Socio-Economic and Environmental Risk Factors Associated with Tuberculosis in Low- and Middle-Income Countries: A Systematic Review

Abstract

Background: Tuberculosis (TB) remains a public health concern because of its high morbidity and mortality. Despite major advances in diagnosis and treatment, evidence on how socioeconomic and environmental factors are linked to tuberculosis remains insufficient. Aim: This review seeks to provide evidence on the contributory role of prevalent socioeconomic and environmental factors in tuberculosis incidence in low- and middle-income countries. Methodology: This systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) approach. A scientific literature search was conducted using the African Journal Online (AJOL), Elsevier, Scopus and PubMed databases. In addition, grey literature was systematically searched using ResearchGate and Google Scholar. Three searches were conducted between 9 and 11 March 2023, 21 March and 10 May 2024, and 20 September and 19 October 2025. The search focused on studies published within the last 20 years that reported data on socioeconomic and environmental risk factors associated with TB in low- and middle-income countries (LMICs). Of the 861 articles retrieved for review, 29 met the eligibility criteria and were systematically reviewed. Results: The socioeconomic risk factors identified in the study included poor housing types, high household population density, low education level, low monthly income and malnutrition. Other factors included age, transport difficulties caused by limited transport options, long travel distances and lack of access to financial support to meet basic needs while sick. Environmental risk factors associated with TB incidence included temperature, humidity and lighting. High humidity, biofuel use, kitchen gas use and indoor cigarette smoke were also identified as environmental risks. Conclusion: Tuberculosis prevalence is associated with socioeconomic deprivation. Environmental factors were also associated with a potentially higher risk of tuberculosis. Public health efforts to combat tuberculosis should address these issues by promoting health education, improving housing quality and mitigating air pollution.