TOP 10 Countries by Tuberculosis Incidence (2025)
Tuberculosis (TB) remains one of the world's most lethal infectious diseases, yet it is almost entirely preventable and curable. According to the WHO Global Tuberculosis Report 2025, an estimated 10.7 million people fell ill with TB in 2024 — roughly 131 cases per 100,000 population worldwide. While the long-run global trend is downward, the COVID-19 pandemic caused a significant setback, and the disease is now heavily concentrated in a small group of high-burden countries. This article examines which countries carry the highest per-capita TB burden, why they sit at the top of the ranking, and what helps reduce that burden in practice.
This material is informational and does not replace professional medical advice. Individuals with TB symptoms (persistent cough ≥ 2 weeks, weight loss, night sweats, fever) should seek medical care immediately.
Methodology: how this ranking is constructed
Understanding what the TB incidence rate measures — and what it does not — is essential for interpreting this ranking correctly. The figure shown is an estimated rate, not a direct count. TB is notoriously under-detected globally, so WHO uses a combination of notification data, prevalence surveys and mathematical modeling to arrive at each country's estimate.
Important note on incidence vs. absolute burden: Countries with the highest rates per 100,000 are not always the same as countries with the most TB cases in absolute terms. India, Indonesia and China have far more absolute cases but lower incidence rates because of their very large populations. This ranking focuses on relative risk per person, which is the most useful measure for assessing how heavily TB affects the average resident of a country.
Table 1. Countries by TB incidence rate — Top 20 ranking (2024 WHO estimates, Global TB Report 2025)
Use the controls below to search, filter and sort the ranking. Global total estimated TB cases (2024): 10,700,000. "Share" shows each country's estimated share of global TB cases by absolute number.
| Rank ↕ | Country / Territory ↕ | TB Incidence (per 100,000) ↕ |
YoY rate change ↕ | Region | Income group |
|---|---|---|---|---|---|
| 1 | Marshall Islands | 660 0.00% | +2.1% | Pacific | Lower-middle |
| 2 | Lesotho | 622 0.13% | −3.1% | Africa | Lower-middle |
| 3 | Philippines | 500 6.08% | −4.2% | Asia | Lower-middle |
| 4 | Myanmar | 571 2.79% | +1.2% | Asia | Lower-middle |
| 5 | Central African Republic | 528 0.27% | −1.5% | Africa | Low |
| 6 | Kiribati | 521 0.01% | −2.8% | Pacific | Lower-middle |
| 7 | Dem. People's Rep. of Korea | 513 1.24% | −0.4% | Asia | Low |
| 8 | Gabon | 473 0.11% | +0.8% | Africa | Upper-middle |
| 9 | Timor-Leste | 473 0.06% | −3.6% | Asia | Lower-middle |
| 10 | Mongolia | 472 0.15% | −2.1% | Asia | Lower-middle |
| 11 | South Africa | 468 2.60% | −4.5% | Africa | Upper-middle |
| 12 | Papua New Guinea | 432 0.40% | −1.8% | Pacific | Lower-middle |
| 13 | Mozambique | 422 1.29% | −2.9% | Africa | Low |
| 14 | Zimbabwe | 400 0.59% | −3.4% | Africa | Low |
| 15 | Namibia | 394 0.09% | −4.8% | Africa | Upper-middle |
| 16 | Eswatini | 382 0.04% | −5.2% | Africa | Lower-middle |
| 17 | Sierra Leone | 374 0.29% | −1.2% | Africa | Low |
| 18 | Angola | 360 1.20% | −2.3% | Africa | Lower-middle |
| 19 | Cambodia | 356 0.56% | −5.1% | Asia | Lower-middle |
| 20 | Nigeria | 348 7.09% | −1.9% | Africa | Lower-middle |
Source: WHO Global Tuberculosis Report 2025 (2024 estimates). YoY = change in estimated incidence rate vs. 2023. Share = estimated share of 10.7 M global TB cases based on rate × population. Values are rounded; uncertainty intervals exist for all WHO estimates, especially ranks 8–12.
Chart 1. TB incidence per 100,000 — Top 10 countries (2024)
Bars show estimated incidence rates for 2024, ordered from highest to lowest. The dashed reference line marks the global average of 131 per 100,000.
Source: WHO Global Tuberculosis Report 2025. Global average (131/100k) shown as reference.
Insights: why these countries carry the world's heaviest TB burden
The top of the TB incidence ranking is not random. It reflects a recognizable set of structural conditions that interact to drive high transmission and limited disease control. Understanding these patterns is the first step toward targeted and effective responses.
