Burden of tuberculous meningitis (TBM) and disseminated tuberculosis (DTB) in under 5-year-old children in low- and middle-income countries: systematic review and meta-analysis

Introduction Tuberculous Meningitis (TBM) and Disseminated Tuberculosis (DTB) are severe forms of Tuberculosis that cause significant mortality and morbidity in children. Moreover, tuberculosis is disproportionately high in low and middle-income countries. We sought to systematically quantify the burden of disease resulting from TBM and DTB in those countries, with a focus on children under 5 years old. Methods A systematic review was conducted, searching 5 databases: PubMed, Web of Science, EBSCOHost (Academic Premier, Africa Wide information, CINAHL, Health Source Nursing Academic, APA PsychArticles, and APA PsycInfo), Central Cochrane Library, and LILACS. Screening was done on Rayyan by two independent, blinded reviewers. Data were extracted in a standardized manner by the two independent reviewers and then analyzed in STATA version 18. The data were pooled using a random effects model in order to do a meta-analysis and thereafter were interpreted and the results discussed. Results There were 2194 articles in total after the searches were conducted. Once title and abstract screening was completed, 73 remained and were retrieved for full-text screening. Ultimately 18 articles were included in the analysis. Prevalence of TBM, followed by prevalence of DTB, was the most commonly reported outcome. Case fatality was also reported and analyzed, while other outcomes of interest yielded minimal data. Most of the countries represented in the systematic review fell into the middle-income category, and very few studies were limited to the under 5 years old age range. The data for all 3 main outcomes could not be pooled due to high heterogeneity and did not support a formal meta-analysis. Ethics and Registration This systematic review does not require formal ethics approval. The protocol was registered on PROSPERO (Ref No CRD42024577827). Conclusion Given the paucity of data, we recommend additional research focused on delineating the burden of disease in the under 5 years old age group, especially in low-income countries. This will serve to inform public health decisions such as treatment and vaccination resource allocation.