Risk Factors for Tuberculosis in Children

Abstract

Background: Childhood tuberculosis remains a major contributor to morbidity and mortality in high-burden countries and is frequently under-diagnosed, particularly in resource-limited settings where environmental, household, and nutritional vulnerabilities coexist. Objective: To determine the household and environmental risk factors associated with pulmonary tuberculosis among children aged 1 to 15 years presenting to a tertiary care pediatric hospital in Quetta, Pakistan. Methods: A hospital-based case–control study was conducted at the Institute of Child Health Services, Quetta. Forty-seven children with pulmonary tuberculosis and 47 children without tuberculosis were enrolled. Data on sociodemographic characteristics, household conditions, environmental exposures, nutritional status, and contact history were collected using a structured proforma. Univariate and multivariable logistic regression analyses were performed to estimate crude and adjusted odds ratios with 95% confidence intervals. Results: Children with tuberculosis were more likely than controls to report contact with a known tuberculosis case (55.3% vs 25.5%), absence of cross-ventilation (61.7% vs 40.4%), and malnutrition (42.6% vs 21.3%). On multivariable analysis, household contact with a tuberculosis case (aOR 4.20, 95% CI 1.50-11.50), no cross-ventilation (aOR 2.30, 95% CI 1.00-5.40), and malnutrition (aOR 2.70, 95% CI 1.10-6.80) remained independent predictors of pediatric pulmonary tuberculosis. Conclusion: Household tuberculosis exposure, poor ventilation, and malnutrition are the principal independent risk factors for pediatric tuberculosis in Quetta. Strengthening contact tracing, improving household airflow, and integrating nutritional support into tuberculosis control strategies may help reduce childhood disease burden in high-risk settings.