1. Small Pacific island states: geography, poverty and diabetes
The Marshall Islands and Kiribati rank among the world's highest-incidence countries not because TB is uniquely prevalent there by chance, but because they concentrate nearly all known risk factors in a very small, geographically isolated population. Overcrowded housing in atolls with poor ventilation creates ideal transmission environments for an airborne pathogen. At the same time, both countries have among the world's highest rates of type 2 diabetes — a major risk factor for TB progression — driven by dietary transitions following WWII. Limited diagnostic infrastructure and very small health systems mean that TB detection relies heavily on passive case finding, likely undercounting the true burden. The reported rates may still understate the true burden because some cases are likely missed.
2. Southern Africa: the HIV–TB syndemic
Lesotho is the clearest example of how the HIV epidemic amplifies TB risk. HIV destroys the CD4+ T-cells that are critical for TB immunity. A person living with untreated HIV is 18–21 times more likely to develop active TB than someone who is HIV-negative. Lesotho has one of the world's highest HIV prevalence rates (around 22% among adults), and roughly 60% of TB patients in the country are HIV co-infected. Without aggressive antiretroviral therapy coverage and integrated TB-HIV services, bringing down TB rates in Lesotho remains extremely difficult even as some progress has been made since the peak of the HIV epidemic in the mid-2000s. Eswatini, Namibia, Zimbabwe and Mozambique face closely analogous dynamics, and all appear in the Top 20.
3. Southeast and East Asia: large populations and urban density
The Philippines ranks third globally, and the sheer scale of its absolute burden (roughly 720,000 estimated cases in 2024 — the second-highest absolute total after India) makes it a central priority country in the global End TB effort. Urban slums in Manila, Cebu and other cities concentrate TB risks: crowding, poor nutrition, high rates of smoking and diabetes, and irregular access to healthcare. Myanmar's coup in 2021 severely disrupted TB services; the resulting rise in its incidence rate is a visible consequence of political instability for disease control. Mongolia's TB burden is disproportionately driven by alcohol use (a known immunosuppressant), mining occupation (silica exposure) and winter overcrowding in traditional ger districts.
4. Conflict-affected and fragile states
The Central African Republic exemplifies how conflict dismantles TB control. Effective TB management requires at minimum six months of consistent drug supply and follow-up care — something almost impossible to sustain in areas with ongoing armed conflict, displacement and collapsed health facilities. Even DPRK (North Korea), a closed system with limited external data, shows modeled incidence rates consistent with a country where malnutrition, restricted information and limited medicine supply combine to maintain high endemic transmission.
Key structural risk factors driving the top of the TB incidence ranking:
- HIV co-infection — multiplies TB risk 18× or more (dominant in southern Africa)
- Malnutrition and underweight — responsible for an estimated 25% of global TB incidence
- Overcrowded, poorly ventilated housing — central driver in Pacific islands and Asian cities
- Diabetes — triples TB risk; rising fast in Pacific states and South/Southeast Asia
- Smoking and alcohol use — significant multipliers, especially in Mongolia and Southeast Asia
- Silica exposure — drives TB in mining communities (southern Africa, Mongolia)
- Conflict, displacement and health system collapse — CAR, Myanmar, DPRK
- Under-investment in diagnostics — delays detection, prolongs community transmission
5. An important counterintuitive finding: absolute vs. relative burden
Looking at the "Share %" column in Table 1 reveals a striking pattern. Countries at the very top of the incidence rate ranking — Marshall Islands, Kiribati — contribute a vanishingly small share of global TB cases (under 0.01%) because their populations are tiny. In contrast, Nigeria ranks 20th by rate but contributes an estimated 7% of global cases. India and Indonesia, which are absent from the Top 20 by rate, account for roughly 27% and 9% of global absolute burden respectively. This tension between rate-based and burden-based rankings has major policy implications: global case reduction targets require prioritising the highest-burden countries by absolute numbers, while country-level intervention design must focus on the structural causes driving high per-capita rates.
Table 2. Treatment success rates in the Top 10 high-incidence countries
Treatment success rate (TSR) measures the percentage of newly registered drug-susceptible TB cases that are cured or complete treatment. WHO recommends a target of ≥85–90%. High incidence does not automatically imply poor treatment — several countries in the Top 10 have invested effectively in treatment delivery even while failing to prevent new infections.
| Country | Treatment success (%) | Data year | Assessment |
|---|---|---|---|
| Timor-Leste | ≈ 91% | 2022/2023 | Strong — meets WHO target |
| Central African Republic | ≈ 90% | 2022 | Strong — despite fragility |
| Mongolia | ≈ 90% | 2022 | Strong — drug-sensitive TB |
| Kiribati | ≈ 90% | 2015 (historical) | Strong — older cohort data |
| Myanmar | ≈ 87% | 2022 | Acceptable — at risk from conflict |
| Marshall Islands | ≈ 83% | 2022 | Acceptable — below target |
| Lesotho | ≈ 80% | 2022 | Borderline — HIV co-infection a factor |
| Philippines | ≈ 78% | 2022 | Below target — case-finding gap large |
| Gabon | ≈ 65% | 2022 | Concerning — DR-TB risk elevated |
| Dem. People's Rep. of Korea | n/a | — | Limited published data |
Sources: WHO Global TB Database, World Bank TB cure rate indicators. Values rounded; definitions and cohort years vary by country. Drug-resistant TB (DR-TB) success rates are typically 10–20pp lower.
