Environmental health recommendations for Multidrug-Resistant Tuberculosis in low- and middle-income countries: a systematic review.

BACKGROUND: The impact of environmental health risk factors on the optimization of health in MDR-TB infected individuals, as well as on the prevention of transmission to household contacts, is not well documented. Establishing the recommendations of environmental health risk factors for individuals living at home with MDR-TB will have important policy implications in LMICs, such as South Africa.

AIMS: The study objectives were to identify current environmental health recommendations to optimize the health of individuals infected with MDR-TB, while living at home during the completion of their treatment regimen; and to prevent transmission to household contacts by individuals infected with MDR-TB.

METHODS: A systematic search of electronic databases was conducted in May 2021 using a predefined search strategy. An updated search was conducted in November 2023. All primary observational studies evaluating populations  13 years of age in LMICs were included if they examined the relationship between MDR-TB and the pre-defined exposures and outcomes.

RESULTS: The results of the systematic review highlighted an important potential relationship between environmental risk factors and optimising the health of individuals infected with MDR-TB. It also emphasized the role that promoting good environmental health practices may play in preventing the transmission to household contacts and should be incorporated into local health system strategies and global policy.

TRIAL REGISTRATION: The protocol of this review was submitted and published on the PROSPERO register (Protocol registration number: CRD42021255946).

SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12889-026-26503-4.