Date of Award

January 2023

Document Type


Degree Name

Master of Public Health (MPH)


School of Public Health

First Advisor

Lucian (Luke) Davis

Second Advisor

Sheela Shenoi


Background: South Africa (SA) is among the world’s highest tuberculosis (TB)-burden countries, and people living in informal settlements are at especially high risk. To inform South Africa's national TB program strategy, updated TB prevalence and incidence estimates are needed. This review aims to determine the prevalence and incidence of active TB disease among people living in informal settlements in SA.

Methods: Published and unpublished observational and randomized studies reporting SA TB prevalence and/or incidence were sought in, Ovid EMBASE, Africa Index Medicus, and Incidence & Prevalence Database (January 2010-February 2023). Quality assessment was performed using the JBI Checklist for Prevalence Studies. Studies using WHO-endorsed diagnostic tools were included in the random-effects meta-analysis to obtain pooled estimates and assess heterogeneity. Publication bias was assessed through funnel plots and Egger’s regression test (significance level α=0.05).

Results: Database search yielded 813 results. 18 studies reporting on TB prevalence (n=12) and TB incidence (n=6) were included. Study quality was mostly low-moderate (n=16). 5 studies included only persons living with HIV (PLHIV). Meta-analysis of 8 eligible studies (n=20,599 participants) yielded a pooled TB prevalence of 16.2% [95% CI: 4.5-33.4%] in PLHIV and 7.9% [95% CI: 0.4-23.1%] in mixed HIV-status populations. Compared to the national TB prevalence of 0.8% (2018), informal settlements are at a 10-fold increased risk for TB disease. Heterogeneity was high (I2=92.3% in PLHIV, 99.8% in mixed HIV-status populations). We observed funnel plot asymmetry. Egger’s test was marginally significant (p=0.059).

Discussion: This review identified an extremely high TB disease prevalence among persons living in informal settlements in South Africa, a subpopulation who may benefit from targeted TB interventions. The review had some limitations, including between-study statistical heterogeneity, small sample sizes, and the presence of probable design-related bias and publication bias.


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