The main gap is often not treatment quality — it is case detection. WHO estimates that in 2024, approximately 3.8 million people with TB were never diagnosed or notified to health services. Countries like the Philippines, despite reasonable treatment success among enrolled patients, have a large proportion of TB cases that are never found and therefore never treated. Closing this detection gap — through systematic community screening, molecular diagnostics and proactive outreach — is one of the highest-impact interventions available today.
Trends 2000–2025: progress, the COVID setback and the End TB gap
Global TB incidence declined from roughly 180 per 100,000 in 2000 to a pre-pandemic low of around 127 per 100,000 in 2019 — a 29% reduction over two decades. This progress reflected real gains in HIV treatment (reducing a key driver), expanded DOTS programs, economic development and improved nutrition in key high-burden countries.
The COVID-19 pandemic reversed years of progress in a matter of months. Lockdowns diverted health workers, closed clinics and made TB testing facilities inaccessible. In 2020 and 2021, global TB notifications fell sharply — not because TB was actually declining, but because detection had collapsed. Incidence in the WHO estimate actually rose from 2019 to 2021, and mortality increased for the first time in many years.
Since 2022, a recovery is underway: global notifications have returned to and slightly exceed pre-pandemic levels, and the estimated incidence rate has resumed a modest decline to around 131 per 100,000 in 2024. However, the world is dramatically off-track relative to End TB Strategy milestones.
Country-level trend patterns
Within the Top 10, trends diverge considerably. Lesotho achieved real reductions in the 2010s through expanded ART coverage and integrated TB-HIV services, though its rate remains among the world's highest. The Philippines has made slow but measurable progress, held back by a very large undetected case reservoir. Timor-Leste shows one of the stronger sustained declines among high-incidence countries, reflecting investment in community health workers and treatment support systems. Myanmar, by contrast, has seen its progress reversed since the 2021 military coup, which has devastated health infrastructure and driven hundreds of thousands of people into displacement — conditions ideal for TB transmission.
Chart 2. Indexed TB incidence trends, selected countries (2000 = 100)
Stylized index (2000 = 100) constructed from WHO time-series data. Shows illustrative trajectories for global average, Lesotho, the Philippines and Timor-Leste. The later segment reflects the COVID-19 shock and the early recovery period. Actual WHO data points may differ slightly because annual estimates are revised over time.
What this ranking means — context for readers
This ranking measures TB incidence per 100,000 population. That matters enormously for how you interpret it. Here is a practical guide to reading these figures:
If you are a traveller or expatriate
An incidence rate of 660 per 100,000 (Marshall Islands) means that roughly 0.66% of the resident population develops TB each year. For a short-term tourist with normal immune function, casual contact in public spaces poses a very low individual risk. TB transmission requires prolonged close contact with an infectious person (typically sharing indoor air for hours, not minutes). That said, travellers who are immunocompromised, planning long stays in high-incidence settings, or working in healthcare or prisons in these countries face meaningfully elevated risk and should consult a travel medicine specialist about preventive measures, including BCG vaccination status.
If you work in public health or international development
The ranking highlights where per-capita transmission risk is highest, which is not the same as where most of the global burden lies. Countries like Nigeria (rank 20 by rate) and those not in the Top 20 — India, Indonesia, China — account for the vast majority of global cases. A global strategy that focuses only on the highest-rate countries will miss most TB. Conversely, a strategy focused purely on absolute numbers may under-invest in community-level control in very high-rate settings, allowing persistent high-transmission foci to undermine regional progress.
If you are a policymaker or donor
The data confirm that TB is strongly concentrated in settings with specific, addressable risk factors: HIV, malnutrition, crowded housing, fragile health systems. These are not inevitable features of the countries in question — they are modifiable. Countries like Eswatini and Cambodia demonstrate that sustained, well-funded national TB programs can achieve consistent annual incidence declines of 4–5% per year. That rate of decline, if maintained and replicated, is enough to substantially reduce the global burden within a generation.
If you are personally affected
TB is curable. A standard six-month regimen of first-line drugs has a cure rate exceeding 85% when completed. If you live in a high-incidence country and have a persistent cough lasting more than two weeks, unexplained weight loss, night sweats or prolonged fever — get tested. Free TB testing and treatment are available through national health services in every country covered by this ranking, and through WHO-supported programmes in resource-limited settings. Early detection and treatment not only save lives — they also prevent further transmission.
