Dunbar R, et al. Morbidity and mortality up to 5 years post tuberculosis treatment in South Africa: A pilot study. \u003cem\u003eInt J Infect Dis\u003c/em\u003e 2019; 85: 57\u0026ndash;63.\u003c/li\u003e\n\u003cli\u003eAkanbi MO, Taiwo BO, Achenbach CJ, et al. AIDS \u0026amp; Clinical Research HIV Associated Chronic Obstructive Pulmonary Disease in Nigeria. 6. Epub ahead of print 2015. DOI: 10.4172/2155-6113.1000453.\u003c/li\u003e\n\u003cli\u003eKhosa C, Bhatt N, Massango I, et al. Development of chronic lung impairment in Mozambican TB patients and associated risks. 2020; 1\u0026ndash;11.\u003c/li\u003e\n\u003cli\u003eSilva DR, Freitas AA, Guimar\u0026atilde;es AR, et al. Post-tuberculosis lung disease: a comparison of Brazilian, Italian, and Mexican cohorts. \u003cem\u003eJ Bras Pneumol\u003c/em\u003e 2022; 48: 6\u0026ndash;11.\u003c/li\u003e\n\u003cli\u003eId EM, Atieno M, Id O, et al. PLOS GLOBAL PUBLIC HEALTH Magnitude and factors associated with post- tuberculosis lung disease in low- and middle- income countries : A systematic review and. 2022; 1\u0026ndash;26.\u003c/li\u003e\n\u003cli\u003eAllwood BW, Byrne A, Meghji J, et al. Post-Tuberculosis Lung Disease: Clinical Review of an Under-Recognised Global Challenge. \u003cem\u003eRespiration\u003c/em\u003e 2021; 100: 751\u0026ndash;763.\u003c/li\u003e\n\u003cli\u003eMeghji J, Simpson H, Squire SB, et al. A Systematic Review of the Prevalence and Pattern of Imaging Defined Post-TB Lung Disease. \u003cem\u003ePLoS One\u003c/em\u003e 2016; 11: e0161176.\u003c/li\u003e\n\u003cli\u003eMeghji J, Mortimer K, Agusti A, et al. Improving lung health in low-income and middle-income countries: from challenges to solutions. \u003cem\u003eLancet (London, England)\u003c/em\u003e 2021; 397: 928\u0026ndash;940.\u003c/li\u003e\n\u003cli\u003eHumayun M, Chirenda J, Ye W, et al. Effect of Gender on Clinical Presentation of Tuberculosis (TB) and Age-Specific Risk of TB, and TB-Human Immunodeficiency Virus Coinfection. \u003cem\u003eOpen Forum Infect Dis\u003c/em\u003e 2022; 9: 1\u0026ndash;9.\u003c/li\u003e\n\u003cli\u003eLin CY, Chen TC, Lu PL, et al. Effects of Gender and Age on Development of Concurrent Extrapulmonary Tuberculosis in Patients with Pulmonary Tuberculosis: A Population Based Study. \u003cem\u003ePLoS One\u003c/em\u003e; 8. Epub ahead of print 2013. DOI: 10.1371/journal.pone.0063936.\u003c/li\u003e\n\u003cli\u003ePeer V, Schwartz N, Green MS. Gender differences in tuberculosis incidence rates\u0026mdash;A pooled analysis of data from seven high-income countries by age group and time period. \u003cem\u003eFront Public Heal\u003c/em\u003e; 10. Epub ahead of print 2023. DOI: 10.3389/fpubh.2022.997025.\u003c/li\u003e\n\u003cli\u003eMar\u0026ccedil;\u0026ocirc;a R. Tuberculosis and gender \u0026ndash; Factors influencing the risk of tuberculosis among men and women by age group. \u003cem\u003ePulmonology\u003c/em\u003e 2018; 24: 199\u0026ndash;202.\u003c/li\u003e\n\u003cli\u003eNhamoyebonde S, Leslie A. Biological differences between the sexes and susceptibility to tuberculosis. \u003cem\u003eJ Infect Dis\u003c/em\u003e; 209. Epub ahead of print 2014. DOI: 10.1093/infdis/jiu147.\u003c/li\u003e\n\u003cli\u003eSahile Z, Tezera R, Mariam DH, et al. Nutritional status and TB treatment outcomes in Addis Ababa, Ethiopia: An ambi-directional cohort study. \u003cem\u003ePLoS One\u003c/em\u003e 2021; 16: 1\u0026ndash;14.\u003c/li\u003e\n\u003cli\u003eYen YF, Tung FI, Ho BL, et al. Underweight increases the risk of early death in tuberculosis patients. \u003cem\u003eBr J Nutr\u003c/em\u003e 2017; 118: 1052\u0026ndash;1060.\u003c/li\u003e\n\u003cli\u003eLeung CC, Yew WW, Chan CK, et al. Smoking adversely affects treatment response, outcome and relapse in tuberculosis. \u003cem\u003eEur Respir J\u003c/em\u003e 2015; 45: 738\u0026ndash;745.\u003c/li\u003e\n\u003cli\u003eGanderia B. The association between asthma and tuberculosis. \u003cem\u003eJ Allergy\u003c/em\u003e 1962; 33: 112\u0026ndash;129.\u003c/li\u003e\n\u003cli\u003eAlavi-Naini R, Sharifi-Mood B, Metanat M. Association Between Tuberculosis and Smoking. \u003cem\u003eInt J High Risk Behav Addict\u003c/em\u003e 2012; 1: 71\u0026ndash;4.\u003c/li\u003e\n\u003cli\u003eMkoko P, Naidoo S, Mbanga LC, et al. Chronic lung disease and a history of tuberculosis (post-tuberculosis lung disease): Clinical features and in-hospital outcomes in a resource-limited setting with a high HIV burden. \u003cem\u003eS Afr Med J\u003c/em\u003e 2019; 109: 169\u0026ndash;173.\u003c/li\u003e\n\u003cli\u003eHnizdo E, Singh T, Churchyard G. Chronic pulmonary function impairment caused by initial and recurrent pulmonary tuberculosis following treatment. \u003cem\u003eThorax\u003c/em\u003e 2000; 55: 32\u0026ndash;38.\u003c/li\u003e\n\u003cli\u003eId AG, Juneja S, Sahu S, et al. PLOS GLOBAL PUBLIC HEALTH Lifesaving , cost-saving : Innovative simplified regimens for drug-resistant tuberculosis. 2022; 10\u0026ndash;13.\u003c/li\u003e\n\u003cli\u003eAcademy of Medical Sciences. Improving the prevention and management of multimorbidity in sub-Saharan Africa, https://acmedsci.ac.uk/file-download/65601508 (2019).\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTables 1 and 2 are available in the Supplementary Files section.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-pulmonary-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pulm","sideBox":"Learn more about [BMC Pulmonary Medicine](http://bmcpulmmed.