Tuberculosis notification trends and treatment outcomes in Bangladesh: findings from a National TB Program data, 2019-2021.
Mohammad Julhas Sujan, Afzalur Rahman, Abu Taleb, Ahmadul Hasan Khan, Shanjida Rahman Sultana, Mohammad Ali Moni, Hasan Mahmud Reza, Md Hasinur Rahman Khan, et al. (9 authors)
BMC infectious diseases · 2026-01
Abstract
BACKGROUND: Tuberculosis (TB) remains a major public health challenge in Bangladesh, which ranks among the world’s high-burden countries. While previous studies have examined TB outcomes in specific populations, comprehensive national data on age-stratified outcomes, particularly comparing children and adult cohorts, remain scarce. This study aimed to (1) analyze trends in TB notifications; (2) compare treatment outcomes across age groups, sex, treatment history, and disease types; and (3) identify potential risk factors for unsuccessful outcomes.
METHODS: We analyzed Bangladesh’s National TB Program (NTP) data (2019–2021), including 494,685 confirmed cases of TB. Treatment outcomes were categorized per WHO definitions. Analyses included: (1) temporal assessment of notification patterns; (2) comparative evaluation of treatment outcomes stratified by demographic, clinical, and health system characteristics; and (3) identification of associated factors for unsuccessful outcomes through multivariable modified Poisson regression, reporting adjusted relative risks (aRR) with 95% confidence intervals.
RESULTS: Between 2019 and 2021, 494,685 people with tuberculosis (TB) were reported to the NTP of Bangladesh. Notifications increased by 64% from 2019 to 2020 and by 83% from 2020 to 2021. Analysis of 300,974 patients demonstrated a treatment success rate exceeding 95.0% in both adults and children. Among children aged under 5 years, mortality reached 5 × 4%, with an overall unsuccessful outcome rate of 7 × 7%. Extrapulmonary TB was associated with poorer outcomes compared to pulmonary TB in both children (mortality: 2.3% vs 1.1%) and adults (aRR: 2.01; 95% CI:1.92–2.10). Rural health facilities had higher loss to follow-up in children (2.5% vs 0.7% in urban areas). In adults, mortality increased markedly with age, from 1.0% in those aged 18–30 years to 6.4% in individuals aged 60 years and older (aRR:3.53; 95% CI: 3.32–3.76). Male sex was independently associated with a higher risk of unsuccessful treatment (aRR 1.58; 95% CI:1.52–1.65), as were previous TB history (aRR:1.74; 95% CI:1.63–1.86) and receipt of retreatment (aRR:1.71; 95% CI:1.43–2.06) or second-line regimens (aRR:1.78; 95% CI:1.48–2.13).
CONCLUSION: Bangladesh’s TB program showed resilience but revealed critical gaps. Children < 5 and adults ≥60 had worse outcomes, signaling age-specific care deficiencies. Persistent male disparities suggest access or biological differences. Rural facilities excelled with adults but struggled with children with TB retention. High retreatment failure rates demand better drug-resistant TB management. Key priorities: 1) age-specific protocols, 2) gender-sensitive interventions, 3) improved rural children’s care, and 4) enhanced drug-resistant TB services. Addressing these gaps is vital for achieving the END TB targets.
SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12879-026-12664-5.