Prevalence and Associated Clinical Factors of Tuberculosis Infection and Disease Among Pediatric Household Contacts: A Facility-Based Cross-Sectional Study

Introduction: Household contact screening is a key strategy for early detection of tuberculosis (TB) disease and infection in children exposed to microbiologically confirmed pulmonary TB. The National Tuberculosis Elimination Program data forms the vital foundation for national policy decisions. Complementary facility-based evaluations remain valuable for capturing region-specific nuances, particularly in geographically challenging areas. This study aimed to estimate the prevalence of TB disease and TB infection among pediatric household contacts and assess associated demographic and clinical factors. Methods: This facility-based cross-sectional study was conducted at Indira Gandhi Medical College, Shimla, from August 2024 to September 2025. Index cases with microbiologically confirmed pulmonary TB registered on the government of India Nikshay portal were identified, and their household contacts were screened in the pediatric outpatient or inpatient departments as per National Tuberculosis Elimination Program guidance. Clinical assessment, anthropometry, Bacillus Calmette-Guérin (BCG) scar assessment, chest radiography, Mantoux testing, and nucleic acid amplification test-based microbiology were performed as indicated. Associations were assessed using chi-square or Fisher’s exact tests and logistic regression. Results: A total of 170 pediatric household contacts were evaluated (mean age 9.6 ± 4.9 years; 55.3% male; 62.4% rural). TB disease was diagnosed in 10 contacts (5.9%): six microbiologically confirmed pulmonary TB, two clinically diagnosed pulmonary TB, and two extrapulmonary TB. Among children up to 10 years of age (n=100), the TB disease prevalence was 4.6% (95% CI: 1.8-11.2). Symptomatic presentation was clinically associated with TB disease and anti-tubercular therapy (ATT) initiation (OR: 3.16, 95% CI: 2.05-5.12), whereas age, sex, residence, chullah smoke exposure, and body mass index (BMI) were not statistically significant in unadjusted analysis. Conclusions: Pediatric household contact screening in routine care yields clinically meaningful TB case detection. A symptom-focused strategy, supported by targeted diagnostics and TB preventive treatment implementation, remains central to pediatric TB control.