Prevalence of latent tuberculosis infection in Malaysia: the first systematic review and meta-analysis

Abstract

BACKGROUND: Latent tuberculosis infection (LTBI) remains a major public health challenge in Malaysia, yet prevalence estimates across population groups and settings are fragmented. This systematic review and meta-analysis aimed to synthesize available evidence and identify sources of heterogeneity. METHODS: We searched major databases for studies reporting LTBI prevalence in Malaysia. Random-effects meta-analyses were performed, with subgroup and meta-regression analyses to explore heterogeneity. Publication bias was assessed using Egger's and Begg's tests. Meta-analysis was performed using OpenMeta Analyst software and Comprehensive meta-analysis version 3. RESULTS: Eighteen studies were included, yielding a pooled LTBI prevalence of 30.0% (95% CI; 18.7-44.4%). Marked variation was observed across states, populations, diagnostic tests, and settings. By state, prevalence ranged from 5.2% (95% CI: 4.0-6.7%) in Terengganu to 48.8% (95% CI: 1.8-98.0%) in Kelantan. By population group, the highest prevalence was recorded among people who are incarcerated (PWI) (83.0%, 95% CI: 65.3-92.7%), prison employees (81.0%, 95% CI: 76.9-84.4%), and contacts of multidrug-resistant TB patients (CMDR TB Patients) (52.7%, 95% CI: 41.4-63.8%), while lower rates were observed in Diabetes Mellitus patients (DMP) (10.2%, 95% CI: 3.7-24.8%), medical students (3.8%, 95% CI: 2.2-6.6%), and refugee children (12.8%, 95% CI: 10.0-16.3%). Diagnostic method was a significant source of heterogeneity: tuberculin skin test (TST) yielded higher prevalence (35.1%, 95% CI: 21.0-52.5%) than interferon gamma release assays (IGRA) (16.3%, 95% CI: 8.9-28.1%). By study setting, prisons showed the highest prevalence (82.4%, 95% CI: 71.4-89.8%), compared to hospitals (18.4%, 95% CI: 11.8-27.4%) and refugee schools (12.8%, 95% CI: 10.0-16.3%). Meta-regression confirmed states, diagnostic test, population groups, and setting as key sources of heterogeneity. Egger's (p = 0.4765) and Begg's tests (p = 0.9095) found no evidence of publication bias. CONCLUSION: LTBI prevalence in Malaysia is high, particularly in prisons and high-risk occupational groups. Diagnostic method strongly influences estimates. Targeted screening, preventive therapy, and harmonization of diagnostic standards are essential for Malaysia's End TB strategy.