Prevalence and factors associated with multidrug resistant Mycobacterium tuberculosis disease in Cameroon: a systematic review and meta-analysis

Multidrug-resistant tuberculosis (MDR-TB) remains a significant public health threat in low- and middle-income countries, including Cameroon. This systematic review and meta-analysis aimed to determine the pooled prevalence of MDR-TB and other anti-tuberculosis drug resistance patterns, and identify factors associated with drug-resistant tuberculosis in Cameroon. A comprehensive literature search was conducted in PubMed, Scopus, Web of Science, Embase, Cochrane Library, and African Journals Online. Additional studies were identified through Google Scholar and reference list screening. Observational studies (cross-sectional and cohort) reporting drug resistance among bacteriologically confirmed tuberculosis patients in Cameroon were eligible. Joanna Briggs Institute critical appraisal tools assessed study quality. Pooled prevalence estimates used random-effects meta-analysis. A p -value ˂ 0.05 was considered statistically significant. Twenty-seven studies (from 1995 to 2022) were included. Pooled prevalence of MDR-TB was 4.9% (95% CI: 2.5–9.4; 20 studies; n = 6,914), with significantly higher resistance among previously treated patients (11.2%; 95% CI: 5.6–21.2; 10 studies; n = 1,469) than new patients (2.0%; 95% CI: 1.1–3.5; 11 studies; n = 3,345). Multiregion studies revealed a higher pooled prevalence (13.6%; 95% CI: 4.1–36.8; 4 studies; n = 743) than Adamawa region (1.6%; 95% CI: 0.9–2.7; 2 studies; n = 882), where the lowest pooled prevalence was observed. Any resistance prevalence was 16.0% (95% CI: 10.1–24.3; 27 studies; n = 9,330), and rifampicin resistance was 4.6% (95% CI: 2.4–8.6; 25 studies; n = 8,728). Monoresistance was highest for streptomycin (6.4%; 95% CI: 3.7–10.8; 13 studies; n = 3,813) and isoniazid (4.7%; 95% CI: 3.0-7.4; 15 studies; n = 4,579). Previous tuberculosis disease was the strongest factor associated with drug resistance (OR = 3.9; 95% CI: 1.8–8.4; 7 studies), followed by alcohol consumption (OR = 1.8; 95% CI: 1.2–2.7; 2 studies) and incarceration history (OR = 1.7; 95% CI: 1.1–2.6; 2 studies). High heterogeneity was observed across most of the pooled estimates. Drug-resistant tuberculosis, particularly MDR-TB, poses a substantial burden in Cameroon. These findings underscore the urgent need to strengthen routine drug susceptibility testing, scale up rapid molecular diagnostics, enhance treatment adherence, and implement targeted interventions for high-risk populations.