Tuberculosis is most common in South-East Asia and sub-Saharan Africa, which together account for the majority of the world’s estimated 10.8 million new cases each year. The disease kills roughly 1.25 million people annually, making it one of the deadliest infectious diseases on the planet.
Regions With the Highest TB Rates
The WHO divides global TB data by region, and two regions stand far above the rest. South-East Asia has the highest incidence rate at 234 cases per 100,000 people, driven largely by enormous caseloads in India, Indonesia, and Bangladesh. The African Region follows closely at 206 per 100,000, with countries like Nigeria, the Democratic Republic of the Congo, and South Africa contributing heavily. The Western Pacific Region, which includes China and the Philippines, comes in third at 97 per 100,000.
These numbers reflect new cases diagnosed in a single year. They don’t capture the roughly one-quarter of the world’s population that carries a latent TB infection, meaning the bacteria are present in their body but not causing symptoms. About 5 to 10 percent of people with latent TB will develop active disease at some point in their lives, with half of that risk concentrated in the first two years after infection.
The 30 High-Burden Countries
The WHO maintains a list of 30 “high TB burden” countries that receive focused international support. The list is built from two criteria: the 20 countries with the largest absolute number of new cases, plus 10 additional countries with the highest incidence rates per capita (provided they have at least 10,000 new cases per year). India and Indonesia consistently top the list in terms of total cases. Countries like Mongolia, Gabon, and Uganda were added to the most recent list, while Cambodia, Russia, and Zimbabwe were removed after making enough progress to transition off.
Separate lists exist for countries with the highest burden of HIV-associated TB (heavily concentrated in Africa) and drug-resistant TB (spread across Eastern Europe, Central Asia, and parts of Africa and South-East Asia). About 400,000 new cases each year involve drug-resistant strains, and those cases cause an estimated 150,000 deaths.
Why These Regions Are Hit Hardest
TB thrives where poverty, malnutrition, overcrowding, and HIV converge. Poverty is one of the strongest predictors: it creates the crowded, poorly ventilated living and working conditions where the airborne bacteria spread most easily. Malnutrition weakens the immune system enough to let a latent infection become active disease. And poverty limits access to both health knowledge and healthcare itself, which delays diagnosis and treatment.
HIV is the other major driver. In African countries, roughly 31 percent of TB patients are also living with HIV, though in some nations that figure reaches as high as 80 percent. HIV cripples the immune cells that normally keep TB bacteria in check, so a person with both infections is far more likely to develop active, transmissible disease. This is a major reason sub-Saharan Africa’s TB burden remains so high despite relatively smaller population sizes compared to South-East Asia.
High-Risk Settings Within Countries
Even within high-burden countries, TB clusters in specific environments. Prisons are among the worst. A large systematic review covering more than 6.7 million incarcerated people found TB prevalence exceeded 1,000 per 100,000 prisoners in nearly every global region except North America and the Western Pacific. In African prisons, TB incidence reached roughly 2,190 per 100,000 person-years, and in South-East Asian prisons it was about 1,550. For context, in South American prisons the TB rate was nearly 27 times higher than in the general population of the same countries.
The reasons are straightforward: prisons pack large numbers of people into small, poorly ventilated spaces for extended periods. Many inmates arrive with untreated infections, malnutrition, or HIV. Screening on intake is inconsistent in many countries. Urban slums and mining communities face similar dynamics of overcrowding, poor air circulation, and limited healthcare access.
The Diagnostic Gap
A significant share of TB cases worldwide are never diagnosed or reported. Among incarcerated populations specifically, the global case detection ratio was estimated at just 53 percent in 2019, meaning nearly half of all cases went undetected. The gap is widest in low-income countries where diagnostic tools like rapid molecular tests are scarce, and where people may not seek care until the disease is advanced.
This matters because every undiagnosed person with active TB can transmit the bacteria to 10 to 15 others over the course of a year. Closing the detection gap is one of the most direct ways to reduce transmission in high-burden regions.
Recent Trends
Global TB incidence rose for several consecutive years after the COVID-19 pandemic disrupted healthcare systems, delayed diagnoses, and diverted resources. That trend reversed in 2024, when both the total number of new cases and the incidence rate dropped for the first time since the pandemic began. The rate fell by 1.7 percent between 2023 and 2024, bringing it back to the historic pre-pandemic low reached in 2020.
The decline is encouraging but modest. The latent TB prevalence rate has been slowly decreasing for decades, from about 31 percent of the global population in 1990 to roughly 24 percent in 2019. Progress depends heavily on sustained investment in diagnosis, treatment, and prevention in the regions where TB remains most entrenched: South-East Asia, sub-Saharan Africa, and the specific high-risk environments within those regions where the disease spreads fastest.