The incidence and mortality of COVID-19 related TB infection in Sub-Saharan Africa: A systematic review and meta-analysis

BackgroundCoronavirus disease 2019 (COVID-19) is also associated with other co-morbidities in people who have previously or currently have pulmonary tuberculosis (PTB). PTB is a risk factor for COVID-19, both in terms of severity and mortality, regardless of HIV status. However, there is less information available on COVID-19 and PTB in terms of incidence and mortality rates in Sub-Saharan Africa (SSA), a high-burden TB region. This systematic review provided a data synthesis of available evidence on COVID-19/PTB incidence and case fatality rates, as well as mortality rates found in clinical and post-mortem COVID-19/PTB diagnostics in SSA. MethodsWe conducted an electronic search in the PubMed, Medline, Google Scholar, Medrxix, and COVID-19 Global literature on coronavirus disease databases for studies involving COVID-19 and PTB in Sub-Saharan Africa. The primary outcomes were the incidence proportion of people with COVID-19 who had current or previous PTB, as well as the case fatality rate associated with COVID-19/PTB. Based on methodological similarities in the included random effect model studies, the combination method was developed using Stata version 16 and Prometa 3 software. We also performed sensitivity analysis and meta-regression. ResultsFrom the 548 references extracted by the literature search, 25 studies were selected and included in the meta-analysis with a total of 191, 250 COVID-19 infected patients and 11, 480 COVID-19 deaths. The pooled COVID-19/PTB incidence was 3% [2%-5%] and a case fatality rate of 13% [4%-23%]. The pooled estimates for case fatality rate among COVID-19/PTB were 7% [1%-12%] for clinical PTB diagnostic and 25% [3%-47%] for post-mortem PTB diagnostic. Previous TB had the highest incidence and fatality rates with 46 [19-73] per 1, 000 population and 8% [3%-19%], respectively. Meta-regression model including the effect sizes and cumulative COVID-19 cases (P= 0.032), HIV prevalence (P= 0.041), and TB incidence (P= 0.002) to explain high heterogeneity between studies. ConclusionTo summarize, the incidence of TB associated with COVID-19 is higher in SSA, as are the case fatality rates, when compared to the rest of the world. However, because the post-mortem TB diagnostic was higher, COVID-19 associated with TB may have been underreported in studies conducted in SSA. To confirm COVID-19/TB incidence and case fatality rates in SSA, large-scale cohort studies that adequately clear tools on previous and/or current TB diagnostic tools are required. Review registrationPROSPERO (CRD42021233387)