Multidrug-resistant tuberculosis (MDR-TB), defined as resistance to at least isoniazid and rifampicin, remains a major public health challenge globally and in Zambia. The World Health Organization target for favorable MDR-TB treatment outcomes is 90%, but programmatic reports and regional analyses indicate much lower success rates. This study aimed to estimate the proportion of patients with MDR-TB achieving favorable treatment outcomes in Zambia between 2018 and 2022 and to identify factors independently associated with these outcomes using national programmatic data.
A retrospective cross-sectional design was used. The authors analysed secondary data extracted from the National Tuberculosis and Leprosy Programme (NTLP) Yathu database covering all laboratory-confirmed MDR-TB cases who initiated treatment from 1 January 2018 to 31 December 2022. All treatment sites across Zambia’s ten provinces, including primary, secondary and tertiary facilities, were included in the dataset.
The analysis used a census sampling strategy: every patient in the NTLP database meeting the inclusion criteria (laboratory-confirmed MDR-TB and treatment initiation during the study period) was included. The final sample comprised 1,258 participants.
Demographic and clinical variables were extracted from routine program records. The source reports median age and interquartile range, sex distribution, HIV status, and nutritional status (reported as body weight categories). Treatment outcomes were categorized into favorable and unfavorable according to program definitions used by the NTLP; the article reports aggregate counts for favorable versus unfavorable outcomes. Specific operational definitions beyond those reported in the source (for example how ‘normal body weight’ was defined or the full list of covariates included in modelling) were not detailed in the abstract.
Multivariable logistic regression was performed to identify factors independently associated with favorable treatment outcomes. Adjusted odds ratios (aORs) with 95% confidence intervals (CIs) and p-values are reported in the source for the key associations highlighted. The source indicates the analytic approach but does not provide the complete modelling strategy in the abstract excerpt.
A total of 1,258 MDR-TB patients were included. The median age was 36 years (IQR 28–44). Most participants were male (67.2%, n = 843). Over half (53.0%, n = 662) were reported as living with HIV. The source reports nutritional status in relation to outcomes but does not provide a full breakdown of weight categories in the abstract.
Overall, 68.1% (n = 857) of patients achieved favorable treatment outcomes, while 31.9% (n = 401) experienced unfavorable outcomes. The reported national favorable outcome proportion falls short of the WHO 90% target and aligns with global concerns about lower-than-desired MDR-TB program success.
In multivariable analysis, patients with normal body weight had higher odds of achieving a favorable outcome (aOR 2.07; 95% CI 1.02–4.21). By contrast, residence in certain provinces was associated with substantially lower odds of favorable outcomes: Muchinga province (aOR 0.12; 95% CI 0.03–0.45; p = 0.002) and Western province (aOR 0.17; 95% CI 0.04–0.80; p = 0.024). Other covariates and their effect estimates were not reported in the abstract excerpt available here.
The authors interpret the findings as indicating that nutritional status and geographic inequities across provinces substantially influence MDR-TB treatment success in Zambia. The positive association between normal body weight and favorable outcomes is consistent with evidence linking malnutrition and low body mass index to worse TB outcomes. The large negative associations observed for Muchinga and Western provinces point to important subnational disparities in program performance or access to services.
The study fills a national-level evidence gap by using NTLP program data across all provinces and multiple years. The authors position their findings alongside prior subnational studies in Zambia that identified health system barriers—such as delayed specimen transport, inconsistent drug supply, and limited diagnostic access—as contributors to poor outcomes in localized settings.
Favorable MDR-TB treatment outcomes in Zambia (2018–2022) were achieved by 68.1% of patients in this national programmatic cohort. The analysis links better outcomes to normal body weight and identifies significant provincial disparities, with Muchinga and Western provinces showing markedly lower odds of success. The authors recommend strengthening nutritional support for people with MDR-TB and targeting interventions to address provincial inequities to improve national program performance.
This report is based on secondary program data. The abstract and provided excerpt do not include all methodological details (for example, the complete list of covariates in multivariable models, precise definitions for some variables, or granular data on programmatic factors at provincial level). Programmatic databases can be subject to incomplete records and misclassification; the authors acknowledge that many previous studies were subnational and that national-level analysis helps address generalisability gaps.
The source states that all relevant data are provided within the paper and its supporting information files. The authors report no specific funding and declare no competing interests. Further ethical or data governance details appear in the full article and supporting information but were not detailed in the abstract excerpt.