Socio-demographic and environmental factors associated with tuberculosis infection among children less than 15 years in Hhohho region of Eswatini (Swaziland)

Abstract

OBJECTIVE : Tuberculosis (TB) is one of the most prevalent public health challenges, particularly in developing countries where poverty, lack of sanitation and improper housing exacerbate the spread of infectious diseases. This study aimed to determine the socio-demographic and environmental factors associated with TB infection among children in the Hhohho region of Eswatini. METHODS : We conducted a cross-sectional study among children under 15 years diagnosed with TB (2022–2023) in Eswatini's Hhohho region, identified through hospital records. Data were collected via a structured survey and medical record review to assess environmental and socio-demographic risk factors. A Social Vulnerability Index (SVI) was constructed using 13 binary indicators to quantify cumulative social and environmental disadvantage. Social Vulnerability Index (SVI) from the Centers for Disease Control and Prevention (CDC) was utilised to investigate whether higher vulnerability correlates with a greater prevalence of TB symptoms. RESULTS : A high proportion (64%) of children were socially vulnerable, indicating multidimensional disadvantage. Children who are socially vulnerable face a significantly higher burden of TB symptoms (94%) compared to their less vulnerable peers (78%). Thus, social disadvantage directly increases health risks in children. The Expanded SVI therefore serves as an important indicator of social determinants of TB risk in the study population CONCLUSION : These results strongly suggest a need for targeted public health interventions that prioritize children who are economically disadvantaged. There is an ever-increasing need for policies that address upstream social determinants such as poverty, overcrowding, and poor nutrition that heighten TB risk.