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 in Zambezi District, North-Western Province, Zambia. Methods : A retrospective cross-sectional study was conducted using routinely collected data from the tuberculosis registers in 16 diagnostic health facilities in Zambezi District. The study period spanned from January 2020 to December 2024. Records of children aged 0–14 years who were screened for TB during the period were reviewed. Data on sociodemographic and clinical variables, including age, sex, HIV status, nutritional status, and TB contact history, were extracted using a standardized abstraction tool. Descriptive statistics were used to summarize the data. Bivariate associations were explored using chi-square tests, and multivariable logistic regression was used to identify independent predictors of TB diagnosis. Statistical significance was set at p < 0.05. Results : Out of 412 children screened for TB, 57 were diagnosed with TB, resulting in an overall prevalence of 15.7%. The most affected age group was 5–9 years, accounting for 56.1% of the cases. HIV-positive children were nearly five times more likely to be diagnosed with TB compared to HIV-negative counterparts (adjusted odds ratio [aOR] = 4.65, 95% CI: 2.10–10.30, p < 0.001). Severe malnutrition (aOR = 3.72, 95% CI: 1.45–9.57, p = 0.006) and a history of close contact with a known TB case (aOR = 5.23, 95% CI: 2.01–13.57, p < 0.001) were also found to be significant predictors of TB. Conclusion : The study reveals a high burden of paediatric TB in Zambezi District. HIV infection, malnutrition, and household TB exposure significantly increase the risk of TB in children. There is an urgent need for strengthened TB-HIV integration, improved nutritional interventions, and robust household contact tracing strategies to reduce the paediatric TB burden in rural Zambia.