Modifiable risk factors associated with tuberculosis disease in children in Pune, India.

Document Type


Publication Date




Journal Title

The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease

MeSH Headings

Age Factors, Air Pollution, Indoor, Case-Control Studies, Child, Preschool, Female, Food Supply, Humans, India, Infant, Logistic Models, Male, Multivariate Analysis, Odds Ratio, Prospective Studies, Residence Characteristics, Risk Factors, Tuberculosis, Vitamin D Deficiency


SETTING: India accounts for the largest burden of tuberculosis (TB) worldwide, with 26% of the world's cases.

OBJECTIVE: To assess the association between novel modifiable risk factors and TB in Indian children.

DESIGN: Cases were children aged ≤ 5 years with confirmed/probable TB based on World Health Organization definitions (definition 1). Controls were healthy children aged ≤ 5 years. Logistic regression was performed to estimate the adjusted odds ratio (aOR) of being a TB case given exposure, including indoor air pollution (IAP; exposure to tobacco smoke and/or biomass fuels) and vitamin D deficiency. Cases were re-analyzed according to a new consensus research definition of pediatric TB (definition 2).

RESULTS: Sixty cases and 118 controls were enrolled. Both groups had high levels of vitamin D deficiency (55% vs. 50%, P = 0.53). In multivariable analysis, TB was associated with household TB exposure (aOR 25.41, 95%CI 7.03-91.81), household food insecurity (aOR 11.55, 95%CI 3.33-40.15) and IAP exposure (aOR 2.67, 95%CI 1.02-6.97), but not vitamin D deficiency (aOR 1.00, 95%CI 0.38-2.66). Use of definition 2 reduced the number of cases to 25. In multivariate analysis, TB exposure, household food insecurity and IAP remained associated with TB.

CONCLUSIONS: Household TB exposure, exposure to IAP and household food insecurity were independently associated with pediatric TB.



First Page


Last Page