Treatment outcomes and associated factors among persons with pulmonary tuberculosis in Morocco: a systematic review and meta-analysis

Background Tuberculosis (TB) remains a major public health challenge. Treatment success rate (TSR) is a key indicator for TB control, yet national level evidence on treatment outcomes in Morocco is fragmented. This systematic review and meta-analysis aimed to estimate pooled TB treatment outcomes and summarize factors influencing success and unsuccessful outcomes among persons with pulmonary tuberculosis (PTB). Methods We systematically searched PubMed, ScienceDirect, and Web of Science for studies published up to January 2025. The research question was structured using the PICO framework: participants (adults with PTB), intervention (anti-tuberculosis treatment), and outcomes (TB treatment outcomes). Eligible studies were conducted in Morocco, published in English or French, and reported TB treatment outcomes; non-original articles, studies without outcome data, and those outside Morocco were excluded. Two reviewers independently performed study selection, data extraction, and quality assessment. Meta-analysis was conducted in R software, calculating pooled TSR, unsuccessful treatment outcomes, failure, loss to follow-up, and death rates using a random-effects model. Subgroup analyses were performed by drug-susceptibility status and treatment history. Heterogeneity was assessed using the I² statistic, and risk of bias was evaluated using Joanna Briggs Institute Critical Appraisal Checklists of prevalence and case control studies. Results Thirty-three studies were included. Pooled estimates showed a TSR of 79.00% (95%CI:72.85-84.07, I²=99%), defined as the proportion of persons with tuberculosis who were cured or completed treatment among all treated cases. The pooled proportion of unsuccessful treatment outcomes was 10.03% (95%CI:7.17-13.85,I²=99%), with separate estimates for treatment failure (1.86%, 95%CI:1.08-3.19), loss to follow-up (5.49%,95%CI:3.47-8.59) and death rate (2.00%, 95%CI:1.20-3.30). Subgroup analysis showed lower TSR and higher unsuccessful outcomes among drug-resistant and retreatment cases. Associated factors for higher TSR included younger age, new and smear-negative cases, and enrollment in integrative health programs. Factors linked to unsuccessful outcomes included older age, male gender, rural residence, and smoking. Conclusion TSR among persons with TB in Morocco remains below the WHO target (≥ 90%), with higher unsuccessful outcomes observed among drug-resistant and retreatment cases. Considerable variability across studies highlights the need for targeted interventions. These findings may inform program strategies to improve TB treatment outcomes. Trial registration Clinical trial number: Not applicable.