Background: Tuberculosis (TB) remains a leading cause of death in the Global South, where the burden of disease is compounded by structural inequalities. Despite decades of biomedical interventions, TB control efforts have often failed to address the deeper socio-political and historical factors that sustain the epidemic. Aim: This literature review aims to examine how colonial legacies continue to shape TB control and to explore how decolonial frameworks can reimagine TB care by centering indigenous knowledge, community agency, and health sovereignty. Methods: A narrative literature review was conducted using interdisciplinary sources from public health, global health governance, medical anthropology, and decolonial theory. Key themes were identified through a review of peer-reviewed articles, reports, and grey literature related to TB, colonialism, indigenous knowledge, and community participation. Discussion: Findings highlight enduring power asymmetries in global TB governance, with institutions based in the Global North often dictating priorities that may not align with community needs. The marginalization of indigenous epistemologies further weakens the cultural relevance of TB interventions. However, documented examples of community-led initiatives and integrated traditional practices demonstrate alternative models rooted in relational, participatory approaches. These approaches underscore the importance of ethical collaboration, epistemic pluralism, and local leadership. Conclusion: Decolonising TB control means more than changing tools; it means changing relationships. By centering indigenous knowledge, dismantling power hierarchies, and fostering true community leadership, TB strategies can become more just and effective. In reclaiming the breath, we restore the right to heal on one’s own terms.
References
[1]
Abimbola, S., Asthana, S., Montenegro, C., Guinto, R. R., Jumbam, D. T., Louskieter, L. et al. (2021). Addressing Power Asymmetries in Global Health: Imperatives in the Wake of the COVID-19 Pandemic. PLOS Medicine, 18, e1003604. https://doi.org/10.1371/journal.pmed.1003604
[2]
Adaw, S. A. (2012). Socio-Cultural and Operational Factors Affecting Tuberculosis Control among the Nomads of Northern Kenya. http://ir-library.ku.ac.ke/handle/123456789/4870
[3]
Affun-Adegbulu, C., & Adegbulu, O. (2020). Decolonising Global (public) Health: From Western Universalism to Global Pluriversalities. BMJ Global Health, 5, e002947. https://doi.org/10.1136/bmjgh-2020-002947
[4]
Amare, D., Alene, K. A., & Ambaw, F. (2024). Impact of Integrating Traditional Care with the Modern Healthcare System in Reducing Tuberculosis Diagnosis Delays in Ethiopia: A Clustered Randomized Controlled Study. Tropical Medicine and Health, 52, Article No. 83. https://doi.org/10.1186/s41182-024-00641-0
[5]
Apangu, T., Candini, G., Abaru, J., Candia, B., Okoth, F. J., Atiku, L. A. et al. (2023). Engagement with Traditional Healers for Early Detection of Plague in Uganda. The American Journal of Tropical Medicine and Hygiene, 109, 1129-1136. https://doi.org/10.4269/ajtmh.23-0101
[6]
Atre, S. R., Kudale, A. M., Morankar, S. N., Rangan, S. G., & Weiss, M. G. (2004). Cultural Concepts of Tuberculosis and Gender among the General Population without Tuberculosis in Rural Maharashtra, India. Tropical Medicine & International Health, 9, 1228-1238. https://doi.org/10.1111/j.1365-3156.2004.01321.x
[7]
Baquero-Artigao, F., del Rosal, T., Falcón-Neyra, L., Ferreras-Antolín, L., Gómez-Pastrana, D., Hernanz-Lobo, A. et al. (2023). Update on the Diagnosis and Treatment of Tuberculosis. Anales de Pediatría (English Edition), 98, 460-469. https://doi.org/10.1016/j.anpede.2023.03.009
[8]
Barter, D. M., Agboola, S. O., Murray, M. B., & Bärnighausen, T. (2012). Tuberculosis and Poverty: The Contribution of Patient Costs in Sub-Saharan Africa—A Systematic Review. BMC Public Health, 12, Article No. 980. https://doi.org/10.1186/1471-2458-12-980
[9]
Biesma, R. G., Brugha, R., Harmer, A., Walsh, A., Spicer, N., & Walt, G. (2009). The Effects of Global Health Initiatives on Country Health Systems: A Review of the Evidence from HIV/AIDS Control. Health Policy and Planning, 24, 239-252. https://doi.org/10.1093/heapol/czp025
[10]
Brynildsrud, O. B., Pepperell, C. S., Suffys, P., Grandjean, L., Monteserin, J., Debech, N. et al. (2018). Global Expansion of Mycobacterium tuberculosis Lineage 4 Shaped by Colonial Migration and Local Adaptation. Science Advances, 4, eaat5869. https://doi.org/10.1126/sciadv.aat5869
[11]
Büyüm, A. M., Kenney, C., Koris, A., Mkumba, L., & Raveendran, Y. (2020). Decolonising Global Health: If Not Now, When? BMJ Global Health, 5, e003394. https://doi.org/10.1136/bmjgh-2020-003394
[12]
Chandanabhumma, P. P., & Narasimhan, S. (2020). Towards Health Equity and Social Justice: An Applied Framework of Decolonization in Health Promotion. Health Promotion International, 35, 831-840. https://doi.org/10.1093/heapro/daz053
[13]
Colvin, C., Mugyabuso, J., Munuo, G., Lyimo, J., Oren, E., Mkomwa, Z. et al. (2014). Evaluation of Community-Based Interventions to Improve TB Case Detection in a Rural District of Tanzania. Global Health: Science and Practice, 2, 219-225. https://doi.org/10.9745/ghsp-d-14-00026
[14]
Edginton, M. E., Sekatane, C. S., & Goldstein, S. J. (2002). Patients’ Beliefs: Do They Affect Tuberculosis Control? A Study in a Rural District of South Africa. The International Journal of Tuberculosis and Lung Disease, 6, 1075-1082.
