Prevalence of Sputum-Positive Tuberculosis and Its Association with Demographic Factors in Salah Al-Deen Governorate, Iraq

Background: Tuberculosis (TB) remains a major global health challenge, particularly in low- and middle-income countries. Understanding epidemiology at the subnational level is critical for designing targeted interventions. Objective: This study aimed to estimate the prevalence of sputum-positive TB in Salah Al-Deen Governorate, Iraq, and to assess its association with demographic and geographic factors. Methodology: A cross-sectional study was conducted from February 1, 2022, to November 30, 2024. A total of 1,486 sputum specimens were collected from patients attending TB centers in Tikrit and Samarra, as well as from peripheral health facilities in multiple districts. Following the National Tuberculosis Program in Iraq, three sputum samples were obtained per patient and examined using Ziehl–Neelsen microscopy. Culture on Lowenstein–Jensen medium and standard biochemical tests were performed for confirmation. Data were analyzed using descriptive statistics and symmetric analysis to explore associations with sex, age group, and district. Results: The overall prevalence of sputum-positive TB was 40.04% (595/1,486). Females had a higher prevalence (55.8%) compared with males (44.2%). The highest prevalence by district was observed in Tikrit (28.07%) and Balad (22.52%), while no cases were recorded in Al-Alam or Dijlah. The ≥65 years age group had the highest age-specific prevalence (18.49%). Conclusions: Sputum-positive TB prevalence in Salah Al-Deen Governorate is high and varies significantly by sex, age, and location. Females, elderly individuals, and residents of specific districts bear a disproportionate burden. These findings highlight the need for targeted TB control strategies in high-prevalence areas, enhanced diagnostic coverage in low-reporting districts, and prioritized screening of high-risk populations.