Retrospective cross-sectional study of clinical and laboratory profiles of paediatric tuberculosis at Ayder Comprehensive Specialized Hospital, Ethiopia (2018–2021)

Pediatric Tuberculosis (TB) remains a diagnostic challenge owing to its paucibacillary nature and diverse clinical presentation. We aimed to characterise the clinical pattern, diagnostic yields, and predictors of disease forms among children managed at Ayder Comprehensive Specialized Hospital (ACSH), Mekelle, Ethiopia. To describe the disease form distribution, clinical features, and laboratory profiles of pediatric tuberculosis at a tertiary Ethiopian hospital, and to identify independent predictors of extrapulmonary and disseminated disease using multivariable logistic regression. We conducted an institution-based, retrospective analytical cross-sectional study of 123 children (< 18) diagnosed with TB at ACSH between May 2018 and April 2021. From 180 screened charts, we excluded 57 cases (prior treatment n = 27, incomplete records n = 20, insufficient evidence n = 10). Using validated data extraction checklist, we analysed sociodemographics, clinical presentation, nutritional status, comorbidities, laboratory results (GeneXpert, ESR, haemoglobin), and TB disease forms via SPSS version 23, applying bivariable and multivariable logistic regression. The mean age was 8.8 ± 5.3 years; adolescents (11–17 years) comprised 42.3% ( n = 52). Females were slightly predominant (52%). Common presenting symptoms included fever (78%), weight loss (71.5%), and cough (55.5%). Severe acute malnutrition (SAM) affected 37.7% ( n = 40/106), with the highest burden in children aged < 5 years (45.7%). Anaemia was prevalent in 62.7% ( n = 74/118); ESR was elevated in 84% ( n = 89/106). Extrapulmonary TB (EPTB) was the most common form (43.9%; 95% CI 35.2–52.9). GeneXpert positivity was 31.3%. Younger age was significantly associated with EPTB ( p < 0.001); children aged 0–4 years had over 3.5 times higher odds of EPTB compared with adolescents (AOR 3.57; 95% CI 1.28–10.00; p = 0.015). Paediatric TB in this referral setting is characterised by high rates of extrapulmonary and disseminated disease, severe malnutrition, and low bacteriological confirmation. Younger age was independently associated with disease dissemination, a finding consistent with the immunological characteristics of early childhood. Early, age-stratified screening and adoption of more sensitive diagnostic tools are urgently needed in similar high-burden settings.