Treatment outcomes of drug-resistant Mycobacterium tuberculosis disease in Cameroon: a systematic review and meta-analysis

Cameroon faces substantial challenges in managing DR-TB. However, national evidence on treatment outcomes remains unsynthesized. This systematic review and meta-analysis aimed to estimate pooled treatment outcomes, adverse drug events (ADEs), and predictors of unfavorable outcomes among patients with DR-TB in Cameroon. This systematic review and meta-analysis followed the PRISMA 2020 guidelines. PubMed, Scopus, Embase, Web of Science, Cochrane Library, and African Journals Online were searched. Studies reporting World Health Organization-defined treatment outcomes among patients with DR-TB were included. Random-effects meta-analyses using generalized linear mixed models with logit transformation were performed. Heterogeneity was assessed using the I 2 statistic, and publication bias and sensitivity analyses were conducted. Fifteen studies conducted between 1998 and 2022 were included, most of which were observational cohort studies. The pooled mortality rate was 6.8% (95% CI: 4.7–9.7; 14 reports; n = 2,351 participants; I 2 = 58.1%), loss to follow-up was 4.1% (95% CI: 2.8–6.1; 12 reports; n = 2,244 participants; I 2 = 55.5%), and treatment failure was 4.2% (95% CI: 1.1–14.3; 13 reports; n = 2,050 participants; I 2 = 93.3%). The pooled treatment success rate was 74.2% (95% CI: 60.4–84.4; 13 reports; n = 2,146 participants; I 2 = 88.1%). Among patients with multidrug-resistant-TB, the pooled prevalence of adverse drug events was 70.8% (95% CI: 40.2–89.7; 3 studies; n = 251 participants), with ototoxicity (41.9%; 95% CI: 23.7–62.6; 3 studies; n = 251 participants) and gastrointestinal disorders (40.9%; 95% CI: 25.5–58.2; 2 studies; n = 172 participants) being the most common events. HIV co-infection was significantly associated with unfavorable treatment outcomes (pooled OR = 2.76; 95% CI: 1.95–3.93; 6 studies), and male sex was also associated with increased odds of unfavorable outcomes (OR = 1.73; 95% CI: 1.25–2.40; 5 studies). Approximately three-quarters of DR-TB patients in Cameroon achieved treatment success under standard regimens, falling short of the 85% target in the 2024–2026 National Strategic Plan. With mortality, treatment failure, and adverse drug events remaining major concerns, strengthening pharmacovigilance, integrating TB/HIV care, and implementing all-oral regimens are essential to improve outcomes and meet national targets. CRD420261404490. Not applicable.