Prevalence and determinants of drug-resistant pulmonary tuberculosis in the MENA region: a systematic review and meta-analysis

Background: Multidrug-Resistant Tuberculosis (MDR-TB) is a constraining challenge for tuberculosis (TB) control worldwide. The MENA region accounts for a large part of the global MDR-TB burden.
Aim: To estimate the prevalence of MDR-TB and associated factors in the MENA region.
Methods: We searched for studies published in English and French on the subject up to 31st January 2026 on Web of Science, PubMed, Scopus, and Cochrane, without time restriction. Original studies reporting data on the prevalence of MDR-TB (resistance to rifampicin and isoniazid simultaneously) in individuals living in the MENA region were selected. The random effects model was used to perform the meta-analysis, considering the heterogeneity among the included studies, and the I2 statistic was used to assess 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 - 4.1%) to 17.1% (95% CI: 10.6 - 25.4%). The estimated pooled prevalence was 3.54% (95% CI: 2.18 - 5.72%) with a high heterogeneity, I2 = 95.6%; 95% CI: 94.4 - 96.5%. Previous 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, standardized treatment protocols and measures to enhance treatment adherence should be implemented.