[15]
Give, C., Morris, C., Murray, J., José, B., Machava, R., & Wayal, S. (2024). Sociocultural Understanding of Tuberculosis and Implications for Care-Seeking among Adults in the Province of Zambezia, Mozambique: Qualitative Research. PLOS ONE, 19, e0289928. https://doi.org/10.1371/journal.pone.0289928
[16]
Highland Post (2025). NTEP Meghalaya on Rugged Path to Break TB Chain. Highland Post. https://highlandpost.com/ntep-meghalaya-on-rugged-path-to-break-tb-chain/
[17]
Hindmarch, S., & Hillier, S. (2023). Reimagining Global Health: From Decolonisation to Indigenization. Global Public Health, 18, Article ID: 2092183. https://doi.org/10.1080/17441692.2022.2092183
[18]
Jaiswal, A. (2025). City Goes All Out to Eradicate TB, Focus on Slums. The Times of India. https://timesofindia.indiatimes.com/city/delhi/city-goes-all-out-to-eradicate-tb-focus-on-slums/articleshow/121299069.cms
[19]
Juma, B. M., Nzioki, J. M., Kibiti, C., & Shaikh, M. (2022). Socio-Cultural Factors Associated with Patient Delay in Commencement of Anti-TB Drugs among TB Patients in Kwale County, Kenya. African Journal of Health Sciences, 35, 469-474. https://www.ajol.info/index.php/ajhs/article/view/237703
[20]
Kenya, K. (2024). Barriers to Accessing HIV and TB Medicines in Kenya. KELIN Kenya. https://www.kelinkenya.org/barriers-to-accessing-hiv-and-tb-medicines-in-kenya/
[21]
Kwete, X., Tang, K., Chen, L., Ren, R., Chen, Q., Wu, Z. et al. (2022). Decolonizing Global Health: What Should Be the Target of This Movement and Where Does It Lead Us?. Global Health Research and Policy, 7, Article No. 3. https://doi.org/10.1186/s41256-022-00237-3
[22]
Makabayi-Mugabe, R., Musaazi, J., Zawedde-Muyanja, S., Kizito, E., Fatta, K., Namwanje-Kaweesi, H. et al. (2023). Community-Based Directly Observed Therapy Is Effective and Results in Better Treatment Outcomes for Patients with Multi-Drug Resistant Tuberculosis in Uganda. BMC Health Services Research, 23, Article No. 1248. https://doi.org/10.1186/s12913-023-10120-7
[23]
Mant, M., Abonyi, S., & Hackett, P. (2023). Colonial Tuberculosis Legacies and the Dynevor Indian Hospital (1908-1934). Canadian Medical Association Journal, 195, E278-E280. https://doi.org/10.1503/cmaj.221284
[24]
Matakanye, H., Tshitangano, T. G., Mabunda, J. T., & Maluleke, T. X. (2021). Knowledge, Beliefs, and Perceptions of TB and Its Treatment Amongst TB Patients in the Limpopo Province, South Africa. International Journal of Environmental Research and Public Health, 18, Article 10404. https://doi.org/10.3390/ijerph181910404
[25]
Mbuthia, G. W., Nyamogoba, H. D. N., Chiang, S. S., & McGarvey, S. T. (2020). Burden of Stigma among Tuberculosis Patients in a Pastoralist Community in Kenya: A Mixed Methods Study. PLOS ONE, 15, e0240457. https://doi.org/10.1371/journal.pone.0240457
[26]
McCulloch, J., & Miller, P. (2023a). Tuberculosis and Migrant Labour in the High Commission Territories: Bechuanaland: 1885-1998. In J. McCulloch, & P. Miller (Eds.), Mining Gold and Manufacturing Ignorance (pp. 197-229). Springer Nature Singapore. https://doi.org/10.1007/978-981-19-8327-6_8
[27]
