Predictors of pediatric tuberculosis disease in a pastoralist community, Turkana County, Kenya: a case-control study

Abstract

Background Tuberculosis (TB) remains a significant global public health challenge, with 10.8 million cases and 1.23 million deaths reported in 2023. Children comprised 11% of these cases and deaths globally. In Kenya, approximately 77,000 TB cases were reported, with pediatric TB contributing to 9.6% of all cases and 4.8% of TB-related deaths. Turkana County, a pastoralist region, accounted for 19% of the national pediatric TB burden. The specific drivers of this high pediatric TB rate in Turkana remain unclear. Therefore, we conducted a study to identify predictors of pediatric tuberculosis in this pastoralist community. Method We conducted an unmatched case-control study among children aged 0–14 years in Turkana West Subcounty, Turkana County, Kenya, from January to May 2023. A total of 106 pediatric TB cases were randomly selected from local healthcare facilities, with 212 neighborhood controls enrolled. Data collection involved structured interviews using a questionnaire covering socio-demographic characteristics, clinical history, and socioeconomic and behavioral factors. Predictors of pediatric TB were evaluated using both bivariate and multivariate logistic regression analyses. Results Among the 318 respondents, 150 (47%) were male, and 168 (53%) were female. The mean age was 5 years (SD = 4.3) for cases and 6 years (SD = 4.3) for controls. Children with a history of household contact with TB patients in the previous year had significantly higher odds of developing TB (adjusted odds ratio [aOR] = 21.09; 95% confidence interval [CI]: 7.86, 56.59) compared to those without such contact. Similarly, children with a previous history of hospital admissions had three times higher odds of TB (aOR = 3.26; 95% CI: 1.30, 8.24) than those who had not been admitted. The odds of TB diagnosis were markedly elevated among children whose caregivers consumed alcohol (aOR = 6.50; 95% CI: 2.41, 17.53) compared to those whose caregivers did not. Conversely, children with caregivers knowledgeable about TB prevention measures had significantly lower odds, with a 96% reduced likelihood (aOR = 0.04; 95% CI: 0.01–0.12), of TB diagnosis compared to those whose caregivers lacked such knowledge