Molecular epidemiology of Mycobacterium tuberculosis in the Middle East and North Africa: A systematic review and meta-analysis.

OBJECTIVE

The objective of this article was to conduct a comprehensive systematic review and meta-analysis on the molecular epidemiology of Mycobacterium tuberculosis in the Middle East and North Africa.

METHODS

PubMed, Scopus, Web of Science, Embase, and Google Scholar databases were used for literature search on the molecular epidemiology, clustering rate and recent transmission index of Mycobacterium tuberculosis complex (MTBC) published between 1 January 2000 to 31 December 2025. The study quality was assessed using the Newcastle-Ottawa Scale (NOS) and meta-analysis was carried out using R statistics version 4.5.3.

RESULTS

Fifty-nine studies reported 13,194 Mycobacterium tuberculosis (M. tuberculosis) isolates of which 82.0% corresponded to shared international types in the SpolDB4 database. Lineages 4 (42.3%) and 3 (28.3%) were dominant while lineages 1 and 2 were limited. Meta-analysis pooled result showed that the clustering rate and recent transmission index were 52% (95% CI: 43-61%) and 40% (95% CI: 33-47%), respectively. The subgroup analysis showed that clustering rates varied significantly according to the genotyping methods used (χ² = 124.36, P < 0.0001), whereas no significant differences were observed across geographic regions (χ² = 0.00, P = 0.9812).

CONCLUSION

The estimated recent transmission index indicates ongoing transmission, highlighting the need to strengthen targeted TB control measures, including active case finding, effective contact tracing, timely diagnosis and treatment, and the integration of advanced molecular epidemiological methods.