Abstract:
Pulmonary non-tuberculous mycobacterial (NTM) disease epidemiology in sub-Saharan
Africa is not as well described as for pulmonary tuberculosis. Earlier reviews of global
NTM epidemiology only included subject-level data from one sub-Saharan Africa
country. We systematically reviewed the literature and searched PubMed, Embase,
Popline, OVID and Africa Wide Information for articles on prevalence and clinical
relevance of NTM detection in pulmonary samples in sub-Saharan Africa. We applied
the American Thoracic Society/Infectious Disease Society of America criteria to
differentiate between colonisation and disease. Only 37 articles from 373 citations met
our inclusion criteria. The prevalence of pulmonary NTM colonization was 7.5% (95%
CI: 7.2%-7.8%), and 75.0% (2325 of 3096) occurred in males, 16.5% (512 of 3096) in
those previously treated for tuberculosis and Mycobacterium avium complex
predominated (27.7% [95% CI: 27.2-28.9%]). In seven eligible studies, 27.9% (266 of
952) of participants had pulmonary NTM disease and M. kansasii with a prevalence of
69.2% [95% CI: 63.2-74.7%] was the most common cause of pulmonary NTM disease.
NTM species were unidentifiable in 29.2% [2,623 of 8,980] of isolates. In conclusion,
pulmonary NTM disease is a neglected and emerging public health disease and enhanced
surveillance is required.