ASSOCIATION BETWEEN HOUSEHOLD FOOD INSECURITY AND ACTIVE PULMONARY TUBERCULOSIS AMONG UNDER-FIVE CHILDREN IN LOW-RESOURCE SETTING: A MATCHED CASE-CONTROL STUDY IN WEST SUMATERA, INDONESIA

Abstract

Malnutrition weakens children's immune systems, increasing vulnerability to infections. Household food insecurity (HFI), combined with malnutrition and environmental factors, may elevate the risk of tuberculosis (TB) in children under five, though evidence in this age group remains limited. This study aimed to examine the association between HFI and the odds of active pulmonary TB (PTB). A case-control study was conducted in Padang City from July to December 2024, involving 63 PTB cases (aged 1–5 years) and 252 community-matched controls. Cases were identified through healthcare centers and hospitals using the Xpert MTB/Rif assay and/or clinical criteria. Controls were recruited from the same communities via the Posyandu child-maternal health program and showed no signs of PTB. HFI was assessed using the 18-item Household Food Security Survey Module, categorizing households into food secure, low food security, and very low food security. Potential confounders, including child characteristics, Posyandu attendance, and household smoking, were collected through caregiver interviews and adjusted using multivariable logistic regression. Among participants, 38.1% of PTB cases and 15.1% of controls experienced very low food security. In contrast, 33.3% of cases and 43.7% of controls were food secure. Children with very low food security had significantly higher odds of PTB compared to those in food-secure households (adjusted odds ratio [AOR] = 5.16; 95% CI: 2.03–13.7). Conclusion: Very low household food security is significantly associated with increased PTB risk in children under five. In TB-endemic settings, food security assessments could guide targeted screening efforts in young children.