Epidemiology of Pediatric Tuberculosis in the Western Cape: A Population-Based Study (2017-2023)

Background Pediatric tuberculosis (TB) remains a major public health concern in high-burden settings like the Western Cape (WC), South Africa. We analyzed geographic differences in TB burden among children and young adolescents, described temporal trends, and quantified gaps in the TB care cascade. Methods We conducted a population-based descriptive study of pediatric TB episodes recorded in the Provincial Health Data Centre (PHDC) from 2017 to 2023, stratified by 5-year age groups. We assessed HIV status, drug resistance status, microbiological testing, disease classification, place of diagnosis, and TB treatment outcomes. Reporting gaps were estimated by comparing PHDC-recorded episodes with national notifications. Incidence rates of diagnosis were calculated using mid-year population estimates. Results In 2023, TB incidence rates of diagnosis in the WC were 722.4, 189.1, and 171.2 per 100 000 population for ages 0 to 4, 5 to 9, and 10 to 14 years. Children aged 0 to 4 years accounted for 68.9% of pediatric TB episodes. In the Cape Winelands district in 2023, TB incidence of diagnosis among 0- to 4-year-olds was double that of adults in the district and 2 to 4 times higher than 0- to 4-year-olds in other districts. We found high levels of underreporting (20.6%) and initial loss to follow-up (17.9%) among children and young adolescents diagnosed with TB between 2017 and 2023. Conclusions Our findings highlight geographic variation in pediatric TB burden in the WC, emphasizing the need to address local drivers to inform targeted interventions. Gaps in the pediatric TB care cascade remain major concerns. Strengthening integrated data systems beyond TB treatment registers could improve surveillance, health system planning, and patient outcomes.