Tuberculosis notification trends and treatment outcomes in Bangladesh: findings from a National TB Program data, 2019-2021.

backgroundTuberculosis (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.

methodsWe 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.

resultsBetween 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).

conclusionBangladesh’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.