Prevalence of Pulmonary Tuberculosis among Presumptive Cases in North-Central Nigeria: A Multi-facility Based Cross-sectional Study

Background: Tuberculosis (TB) remains a major public health problem in Nigeria despite expanded diagnostic coverage. Understanding the epidemiological distribution of TB and associated factors is essential for strengthening control strategies. Generating region-specific, facility-based prevalence data is critical for guiding targeted interventions and optimising resource allocation in high-burden settings. This study aims to determine the prevalence of pulmonary tuberculosis among presumptive cases in North-central Nigeria. Methods: A facility-based cross-sectional study was conducted among 411 individuals assessed for tuberculosis using Xpert MTB testing. Sociodemographic and clinical characteristics were analysed in relation to TB test outcomes. Associations were determined using the chi-square test, with statistical significance set at p < 0.05. Results: Of the 411 participants assessed, 104 (25.3%) were Xpert-positive, 306 (74.5%) were negative, and 1 (0.2%) had an indeterminate result. Age, gender, educational level, and BCG vaccination status were not significantly associated with TB positivity (p > 0.05). However, a previous history of tuberculosis was significantly associated with current TB positivity (χ² = 9.90, p = 0.007). These findings highlight the contribution of recurrent and previously treated cases to the ongoing TB burden in the region. Conclusion: The prevalence of tuberculosis is high among the study participants. While most demographic factors and BCG vaccination showed no significant association with TB positivity, a previous history of tuberculosis was a strong predictor of current disease. The study uniquely highlights high rates of recurrence, retreatment, and treatment failure in North-Central Nigeria, with many positive cases occurring among previously treated individuals, driven largely by relapse and treatment default. These findings provide context-specific evidence to inform surveillance strengthening, early case detection strategies, and improved treatment monitoring in high-burden settings.