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pulm/default.aspx","title":"BMC Pulmonary Medicine","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Prevalence, Determinants, Risks, Post-tuberculosis (PTLD) lung disease, Lung impairment, Chronic lung disease, Sub-Saharan Africa","lastPublishedDoi":"10.21203/rs.3.rs-6727961/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6727961/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e Post-tuberculosis lung disease (PTLD) is a major public health challenge in sub-Saharan Africa, where the burden of tuberculosis (TB) remains high. Only a few studies have reported the burden of PTLD globally, and the determinants of PTLD have been understudied. This systematic review and meta-analysis aimed to estimate the pooled prevalence and determinants of PTLD in sub-Saharan African countries.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines for systematic review and meta-analysis. We included studies reporting the prevalence and determinants of PTLD among individuals with a history of pulmonary TB in sub-Saharan Africa. A comprehensive literature search was conducted via PubMed, Embase, Google Scholar, and African Journal Online databases. The pooled prevalence of PTLD was estimated using a random-effects model, and associated factors were analyzed using crude odds ratios (ORs).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e A total of 21 studies, consisting of 4,463 participants, were included. The overall pooled prevalence of PTLD in sub-Saharan Africa was 43.26% (95% CI: 34.17%–52.34%). The key determinants significantly associated with PTLD included: female sex (OR: 1.57, 95% CI: 1.16, 2.11), smoking (OR: 1.64, 95% CI: 1.09, 2.46), Presence of cough (OR: 1.73, 95% CI: 1.03, 2.9) and fibrotic pattern (OR:3.94 (95% CI: 1.96, 7.92).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e Nearly half of tuberculosis patients in sub-Saharan Africa develop post-tuberculosis lung disease. Being female, smoking, fibrosis, and posttreatment cough were key determinants associated with PTLD. To effectively manage PTLD in sub-Saharan Africa, it is important to implement targeted interventions for high-risk groups, strengthen screening and chronic care services, enhance healthcare system capacity, and integrate PTLD management into national TB control programs.\u003c/p\u003e","manuscriptTitle":"Prevalence and determinants of post-tuberculosis lung disease in Sub-Saharan Africa: A systematic review and meta-analysis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-06-09 10:22:00","doi":"10.21203/rs.3.rs-6727961/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-06-12T08:45:05+00:00","index":"","fulltext":""},{"type":"reviewerAgreed","content":"268548999136423730927587845886750441729","date":"2025-06-10T08:10:38+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-07T15:20:43+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"260429428167350875201032887809890000985","date":"2025-06-06T10:44:30+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"233783035192342678358038809842624344922","date":"2025-06-05T15:53:02+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-04T12:20:59+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"21225932063099030614597325803595159172","date":"2025-06-04T08:31:13+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"133850190039131452043660606487983309861","date":"2025-06-04T07:32:51+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"253136007844103514319636777678686378416","date":"2025-06-03T15:59:31+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"132938497625300973808636227201419721957","date":"2025-06-03T15:20:04+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"134323610019315955940249610980024016629","date":"2025-06-03T15:16:01+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-06-03T15:06:44+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-06-03T14:54:47+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-06-03T11:26:38+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-06-02T13:47:49+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Pulmonary Medicine","date":"2025-06-02T13:43:27+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-pulmonary-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pulm","sideBox":"Learn more about [BMC Pulmonary Medicine](http://bmcpulmmed.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pulm/default.aspx","title":"BMC Pulmonary Medicine","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"8d287665-e0d9-4227-9fb6-f36ca34cec01","owner":[],"postedDate":"June 9th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-12-29T16:02:54+00:00","versionOfRecord":{"articleIdentity":"rs-6727961","link":"https://doi.org/10.1186/s12890-025-03887-4","journal":{"identity":"bmc-pulmonary-medicine","isVorOnly":false,"title":"BMC Pulmonary Medicine"},"publishedOn":"2025-12-23 15:58:18","publishedOnDateReadable":"December 23rd, 2025"},"versionCreatedAt":"2025-06-09 10:22:00","video":"","vorDoi":"10.1186/s12890-025-03887-4","vorDoiUrl":"https://doi.org/10.1186/s12890-025-03887-4","workflowStages":[]},"version":"v1","identity":"rs-6727961","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6727961","identity":"rs-6727961","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}