Childhood Tuberculosis Detection Gaps within Primary Healthcare Facilities in Punjab, Pakistan

Abstract

Tuberculosis (TB) remains a major cause of morbidity and mortality among children worldwide, with Pakistan ranking among the highest TB-burden countries globally. Childhood TB diagnosis is particularly challenging due to non-specific clinical presentation, paucibacillary disease, and limited access to pediatric diagnostic tools at primary healthcare facilities. This retrospective cross-sectional study analyzed routine surveillance data from the Punjab Tuberculosis Control Program from January 2024 to June 2025 to evaluate facility-level differences in childhood TB detection across Punjab’s public healthcare system. Data included all notified TB cases among children aged 0–14 years and were analyzed using descriptive statistics. Results showed substantial variation in childhood TB detection across healthcare levels. Primary healthcare facilities (BHUs and RHCs) reported the lowest proportion of childhood TB cases, accounting for approximately 4% of total TB notifications despite serving as the first point of contact for most patients. Secondary healthcare facilities (THQs and DHQs) reported the highest absolute number of pediatric TB cases, representing nearly 7% of notifications, while tertiary hospitals demonstrated the highest proportion of childhood TB cases at approximately 10%, likely due to referrals of complicated cases requiring advanced diagnostic services. The findings indicate significant under-diagnosis at the primary healthcare level, likely related to limited diagnostic capacity, inadequate training, weak referral mechanisms, and poor implementation of household contact screening. Strengthening decentralized diagnostic services, expanding GeneXpert testing, improving healthcare worker training, and enhancing community-based contact screening are essential to improve early childhood TB detection and reduce pediatric TB-related morbidity and mortality in Punjab.