Surveillance-Based Analysis of Tuberculosis Incidence in ASEAN: The Role of Expenditure, Infrastructure, and Surveillance Systems
DOI:
https://doi.org/10.24252/ecc.v12i2.60991Keywords:
Tuberculosis surveillance; Health expenditure; Infrastructure; Population; Public health policyAbstract
Tuberculosis is still a serious threat to public health worldwide. This study examines the impact of infrastructure inequalities and surveillance indicators on the incidence of tuberculosis in nine ASEAN countries from 2000 to 2021. The primary research question examines how infrastructure conditions, health system features, and surveillance performance collectively impact TB incidence within ASEAN. The study employed panel data and fixed-effects regression to investigate the relationships between TB incidence and various variables, including case detection rate, treatment success rate, government health spending, out-of-pocket expenses, access to sanitation, and electricity coverage. By giving the first surveillance-driven, multi-indicator comparative assessment of TB incidence throughout ASEAN, this work contributes by providing region-specific insights to improve resource allocation and monitoring. Data were extracted from the World Bank database and analysed using STATA 17.0 software. The findings indicate that improved sanitation, greater access to electricity, better case detection, and higher urbanisation significantly decrease TB incidence, whereas higher government health spending shows an unexpected positive association. Treatment success and out-of-pocket expenditure were not statistically significant. Effective TB control requires strong surveillance systems, equitable health funding, and improved infrastructure. These results emphasise the importance of enhanced monitoring, better facilities, and fair financing, especially in heavily affected areas within ASEAN.
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References
Adima, F. and Arini, M. (2025) ‘The influence of healthcare workers’ social support on compliance to medication in multi drug resistant tuberculosis patients at the Regional General Hospital of Dr. Saiful Anwar’, Clinical Epidemiology and Global Health, 31, p. 101890. doi: 10.1016/j.cegh.2024.101890.
Ahmad Khan, F. et al. (2017) ‘Effectiveness and safety of standardised shorter regimens for multidrug-resistant tuberculosis: individual patient data and aggregate data meta-analyses’, European Respiratory Journal, 50(1), p. 1700061. doi: 10.1183/13993003.00061-2017.
Alshamsan, R. et al. (2010) ‘Impact of pay for performance on inequalities in health care: systematic review’, Journal of Health Services Research & Policy, 15(3), pp. 178–184. doi: 10.1258/jhsrp.2010.009113.
Amare, D., Alene, K. A. and Ambaw, F. (2025) ‘Effect of integrating traditional and modern healthcare systems on tuberculosis case detection in Ethiopia: a cluster randomised controlled study’, Infectious Diseases of Poverty, 14(1), p. 16. doi: 10.1186/s40249-024-01270-9.
Anwar, A. et al. (2023) ‘Government health expenditures and health outcome nexus: a study on OECD countries’, Frontiers in Public Health, 11, p. 1123759. doi: 10.3389/fpubh.2023.1123759.
Ardhana, S. and Dariatno Sihaloho, E. (2025) ‘Investigating the Role of Health Expenditure on Tuberculosis Incidence in Indonesia’, Economics Development Analysis Journal, 13(4). doi: 10.15294/edaj. v13i4.21080.
Ayabina, D. V. et al. (2021) ‘The impact of active case finding on transmission dynamics of tuberculosis: A modelling study’, PLOS ONE. Edited by M. L. Ndeffo Mbah, 16(11), p. e0257242. doi: 10.1371/journal.pone.0257242.
Bernal, O. et al. (2020) ‘Determinantes sociales y meta de tuberculosis en los Objetivos de Desarrollo Sostenible en las Américas’. doi: https://doi.org/10.26633/RPSP.2020.153.
Bhatia, V. et al. (2023) ‘Ending TB in South-East Asia: flagship priority and response transformation’, The Lancet Regional Health - Southeast Asia, 18, p. 100301. doi: 10.1016/j.lansea.2023.100301.
Bio, R. B. et al. (2024) ‘Economic burden and coping mechanisms by tuberculosis treatment supporters: a mixed method approach from Bono Region, Ghana’, BMC Health Services Research, 24(1), p. 148. doi: 10.1186/s12913-024-10611-1.
Blanchet, K. et al. (2017) ‘Governance and Capacity to Manage Resilience of Health Systems: Towards a New Conceptual Framework’, International Journal of Health Policy and Management, 6(8), pp. 431–435. doi: 10.15171/ijhpm.2017.36.
Boccia, D. et al. (2011) ‘Cash transfer and microfinance interventions for tuberculosis control: review of the impact evidence and policy implications’, The International Journal of Tuberculosis and Lung Disease, 15(6), pp. 37–49. doi: 10.5588/ijtld.10.0438.
Brown, J. et al. (2015) ‘Health status and quality of life in tuberculosis’, International Journal of Infectious Diseases, 32, pp. 68–75. doi: 10.1016/j.ijid.2014.12.045.
Bui, V. L. et al. (2025) ‘Impact of Case Detection and COVID-19-Related Disruptions on Tuberculosis in Vietnam: A Modelling Analysis’. Infectious Diseases (except HIV/AIDS). doi: 10.1101/2025.02.27.25323053.
Calderon, J. S. et al. (2022) ‘Innovating tuberculosis prevention to achieve universal health coverage in the Philippines’, The Lancet Regional Health - Western Pacific, 29, p. 100609. doi: 10.1016/j.lanwpc.2022.100609.
Chavez-Rimache, L., Ugarte-Gil, C. and Brunette, M. J. (2023) ‘The community as an active part in the implementation of interventions for the prevention and care of tuberculosis: A scoping review’, PLOS Global Public Health. Edited by L. Gao, 3(12), p. e0001482. doi: 10.1371/journal.pgph.0001482.
Cole, B. et al. (2020) ‘Essential Components of a Public Health Tuberculosis Prevention, Control, and Elimination Program: Recommendations of the Advisory Council for the Elimination of Tuberculosis and the National Tuberculosis Controllers Association’, MMWR. Recommendations and Reports, 69(7), pp. 1–27. doi: 10.15585/mmwr. rr6907a1.
Crofton, J. (2009). Crofton's clinical tuberculosis. Third edition. Edited by H.L. Rieder et al, Oxford; Macmillan. Available at: https://tbrieder.org/publications/books_english/crofton clinical.pdf.
David A. Warrell et al. (2003) Oxford Textbook of Medicine. 4th edition. Available at https://www.bjanaesthesia.org/article/S0007-0912(17)37541-4/fulltext.
