Predictors of Pediatric Tuberculosis Disease in a Pastoralist Community, Turkana County, Kenya: A Case-Control Study

Background: Tuberculosis (TB) remains a significant global public health challenge, with 10 million cases and 1.6 million deaths reported in 2021. 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. Conclusion: Pediatric TB in Turkana West Subcounty, Kenya, was significantly associated with household contact with TB patients, previous hospital admissions, caregiver alcohol consumption, and inadequate knowledge of TB prevention among caregivers. These findings highlight the nature of pediatric TB risk factors in pastoralist communities, emphasizing the need for targeted interventions. Effective strategies should focus on improving healthcare access, enhancing caregiver education on TB prevention, and strengthening infection control measures in healthcare settings to mitigate pediatric TB burden and contribute to global TB elimination efforts.