ArticleBMJ public health2026
Temporal trends and associations between domestic public health spending, donor funding and tuberculosis outcomes in Africa: a serial cross-sectional study (1990-2022).
Article in BMJ public health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Using vital historical data, we modelled tuberculosis (TB) incidence and mortality rates across different scenarios of United States government's (US) development assistance for health (DAH), domestic general government health spending (GHES) and non-US donor funding to determine how changes in these funding would affect TB incidence and mortality in Africa. Methods: A serial cross-sectional ecological analysis was conducted using a panel dataset covering the period from 1990 to 2022 for all 54 African countries. The dataset included age-standardised TB incidence and mortality rates, source-specific DAH and other socioeconomic variables. Mixed-effects tests were performed to assess associations among US DAH, other healthcare funding and TB outcomes. Results: Total annual TB-specific DAH in Africa increased from US$4.4 million in 1990 to US$168.7 million in 2022. The US government contributed more than a quarter of the total funds (US$713 million; 27.4%). Compared with scenarios in which US DAH was low but other funds were high, a combination of high US DAH, high funding from other donors and high GHES (one unit above their means) was associated with a 6.5% (95% Confidence Interval (CI) -73.6% to 49.6%) and a 14.6% (-86% to 60.8%) reduction in TB incidence and mortality, respectively. The corresponding decreases in incidence and mortality rates were 16.8 (-172.17 to 138.57) and 5.88 (-34.85 to 23.16) per 100 000. Conclusion: Although higher US DAH, Other DAH and GHES were associated with declines in TB incidence and mortality rates, the estimated differences in TB outcomes between high-funding and low-US-DAH scenarios were small and not statistically significant.
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