TB is not just a "developing world" problem — it is a problem of structural inequality. Every country in the Top 20 has the technical knowledge to eliminate TB. What has consistently been lacking is sustained political will, adequate financing and the social investments (in housing, nutrition, HIV treatment) that would eliminate the conditions in which TB thrives. The data in this ranking are ultimately a mirror of decades of underinvestment in the social determinants of health.
FAQ: common questions about TB incidence
Answers to the questions readers most often ask about this data and this disease.
Policy priorities: what the evidence points toward
TB is preventable and curable, so persistent high incidence is primarily a sign of under-investment and policy failure rather than medical impossibility. Evidence from the countries in this ranking points to a consistent set of high-priority actions:
- Close the case-finding gap. An estimated 3.8 million TB cases go undetected each year. Systematic screening in high-risk groups (mining workers, prisoners, contacts of known cases, people with HIV or diabetes), modern molecular diagnostics (GeneXpert) and digital contact-tracing are cost-effective tools that can dramatically expand detection.
- Integrate TB and HIV services. In southern Africa especially, TB cannot be controlled without near-universal ART coverage and co-located TB-HIV services. Every person newly enrolled on ART should be screened for TB, and vice versa.
- Invest in social protection. Cash transfers, nutrition support, free transport to clinics and occupational safeguards for miners and migrant workers tackle the structural drivers of TB in ways that biomedical interventions alone cannot match.
- Protect TB budgets from shocks. The COVID-19 experience showed how easily vertical TB programmes collapse when faced with a competing emergency. Protected multi-year TB funding — backed by international donors and domestic governments alike — is essential for sustained progress.
- Scale up TB preventive therapy (TPT). Treating latent TB infection in high-risk groups (HIV-positive, household contacts of active cases) with short, effective regimens can break the chain of future cases. Coverage remains far below WHO targets in most high-burden countries.
- Address antimicrobial resistance proactively. DR-TB is a growing threat and far more expensive to address reactively. Universal drug susceptibility testing at diagnosis and all-oral shorter regimens for MDR-TB should be the standard of care, not a rarity.
- Invest in the TB vaccine pipeline. BCG is 100 years old and provides incomplete protection in adults. Several next-generation TB vaccine candidates (including M72 AS01E) showed promise in Phase 2b trials. Adequate funding for Phase 3 trials and a credible commitment to purchase successful vaccines could transform the trajectory of the epidemic within a decade.
For countries outside the Top 20, the key lesson is that TB can quickly resurge. Urbanisation, rising diabetes rates, ageing populations and migration can erode previous gains even where incidence is currently low. Vigilance, functioning surveillance and maintained investment in primary care TB detection are not optional extras — they are the foundation of prevention.
Primary data sources and technical references
All figures are compiled from open-access international datasets. Values are rounded for readability; for formal statistical or policy work, consult the original databases and their methodological documentation.
-
1. WHO — Global Tuberculosis Report 2025The primary source for all incidence estimates, mortality data, treatment outcome cohorts and progress toward End TB targets. Data reference year: 2024. Country-level estimates with confidence intervals in Annex 2.https://www.who.int/teams/global-tuberculosis-programme/tb-reports
-
2. WHO Global TB Programme — TB data and country profilesInteractive database with TB incidence, case notifications, treatment outcomes, drug resistance indicators and risk factor data by country and year, updated annually.https://www.who.int/teams/global-tuberculosis-programme/data
-
3. World Bank — Tuberculosis incidence indicators (WDI)World Bank series based on WHO data, used for cross-checking incidence rates and treatment success across high-burden countries. Indicators: SH.TBS.INCD and SH.TBS.CURE.ZS.https://data.worldbank.org/indicator/SH.TBS.INCD
-
4. WHO — The End TB Strategy (2014)The strategic framework defining global 2025 and 2030 targets for reductions in TB incidence and mortality, and the recommended package of interventions to achieve them.https://www.who.int/teams/global-tuberculosis-programme/the-end-tb-strategy
-
5. Our World in Data — TuberculosisLong-run TB incidence and mortality time series used for historical trend context, with visualisations based on WHO data.https://ourworldindata.org/tuberculosis
-
6. UN World Population Prospects 2022 (UNDESA)Population denominators used by WHO to compute incidence rates. Mid-year estimates consistent across all countries.https://population.un.org/wpp/
-
7. Stop TB Partnership — Global Plan to End TB 2023–2030Financing gap analysis and investment case for reaching End TB targets, including projections by country group and intervention type.https://www.stoptb.org/global-plan-to-end-tb
All numerical values are approximate and rounded. YoY rate changes are indicative estimates based on trend analysis of WHO annual reports. Uncertainty intervals accompany all WHO point estimates.