Community-level risk factors for active Pulmonary Tuberculosis and their implications for TB Control: An unmatched case-control study in Guji Zone, Oromia Region, Ethiopia

Background Tuberculosis (TB) remains a major global health challenge, especially in low-income countries like Ethiopia. Despite ongoing control efforts, TB remains prevalent, highlighting the need for more in-depth research. Guji Zone of Oromia Region is among high TB burden zones in Ethiopia with a new case detection rate of 279/100,000 population in 2016 Ethiopian Fiscal Year (EFY). This study specifically aims to identify the determinants of active pulmonary tuberculosis (PTB) disease among adult patients in public health facilities of Guji Zone, Ethiopia. Methods and Materials: A facility-based unmatched case-control study was conducted among randomly selected 735 (cases 245 and controls 490) patients in Guji zone from August 2024 to December 2024. A pretested and structured face-to-face interviewer administered questionnaire and chart review were used to collect the data. Data was entered into Epi Data version 4.6.0 and exported to SPSS version 25.0 for analysis. Bi-variable and multi variable binary logistic regression model were used to identify the determinants of active PTB. Adjusted odds ratio with 95% Confidence level and p-value of < 0.05 were used to declare statistically significant associations. Results A total of 735 study participants comprising 245 cases and 490 controls aged 15 years and above were included, with an overall response rate of 99.6%. Being HIV-positive (AOR = 3.47, 95% CI: 1.95–6.11), cigarette smoking (AOR = 2.84, 95% CI: 1.78–4.51), having a body mass index (BMI) of below 18.5 (AOR = 2.55, 95% CI: 1.24–5.24), working as a miner (AOR = 3.51, 95% CI: 1.89–6.50) or daily laborer (AOR = 2.31, 95% CI: 1.30–4.09), having a history of contact with a known TB patient (AOR = 2.92, 95% CI: 1.95–4.36), limited access to health facilities (AOR = 1.76, 95% CI: 1.15–2.71), and poor knowledge of TB (AOR = 2.27, 95% CI: 1.47–3.51) were significantly associated with active PTB. Conclusion Our study identified a multifaceted set of determinants for active PTB, driven by key individual-level factors (HIV status, smoking, low BMI) and significant community-level risks (occupational hazards like mining/laboring, TB patient contact, limited healthcare access, and poor TB knowledge). This necessitates a precise and holistic public health strategy beyond current diagnosis and treatment.