Pediatric Tuberculosis Surveillance in Nuevo Leon, Mexico: A GIS-based Approach to Identify High-burden Areas

BACKGROUND: Pediatric tuberculosis (TB) remains underdiagnosed and underreported in Mexico, with limited data on its spatial distribution. This study used geographic information systems (GIS) to map pediatric TB cases diagnosed at a tertiary referral hospital in Nuevo Leon, Mexico, to identify spatial patterns and socioeconomic inequities. METHODS: We conducted a retrospective study of 145 pediatric TB cases (<15 years) diagnosed between 2010 and 2023 at Hospital Regional Materno Infantil, the main public tertiary referral center for children in Nuevo León. GIS analyses included kernel density estimation, kernel relative risk nearest neighbor index, distance to hospital and overlay with marginalization indices. RESULTS: Pulmonary TB was most common (55.2%; n = 80), followed by lymph node (15.8%; n = 23) and meningeal TB (13.1%; n = 19). Kernel density estimation identified hotspots in urban municipalities (Monterrey, Guadalupe, San Nicolás de los Garza). Nearest neighbor index confirmed significant clustering for pulmonary, lymph node and meningeal TB (P < 0.05). Over 65% of cases resided >10 km from Hospital Regional Materno Infantil, and 85% lived in medium- to high-marginalization areas. Mortality (4.1%; n = 6) and treatment abandonment (11.0%; n = 16) were noted, with most occurring among cases from distant or marginalized areas. CONCLUSION: GIS surveillance at a single tertiary center revealed nonrandom spatial clustering of pediatric TB in urban hotspots and areas of socioeconomic deprivation in Nuevo Leon. Integrating geocoded case data with population denominators could enhance routine TB surveillance to prioritize local investigations and interventions.