Assessment of radiological capacity and disparities in TB diagnosis: a comparative study of Mozambique, South Africa and Spain.

Background: Tuberculosis (TB) remains a significant global health challenge, particularly in children, where diagnosis is challenging. Radiological resources such as chest X-rays and CT scans play a crucial role in early screening and diagnosis, especially in the absence of microbiological confirmation of disease. However, radiological capacity and access vary widely across regions and countries.

Methods: This study retrospectively audited licensed X-ray and CT units in Mozambique, South Africa and Spain in 2022. Population data were used to calculate units per million people. The study used choropleth maps to visualise regional disparities and to explore potential interactions between radiological capacity, population density and TB notifications.

Results: Mozambique had the lowest radiological capacity, with 3.6 X-ray units and 0.4 CT units per million people, compared with South Africa's 34.2 X-ray units, 5.8 CT units and Spain's 811.5 X-ray units and 19.3 CT units. The private sector exhibited higher capacity than the public sector in all countries. Regional disparities were evident, particularly in Mozambique, highlighting urban-rural discrepancies and in-country inequalities.

Conclusion: This study underscores significant disparities in radiological capacity between low-income, middle-income and high-income countries, with economic factors playing a pivotal role. Addressing these disparities is crucial for improving TB and other disease diagnostic capabilities, particularly in resource-limited settings. Potential solutions include establishing dedicated national radio-diagnostic departments, developing national guidelines and integrating portable AI-powered X-ray or point-of-care ultrasonography technology. These findings provide valuable insights for policymakers and stakeholders to advocate for improved radiological resources and equitable healthcare access.