{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T12:46:55Z","timestamp":1785934015843,"version":"3.56.0"},"reference-count":64,"publisher":"BMJ","issue":"3","license":[{"start":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T00:00:00Z","timestamp":1785888000000},"content-version":"unspecified","delay-in-days":35,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["bmjph"],"accepted":{"date-parts":[[2026,7,13]]},"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Using vital historical data, we modelled tuberculosis (TB) incidence and mortality rates across different scenarios of United States government\u2019s (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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Total annual TB-specific DAH in Africa increased from US$4.4\u2009million in 1990 to US$168.7\u2009million in 2022. The US government contributed more than a quarter of the total funds (US$713\u2009million; 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) \u221273.6% to 49.6%) and a 14.6% (\u221286% to 60.8%) reduction in TB incidence and mortality, respectively. The corresponding decreases in incidence and mortality rates were 16.8 (\u2212172.17 to 138.57) and 5.88 (\u221234.85 to 23.16) per 100\u2009000.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjph-2026-005035","type":"journal-article","created":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T12:00:25Z","timestamp":1785931225000},"page":"e005035","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Temporal trends and associations between domestic public health spending, donor funding and tuberculosis outcomes in Africa: a serial cross-sectional study (1990\u20132022)"],"prefix":"10.1136","volume":"4","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-8913-6251","authenticated-orcid":false,"given":"Charles","family":"Limula","sequence":"first","affiliation":[{"name":"Department of Research and Data Analytics, Sub-Saharan Africa Research for Sustainable Development Project, Berekum, Bono Region, Ghana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9617-5435","authenticated-orcid":false,"given":"Daniel","family":"Atta-Nyarko","sequence":"additional","affiliation":[{"name":"Department of Global Health Policy and Development, National Centre for Coordination of Early Warning and Response Mechanism, Accra, Ghana"},{"name":"Sub-Saharan Africa Research for Sustainable Development Project, Berekum, Ghana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-5837-8553","authenticated-orcid":false,"given":"Ebenezer","family":"Gyamfi","sequence":"additional","affiliation":[{"name":"Department of Research and Data Analytics, Sub-Saharan Africa Research for Sustainable Development Project, Berekum, Bono Region, Ghana"},{"name":"Department of Medicine, Methodist Hospital, Wenchi, Ghana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-6214-8689","authenticated-orcid":false,"given":"Rostand Dimitri","family":"Messanga Bessala","sequence":"additional","affiliation":[{"name":"Department of Research and Data Analytics, Sub-Saharan Africa Research for Sustainable Development Project, Berekum, Bono Region, Ghana"},{"name":"Department of Internal Medicine, Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaound\u00e9, Centre Region, 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