THE TUBERCULOSIS CRISIS IN PAKISTAN: CURRENT TRENDS, MAJOR CHALLENGES, AND THE NEED FOR AN INTEGRATED APPROACH : A NARRATIVE REVIEW

Background: Tuberculosis (TB) remains a major public health challenge in Pakistan, ranking fifth globally in terms of incidence and contributing significantly to morbidity and mortality. Despite advances in global TB control, Pakistan continues to face a rising burden, with reported cases increasing from 323,255 in 2015 to 475,761 in 2023, representing a 67.95% escalation. The disease’s persistence reflects a combination of socioeconomic inequities, healthcare system limitations, and the growing threat of drug-resistant tuberculosis (DR-TB). Objective: This narrative review aims to analyze the factors contributing to Pakistan’s high TB prevalence, evaluate the effectiveness of the National Tuberculosis Control Program (NTP), and propose evidence-based recommendations for improved control and prevention strategies. Main Discussion Points: The review highlights major determinants influencing TB prevalence, including poverty, malnutrition, overcrowded housing, and limited access to diagnostic and treatment facilities. Healthcare system challenges—such as insufficient laboratory capacity, inadequate human resources, and poor coordination between public and private sectors—further hinder TB management. The increasing incidence of DR-TB, along with co-morbidities such as diabetes and smoking, exacerbates disease control efforts. Stigma, lack of awareness, and underreporting continue to delay timely diagnosis and adherence to treatment. Conclusion: Effective TB control in Pakistan requires a comprehensive, multi-sectoral approach that strengthens primary healthcare infrastructure, enhances drug-resistance management, and integrates social and economic interventions. Sustained political commitment, domestic funding, and operational research are essential to achieving WHO’s End TB targets.