Multilevel Risk Factors for Tuberculosis at the District Level in Punjab, India: A Comprehensive Global-to-Local Narrative Review

Abstract

Background: Tuberculosis (TB) risk is the result of the interaction of biological, behavioural, environmental, socioeconomic and health system factors. They are locally relevant and need to be assessed carefully.

Objectives: This review aims

To synthesis and organize the health, demographic and epidemiological evidence relevant to TB risk in District Kapurthala, Punjab, India within a structured global to local framework.

To identify the highest risk factors to TB prevalence and control in this District.

Methods: This narrative review examined WHO reports, India’s National TB Prevalence Survey, Punjab STEPS surveys, census and industrial profiles, and selected peer-reviewed literature. Evidence was organised into five domains within a global-to-local framework.

Results: TB infection prevalence was 22.6% nationally, while Punjab’s 2014–2015 survey reported diabetes prevalence of 14.3%. Kapurthala’s agrarian-industrial context suggests potential vulnerabilities linked to diabetes, migrant labour, and overcrowded housing; their contribution to local TB burden requires validation.

Conclusion: Diabetes-related TB screening, worker housing assessment, and continuity of care for migrants should be assessed locally. They need to be assessed in relation to each other through district surveillance and primary research to inform interventions.