Prevalence and factors associated with tuberculosis recurrence among key vulnerable populations in the Ashanti region, Ghana

Abstract

Tuberculosis (TB) is a leading public health challenge, with limited data on the prevalence of recurrence TB and its associated factors among key vulnerable populations (KVPs) in Ghana. This study aimed to determine the prevalence of TB recurrence and identify factors associated with recurrence among PLHIV, informal miners, prisoners, the rural poor, smokers, and children. A cross-sectional study was conducted in five health districts in the Ashanti Region, Ghana, from September to November, 2024. A total of 436 participants, including PLHIV, informal miners, prisoners, the rural poor, smokers, and children, were recruited through systematic random sampling. Data on socio-demographic, clinical and behavioral factors were collected using a validated structured questionnaire. Descriptive statistics were used to summarize data, and logistic regression to identify factors associated with TB recurrence, adjusting for potential confounders using Stata/SE version 16.1. The overall prevalence of TB recurrence among KVPs was 15.6% (68/436). Recurrence was highest among smokers at 25.0% (95% CI: 14.7–37.9), followed by the rural poor at 23.1% (95% CI: 14.9–33.1), informal miners at 19.1% (95% CI: 11.8–28.6), and prisoners at 14.3% (95% CI: 1.8–42.8). PLHIV had a recurrence prevalence of 12.0% (95% CI: 6.4–20.0), while no recurrence was observed among children (0%). In the multivariable logistic regression, two factors were independently associated with TB recurrence, which included; residing in a single-family home compared to a family compound house (AOR: 2.055; 95% CI: 1.002–4.212), and those with the history of heavy alcohol consumption (AOR = 3.596; 95% CI: 1.283–10.080) Compared with participants who reported never consuming alcohol. All other factors, including age, sex, educational level, marital status, key vulnerable population category, and TB support, were not significantly associated with TB recurrence in the adjusted model. TB recurrence among KVPs in the Ashanti Region is an important public health concern, with the burden disproportionately concentrated among smokers, the rural poor, and informal miners. Individuals residing in single-family homes and those with heavy alcohol consumption had higher odds of TB recurrence. These findings indicate that TB control programmes must address both housing conditions that isolate individuals from family support networks and implement integrated alcohol screening and brief interventions within treatment protocols. Targeted interventions addressing these modifiable factors are essential to reduce TB recurrence and improve treatment outcomes among vulnerable populations in Ghana. Not applicable.