Prevalence and predictors of tuberculosis among children in Zambezi District, North-Western Province, Zambia

BACKGROUND: Tuberculosis (TB) remains a leading cause of morbidity and mortality among children in low- and middle-income countries, particularly in sub-Saharan Africa. Paediatric TB is often underdiagnosed due to nonspecific symptoms, limited access to diagnostic tools, and its tendency to mimic other common childhood illnesses. In Zambia, where TB and HIV are co-endemic, understanding the burden of childhood TB at the sub-national level is critical for tailoring effective interventions. This study aimed to determine the prevalence and identify key predictors of TB among children aged 0–14 years in Zambezi District, North-Western Province, Zambia. METHODS: A retrospective cross-sectional study reviewed routinely collected data from tuberculosis registers in 16 diagnostic health facilities in Zambezi District from January 2020 to December 2024. All records of children aged 0–14 years screened for TB were assessed. Data on sociodemographic and clinical variables (age, sex, HIV status, nutritional status, household TB contact, BCG vaccination status, household density, and caregiver education) were extracted using a standardised tool. Descriptive statistics summarised the data. Bivariate associations were examined with chi-square tests, and multivariable logistic regression identified independent predictors of TB diagnosis (p < 0.05). RESULTS: Of 412 children screened for TB, 57 (13.8%) were diagnosed with TB. The most affected age group was < 5 years. HIV-positive children were nearly seven times more likely to be diagnosed with TB than HIV-negative children (adjusted odds ratio [aOR] = 6.8, 95% CI: 3.4–13.6, p < 0.001). Malnutrition (WAZ < − 2; aOR = 3.7, 95% CI: 2.0–6.9, p < 0.001) and household TB contact (aOR = 5.2, 95% CI: 2.7–10.0, p < 0.001) were also significant independent predictors. CONCLUSION: This study reveals a substantial burden of paediatric TB in rural Zambezi District. HIV infection, malnutrition, and household TB exposure are key drivers. Urgent integration of TB-HIV services, nutritional support, and enhanced household contact tracing is required to reduce the paediatric TB burden in rural Zambia.