Treatment outcomes and associated factors among persons with pulmonary tuberculosis in Morocco: a systematic review and meta-analysis

Abstract

BACKGROUND: Tuberculosis (TB) remains a major public health challenge. Treatment success rate (TSR) is a key indicator for TB control, yet national level evidence on treatment outcomes in Morocco is fragmented. This systematic review and meta-analysis aimed to estimate pooled TB treatment outcomes and summarize factors influencing success and unsuccessful outcomes among persons with pulmonary tuberculosis (PTB). METHODS: We systematically searched PubMed, ScienceDirect, and Web of Science for studies published up to January 2025. The research question was structured using the PICO framework: participants (adults with PTB), intervention (anti-tuberculosis treatment), and outcomes (TB treatment outcomes). Eligible studies were conducted in Morocco, published in English or French, and reported TB treatment outcomes; non-original articles, studies without outcome data, and those outside Morocco were excluded. Two reviewers independently performed study selection, data extraction, and quality assessment. Meta-analysis was conducted in R software, calculating pooled TSR, unsuccessful treatment outcomes, failure, loss to follow-up, and death rates using a random-effects model. Subgroup analyses were performed by drug-susceptibility status and treatment history. Heterogeneity was assessed using the I² statistic, and risk of bias was evaluated using Joanna Briggs Institute Critical Appraisal Checklists of prevalence and case control studies. RESULTS: Thirty-three studies were included. Pooled estimates showed a TSR of 79.00% (95%CI:72.85-84.07, I²=99%), defined as the proportion of persons with tuberculosis who were cured or completed treatment among all treated cases. The pooled proportion of unsuccessful treatment outcomes was 10.03% (95%CI:7.17-13.85,I²=99%), with separate estimates for treatment failure (1.86%, 95%CI:1.08-3.19), loss to follow-up (5.49%,95%CI:3.47-8.59) and death rate (2.00%, 95%CI:1.20-3.30). Subgroup analysis showed lower TSR and higher unsuccessful outcomes among drug-resistant and retreatment cases. Associated factors for higher TSR included younger age, new and smear-negative cases, and enrollment in integrative health programs. Factors linked to unsuccessful outcomes included older age, male gender, rural residence, and smoking. CONCLUSION: TSR among persons with TB in Morocco remains below the WHO target (≥ 90%), with higher unsuccessful outcomes observed among drug-resistant and retreatment cases. Considerable variability across studies highlights the need for targeted interventions. These findings may inform program strategies to improve TB treatment outcomes. TRIAL REGISTRATION: Clinical trial number: Not applicable.