# Environmental health recommendations for Multidrug-Resistant Tuberculosis in low- and middle-income countries: a systematic review

## TL;DR

This paper reviews environmental health recommendations to improve outcomes for MDR-TB patients and prevent transmission in low- and middle-income countries.

## Contribution

It systematically identifies environmental health practices that could optimize MDR-TB treatment and reduce household transmission in LMICs.

## Key findings

- Environmental health factors are linked to improved health outcomes for MDR-TB patients.
- Promoting good environmental practices may help prevent MDR-TB transmission to household contacts.
- Findings suggest the need to integrate these practices into local and global health policies.

## Abstract

The impact of environmental health risk factors on the optimization of health in MDR-TB infected individuals, as well as on the prevention of transmission to household contacts, is not well documented. Establishing the recommendations of environmental health risk factors for individuals living at home with MDR-TB will have important policy implications in LMICs, such as South Africa.

The study objectives were to identify current environmental health recommendations to optimize the health of individuals infected with MDR-TB, while living at home during the completion of their treatment regimen; and to prevent transmission to household contacts by individuals infected with MDR-TB.

A systematic search of electronic databases was conducted in May 2021 using a predefined search strategy. An updated search was conducted in November 2023. All primary observational studies evaluating populations ≥ 13 years of age in LMICs were included if they examined the relationship between MDR-TB and the pre-defined exposures and outcomes.

The results of the systematic review highlighted an important potential relationship between environmental risk factors and optimising the health of individuals infected with MDR-TB. It also emphasized the role that promoting good environmental health practices may play in preventing the transmission to household contacts and should be incorporated into local health system strategies and global policy.

The protocol of this review was submitted and published on the PROSPERO register (Protocol registration number: CRD42021255946).

The online version contains supplementary material available at 10.1186/s12889-026-26503-4.