Magnitude of Under Nutrition and Associated Factors Among Children and Adolescent with Tuberculosis on Directly Observed Treatment at Public Health Facilities in Harar and Dire Dawa City, Eastern Ethiopia

Abstract

Background: Tuberculosis (TB) remains a leading cause of mortality in developing countries, including Ethiopia, and has a bidirectional relationship with malnutrition. Malnutrition is more severe in patients with active TB, yet evidence and standardized protocols for nutritional support in Ethiopia particularly for children are limited.

Methods: A cross-sectional study was conducted from February 1 to March 16, 2025, among 253 children with TB on DOT in urban health facilities of Harar and Dire Dawa, selected by simple random sampling. Data on sociodemographic, nutritional, and clinical factors were collected using interviewer- administered questionnaires, and nutritional status was assessed with WHO Anthro and Anthro Plus software (version 1.0.4). Data were entered into EpiData 3.1.1 and analyzed in SPSS v. 26. Bivariate and multivariate logistic regression were used to identify factors associated with nutritional status, with significance set at p < 0.05 and results presented as crude and adjusted odds ratios with 95% CI.

Results: Among 249 children under 15 years on directly observed TB treatment in Harar and Dire Dawa, pulmonary TB was predominant 213 (85.5%), and more than half 143 (57.4%) had received treatment for two months or less. The prevalence of the undernutrition was 96 (38.6%), (95% CI: 32.4– 44.9), although nearly all children 238 (95.6%) maintained a working functional status. Multivariate analysis showed that undernutrition was significantly associated with lower paternal education (AOR = 0.16; 95% CI: 0.03, 0.73), marital status (AOR = 3.44; 95% CI: 1.38, 8.62), higher wealth index (AOR = 0.04; 95% CI: 0.01, 0.16), and rural residency (AOR = 0.31; 95% CI: 0.11, 0.86).

Conclusion: The study shows that undernutrition is highly prevalent among children on TB treatment, with parental education, marital status, wealth, and residence significantly influencing nutritional outcomes. Strengthening nutritional support and addressing social determinants are crucial to improve health and treatment success in pediatric TB patients.