Cultural factors influencing tuberculosis prevention and treatment in Sub-Saharan Africa: A scoping review

This scoping review mapped and synthesised evidence on cultural determinants of tuberculosis (TB) in Sub-Saharan Africa. The study aimed to explore and analyze the cultural beliefs, practices, and values that influence TB prevention, treatment-seeking behavior, and adherence in order to develop a culturally responsive framework to support TB diagnosis and treatment programs. The objectives were to identify and analyze cultural factors influencing TB prevention and treatment-seeking behaviour, and the guiding research question was: What cultural beliefs, practices, and values influence TB prevention, treatment-seeking behavior, and adherence in Sub-Saharan Africa? The review was conducted following the PRISMA-ScR guidelines to systematically map the existing literature on cultural determinants influencing TB prevention in Sub-Saharan Africa. A comprehensive search was carried out across multiple electronic databases, including PubMed, MEDLINE, Scopus, Web of Science, Google Scholar, and African Journals Online, as well as grey literature sources such as World Health Organization reports. The search focused on studies published between January 2020 and April 2025. Articles were screened in two phases—title and abstract, followed by full-text review—using Rayyan, a web-based systematic review management tool. Inclusion criteria encompassed studies addressing culturally responsive approaches to TB prevention, care-seeking behavior, and treatment adherence in Sub-Saharan Africa. Exclusion criteria included studies conducted outside Sub-Saharan Africa, studies focused solely on biomedical or laboratory aspects of TB, and publications not in English. A systematic search strategy was developed with the guidance of a research librarian, using Boolean operators and relevant keywords, synonyms, and controlled vocabulary. Grey literature sources and manual reference list searches were also included to ensure comprehensiveness. Data extraction was performed using a standardized charting form capturing authorship, year, study setting, population, cultural factors, methodology, and key findings. Thematic analysis, following Braun and Clarke (2006), was used to identify, refine, and interpret themes related to cultural influences on TB, including cultural beliefs and traditional healing practices, stigma and discrimination, gender and power dynamics, religion and spiritual healing, knowledge and health literacy, and socio-economic and structural determinants. The final evidence base included 33 studies from Sub-Saharan Africa. The findings highlight the importance of understanding cultural and social contexts in shaping TB experiences and responses and provide a foundation for developing culturally responsive TB prevention and intervention strategies in high-burden settings.