A sex-disaggregated analysis of age-standardized tuberculosis prevalence in Sierra Leone (2000-2019) using World Health Organization Health Equity Assessment Toolkit data.

Background

Tuberculosis (TB) remains a major public health challenge in Sierra Leone, contributing to high morbidity and mortality. Understanding trends in its prevalence and identifying sex-based disparities are crucial for designing targeted, evidence-based interventions. This study explored the trends in the age-standardized prevalence of TB in Sierra Leone from 2000 to 2019, with a focus on sex-based inequalities.

Methods

A cross-sectional analysis was conducted using age-standardized prevalence data (per 100 000 population) from the World Health Organization's Health Equity Assessment Toolkit (HEAT). Data were analysed at five time points (2000, 2005, 2010, 2015 and 2019). Inequality measures, including difference (D), ratio (R), population attributable fraction (PAF) and population attributable risk (PAR) were calculated to assess absolute and relative disparities between males and females. Confidence intervals (CIs) were reported for all estimates to ensure the precision of findings.

Results

The age-standardized prevalence of TB in Sierra Leone declined from 38 741.6 per 100 000 population in 2000 to 23 797.1 in 2019, a relative reduction of 38.6%. However, sex-disaggregated analysis revealed disparities, with males experiencing higher prevalence rates than females. In 2019, the prevalence for males was 24 968.0 per 100 000 population (95% CI 22 051.1 to 28 307.9) compared with 22 651.8 for females (95% CI 20 053.2 to 25 784.3). The absolute difference (D) widened in magnitude over time, from 1130.7 in 2000 to 2316.2 in 2019 (reported as negative values because female prevalence was lower). The inequality ratio (R) remained close to 1.0 throughout the study period, indicating modest relative disparities. The PAF increased from 1.5% in 2000 to 4.8% in 2019, and the PAR increased from 564.1 to 1145.3 per 100 000 population, indicating a small but growing share of the overall TB burden attributable to the higher prevalence among males.

Conclusions

Despite a marked decline in the overall prevalence of TB in Sierra Leone from 2000 to 2019, males consistently faced a higher burden compared with females. These findings underscore the need for targeted strategies to address the sex-based disparities. Strengthening health systems, promoting equitable access to care, and implementing tailored prevention programs are critical to reducing the overall burden of TB and achieving health equity in Sierra Leone.