McCulloch, J., & Miller, P. (2023b). Tuberculosis, Malnutrition and Mining in South Africa: 1903-1960. In J. McCulloch, & P. Miller (Eds.), Mining Gold and Manufacturing Ignorance (pp. 169-196). Springer Nature Singapore. https://doi.org/10.1007/978-981-19-8327-6_7
[28]
McMillen, C. (2021). Indigenous Peoples, Tuberculosis Research and Changing Ideas about Race in the 1930s. Canadian Medical Association Journal, 193, E1666-E1668. https://doi.org/10.1503/cmaj.210613
[29]
Mindu, C., López-Varela, E., Alonso-Menendez, Y., Mausse, Y., Augusto, O. J., Gondo, K. et al. (2017). Caretakers’ Perspectives of Paediatric TB and Implications for Care-Seeking Behaviours in Southern Mozambique. PLOS ONE, 12, e0182213. https://doi.org/10.1371/journal.pone.0182213
[30]
Moffatt, J., Mayan, M., & Long, R. (2013). Sanitoriums and the Canadian Colonial Legacy: The Untold Experiences of Tuberculosis Treatment. Qualitative Health Research, 23, 1591-1599. https://doi.org/10.1177/1049732313508843
[31]
Moralina, A. R. (2009). State, Society, and Sickness: Tuberculosis Control in the American Philippines, 1910-1918. Philippine Studies: Historical and Ethnographic Viewpoints, 57, 179-218. https://doi.org/10.13185/2244-1638.4980
[32]
Msoka, E. F., Orina, F., Sanga, E. S., Miheso, B., Mwanyonga, S., Meme, H. et al. (2021). Qualitative Assessment of the Impact of Socioeconomic and Cultural Barriers on Uptake and Utilisation of Tuberculosis Diagnostic and Treatment Tools in East Africa: A Cross-Sectional Study. BMJ Open, 11, e050911. https://doi.org/10.1136/bmjopen-2021-050911
[33]
Munyangaju, I. (2024). Beyond Decoloniality: Toward a Framework of Global Equity. Advances in Applied Sociology, 14, 728-739. https://doi.org/10.4236/aasoci.2024.1412047
[34]
Neelakantan, V. (2018). Tuberculosis Control in Postcolonial South India and Southeast Asia: Fractured Sovereignties in International Health, 1948-1960. Wellcome Open Research, 2, Article 4. https://doi.org/10.12688/wellcomeopenres.10544.2
[35]
Nhassengo, P., Yoshino, C., Zandamela, A., De Carmo, V., Burström, B., Khosa, C. et al. (2023). Perspectives of Healthcare and Social Support Sector Policymakers on Potential Solutions to Mitigate Financial Impact among People with TB in Mozambique: A Qualitative Study. BMJ Open, 13, e073234. https://doi.org/10.1136/bmjopen-2023-073234
[36]
Nhassengo, P., Yoshino, C., Zandamela, A., De Carmo, V., Burström, B., Lönnroth, K. et al. (2024). “They Didn’t Look at Me with Good Eyes”—Experiences of the Socioeconomic Impact of Tuberculosis and Support Needs among Adults in a Semi-Rural Area in Mozambique: A Qualitative Study. Global Public Health, 19, Article ID: 2311682. https://doi.org/10.1080/17441692.2024.2311682
[37]
Oga-Omenka, C., Tseja-Akinrin, A., Sen, P., Mac-Seing, M., Agbaje, A., Menzies, D. et al. (2020). Factors Influencing Diagnosis and Treatment Initiation for Multidrug-Resistant/Rifampicin-Resistant Tuberculosis in Six Sub-Saharan African Countries: A Mixed-Methods Systematic Review. BMJ Global Health, 5, e002280. https://doi.org/10.1136/bmjgh-2019-002280
[38]
Oladimeji, O., Tsoka-Gwegweni, J., & Udoh, E. (2017). Barriers and Strategies to Improve Tuberculosis Care Services in Resource-Constrained Setting: A Qualitative Analysis of Opinions from Stake-Holders in Oyo State South West Nigeria. SMGgroup.
