BMC pulmonary medicine · 2026
Anemia burden in tuberculosis patients across Southeast Asia: a systematic review and meta-analysis.
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Shrivastav Vaibhavkumar N, Akurathi Hari Krishna, Kalariya Hardikkumar, Savaj Dhruv
Аннотация
BACKGROUND: Anemia represents a significant comorbidity in tuberculosis (TB) patients, affecting treatment outcomes and mortality. Despite Southeast Asia accounting for 46% of global TB cases, no comprehensive regional synthesis of anemia burden exists, limiting evidence-based policy development.
OBJECTIVES: This systematic review and meta-analysis aimed to estimate the pooled prevalence of anemia among tuberculosis patients across Southeast Asia and to examine variations in prevalence by geographic, demographic, and clinical characteristics.
METHODS: We searched PubMed, Embase, Scopus, and Web of Science for observational studies published from 2000 onwards that reported anemia prevalence in drug-susceptible TB patients from Southeast Asian countries. Random-effects meta-analysis was performed to calculate pooled prevalence estimates with 95% confidence intervals. Subgroup analyses were conducted by country, HIV co-infection status, treatment status, study setting, COVID-19 period, and World Bank income classification. Publication bias was assessed using Egger's and Begg's tests.
RESULTS: Twenty-one studies comprising 6,090 TB patients from five Southeast Asian countries were included. The pooled prevalence of anemia was 72% (95% CI: 68%-76%), with substantial heterogeneity (I²=89.9%). These regional prevalence estimates are higher than the global pooled estimate of 53.9% reported by Barzegari et al. (2019), reflecting the distinct epidemiological context of Southeast Asia. Subgroup analysis revealed significantly higher prevalence in HIV-positive patients (88%, 95% CI: 78%-94%) compared to HIV-negative patients (70%, 95% CI: 65%-74%). Studies conducted during COVID-19 showed elevated prevalence (84%, 95% CI: 75%-90%) compared to pre-COVID (72%, 95% CI: 70%-73%) and post-COVID periods (72%, 95% CI: 68%-83%, p = 0.03). Lower-middle income countries showed higher prevalence (73%, 95% CI: 69%-77%) than upper-middle income countries (67%, 95% CI: 63%-70%). No significant publication bias was detected (Egger's p = 0.721, Begg's p = 0.537).
CONCLUSIONS: This first regional synthesis demonstrates that anemia affects three-quarters of TB patients in Southeast Asia, with significant variation by HIV status, income level, and pandemic period. Unlike previous global estimates (53.9%), our region-specific findings (72%) and documentation of COVID-19 impact (84% during pandemic) provide actionable evidence for Southeast Asian TB programs to integrate anemia screening and management, particularly for vulnerable populations during health system disruptions.
OBJECTIVES: This systematic review and meta-analysis aimed to estimate the pooled prevalence of anemia among tuberculosis patients across Southeast Asia and to examine variations in prevalence by geographic, demographic, and clinical characteristics.
METHODS: We searched PubMed, Embase, Scopus, and Web of Science for observational studies published from 2000 onwards that reported anemia prevalence in drug-susceptible TB patients from Southeast Asian countries. Random-effects meta-analysis was performed to calculate pooled prevalence estimates with 95% confidence intervals. Subgroup analyses were conducted by country, HIV co-infection status, treatment status, study setting, COVID-19 period, and World Bank income classification. Publication bias was assessed using Egger's and Begg's tests.
RESULTS: Twenty-one studies comprising 6,090 TB patients from five Southeast Asian countries were included. The pooled prevalence of anemia was 72% (95% CI: 68%-76%), with substantial heterogeneity (I²=89.9%). These regional prevalence estimates are higher than the global pooled estimate of 53.9% reported by Barzegari et al. (2019), reflecting the distinct epidemiological context of Southeast Asia. Subgroup analysis revealed significantly higher prevalence in HIV-positive patients (88%, 95% CI: 78%-94%) compared to HIV-negative patients (70%, 95% CI: 65%-74%). Studies conducted during COVID-19 showed elevated prevalence (84%, 95% CI: 75%-90%) compared to pre-COVID (72%, 95% CI: 70%-73%) and post-COVID periods (72%, 95% CI: 68%-83%, p = 0.03). Lower-middle income countries showed higher prevalence (73%, 95% CI: 69%-77%) than upper-middle income countries (67%, 95% CI: 63%-70%). No significant publication bias was detected (Egger's p = 0.721, Begg's p = 0.537).
CONCLUSIONS: This first regional synthesis demonstrates that anemia affects three-quarters of TB patients in Southeast Asia, with significant variation by HIV status, income level, and pandemic period. Unlike previous global estimates (53.9%), our region-specific findings (72%) and documentation of COVID-19 impact (84% during pandemic) provide actionable evidence for Southeast Asian TB programs to integrate anemia screening and management, particularly for vulnerable populations during health system disruptions.