Systematic review and meta-analysis of MDR-TB prevalence in the MENA region

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BMJ open respiratory research Published May 9, 2026 Medically reviewed May 12, 2026 Study authors: Mahamed Oumar Abakar, Hounnoukon Noussissy Sandokane, Laraqui Houssaini Soraya, El Faziki Imane, Kir… PubMed ↗ DOI ↗ By Dr. Amelia Tan, PhD · Internal Medicine & Chronic Disease

Key Takeaway

Consider the pooled MDR-TB prevalence of 3.54% in the MENA region, noting high heterogeneity.

This is a systematic review and meta-analysis of 25 studies from 6 countries in the MENA region, focusing on the prevalence of multidrug-resistant tuberculosis (MDR-TB). The primary synthesized finding is that the prevalence of MDR-TB in the region ranged from 0% to 17.1%, with a pooled prevalence of 3.54% (95% CI 2.18% to 5.72%). The authors also note high heterogeneity among the studies, with an I² of 95.6% (95% CI 94.4% to 96.5%).

The review identifies associated factors for MDR-TB, including previous exposition to TB treatment, HIV infection, smoking, and comorbidities, but the authors clarify that these associations do not establish causation. The meta-analysis used a random effects model, and the certainty of evidence was not formally assessed in the abstract.

A key limitation acknowledged by the authors is the high heterogeneity among the included studies. The practice relevance suggested is the implementation of multisectoral interventions integrating strong prevention measures, standardized treatment protocols, and measures to enhance treatment adherence.

The evidence is observational and synthesized from existing studies, so causal inferences are not supported. The findings should be interpreted with caution due to the significant variability across studies.

Study Details

Study typeMeta analysis

EvidenceLevel 1

PublishedMay 2026

PMID42103367

View Original Abstract ↓

BACKGROUND: Multidrug-resistant tuberculosis (MDR-TB) is a constraining challenge for tuberculosis (TB) control worldwide. The Middle East and North African (MENA) region represents a significant part of the global MDR-TB burden. AIM: To estimate the pooled prevalence of MDR-TB and its determinants in the MENA region. METHODS: We searched for studies published in English and French on the subject up to 31 January 2026 on Web of Science, PubMed, Scopus and Cochrane, without time restriction. Original studies reporting data on the prevalence of MDR-TB in individuals living in the MENA region were selected. The meta-analysis was done using the random effects model considering the heterogeneity among the included studies and statistic was used to assess the heterogeneity. RESULTS: A total of 1239 articles were identified and 25 studies from 6 countries were included in this review. The prevalence of MDR-TB in the MENA region ranged from 0% (95% CI 0% to 4.1%) to 17.1% (95% CI 10.6% to 25.4%). The pooled prevalence was 3.54% (95% CI 2.18% to 5.72%) with a high heterogeneity, =95.6%; 95% CI 94.4% to 96.5%. Previous exposition to TB treatment, HIV infection, smoking and the presence of comorbidities were the most reported associated factors. CONCLUSION: This review underscores the persistence of MDR-TB in the MENA region, suggesting insufficiency in TB control. Multisectoral interventions integrating strong prevention measures, standardised treatment protocols and measures to enhance treatment adherence should be implemented.