[39]
Otieno, J., Luciani, A., Lumumba, S., Gikunda, G., Kiilu, C., Ogutu, N. et al. (2024). Mental Health Issues Associated with the Management of Tuberculosis in Homabay, Busia and Kakamega Counties, Kenya. PLOS ONE, 19, e0298268. https://doi.org/10.1371/journal.pone.0298268
[40]
Packard, R. M. (1987). Tuberculosis and the Development of Industrial Health Policies on the Witwatersrand, 1902-1932. Journal of Southern African Studies, 13, 187-209. https://doi.org/10.1080/03057078708708141
[41]
Phutane, M. S., Sawant, P. A., Randive, A. P., Hulsurkar, Y. P., Mahajan, U. S., & Kudale, A. M. (2024). Sociocultural Aspects of Delays in Diagnosis among Tuberculosis-Diabetes Comorbid Patients in Satara, India: Its Implications for the Implementation of the National Framework for Joint Tuberculosis-Diabetes Collaborative Activities. Indian Journal of Tuberculosis, 71, 250-261. https://doi.org/10.1016/j.ijtb.2023.05.001
[42]
Schausberger, B., Mmema, N., Dlamini, V., Dube, L., Aung, A., Kerschberger, B. et al. (2021). “We Have to Learn to Cooperate with Each Other”: A Qualitative Study to Explore Integration of Traditional Healers into the Provision of HIV Self-Testing and Tuberculosis Screening in Eswatini. BMC Health Services Research, 21, Article No. 1314. https://doi.org/10.1186/s12913-021-07323-1
[43]
Sen, K., Qadeer, I., & Missoni, E. (2022). Understanding the Context of Global Health Policies: Their Post-Colonial Legacies and Impacts on Health Service Systems. World Review of Political Economy, 13, 322-343. https://doi.org/10.13169/worlrevipoliecon.13.3.0322
[44]
Shariati, S. (2023). Hidden Wounds: Tuberculosis, Colonialism, and the Unsettling Story of Indian Hospitals. IMS Magazine. https://imsmagazine.com/2023/11/06/hidden-wounds-tuberculosis-colonialism-and-the-unsettling-story-of-indian-hospitals/
[45]
Singh, U. B., Rade, K., Rao, R., Kumar, N., Mattoo, S. K., Nair, S. et al. (2025). Lessons and Updates from India’s National TB Elimination Program—Bold Decisions and Innovative Ways of Fast-Tracking Progress towards Ending TB. IJID Regions. https://regions.ijidonline.org/article/S2772-7076(25)00034-7/fulltext
[46]
Suvvari, T. K. (2025). The Persistent Threat of Tuberculosis—Why Ending TB Remains Elusive? Journal of Clinical Tuberculosis and Other Mycobacterial Diseases, 38, Article ID: 100510. https://doi.org/10.1016/j.jctube.2025.100510
[47]
The Shillong Times (2025). Meghalaya Leverages Cutting-Edge Technology to Combat Tuberculosis. https://theshillongtimes.com/2025/03/22/meghalaya-leverages-cutting-edge-technology-to-combat-tuberculosis/
[48]
Tribune, T. A. (2025). Meghalaya Integrates Traditional Healers & Modern Technology to Combat TB. https://assamtribune.com/north-east/meghalaya-integrates-traditional-healers-modern-technology-to-combat-tb-1571757
[49]
Vivek (2025). Power Asymmetries in Global Health Governance: Challenges and Local Struggles in Africa. ROAPE. https://roape.net/2025/03/05/power-asymmetries-in-global-health-governance-challenges-and-local-struggles-in-africa/
[50]
WHO (2024). Global Tuberculosis Report 2024. World Health Organization. https://www.who.int/teams/global-tuberculosis-programme/tb-reports/global-tuberculosis-report-2024
[51]
Yanga, N. (2025). Missed Nuances in Tuberculosis Research: Reflections from a Tibetan Scholar. International Journal of Social Determinants of Health and Health Services, 55, 330-337. https://doi.org/10.1177/27551938251314654
[52]
Yanou, M. P., Ros-Tonen, M. A. F., Reed, J., Moombe, K., & Sunderland, T. (2023). Integrating Local and Scientific Knowledge: The Need for Decolonising Knowledge for Conservation and Natural Resource Management. Heliyon, 9, e21785. https://doi.org/10.1016/j.heliyon.2023.e21785
