Sex-related inequalities in tuberculosis mortality in 47 countries in Africa: a cross-sectional analysis of World Health Organization’s 2022 estimates

Tuberculosis (TB) remains a major public health challenge in Africa, with mortality reflecting both disease burden and underlying inequalities. Sex-related disparities in TB outcomes have received limited attention. Understanding sex-specific outcomes is key to promoting equity and advancing TB elimination goals. As such, this cross-sectional study which happens to be the first continent wide study analyzes sex-related disparities in tuberculosis mortality across 47 African countries using the World Health Organization’s 2022 modeled TB mortality estimates available in WHO Health Equity Assessment Toolkit (HEAT) online software. The outcome measure was tuberculosis (TB) mortality among HIV-negative individuals, defined as the number of deaths due to TB per 100,000 HIV-negative population. The dimension of inequality was sex, with subgroups males and females. Two summary measures: difference (D) and Ratio (R), were used to quantity the inequality. Mortality was consistently higher in males than females, except in Seychelles, where rates were equal. Sex-related differences were negative across all countries, meaning males have higher mortality than females, except in Seychelles. These findings highlight the need for national TB programs to implement targeted interventions for men, including screening in male-dominated settings, improve sex-disaggregated surveillance, and integrate gender considerations into TB control strategies.