Knowledge, Perceptions, and Practices Regarding Pediatric Tuberculosis: Cross-Sectional Study Among Guardians and Health Care Providers in Kabondo Dianda Health Zone, Democratic Republic of the Congo

BACKGROUND: Tuberculosis (TB) remains one of the leading infectious causes of morbidity and mortality worldwide, with children representing a particularly vulnerable group. In the Democratic Republic of the Congo, pediatric TB continues to be underdiagnosed and underreported, particularly in rural health zones such as Kabondo Dianda. OBJECTIVE: This study aimed to assess the knowledge, perceptions, and practices of guardians and health care providers regarding pediatric TB in Kabondo Dianda health zone by using the knowledge, attitude, and practice framework. METHODS: A descriptive cross-sectional study was conducted in 5 diagnostic and treatment centers between January 2020 and December 2022. Guardians of children diagnosed with TB (163/163, 100%) were recruited exhaustively through facility registers and community health workers, while health care providers (27/27, 100%) were included through convenience sampling. Data were collected using a structured questionnaire adapted from national and World Health Organization guidelines. The instrument was pretested with 15 guardians and 5 health care providers in a neighboring health zone to ensure clarity, cultural appropriateness, and reliability; internal consistency was confirmed with Cronbach α (α=0.82). Composite scores were calculated for knowledge, perceptions, and practices. Descriptive statistics and chi-square and Fisher exact tests were applied, with significance set at P<.05. RESULTS: Guardians demonstrated partial biomedical knowledge: cough was widely recognized as a symptom (123/163, 75.5%); however, misconceptions persisted, with 29% (47/163) attributing TB to supernatural causes and 52% (85/163) believing domestic animals were vectors. Preventive knowledge was limited, with only 26.4% (43/163) mentioning the Bacille Calmette-Guérin vaccination. Care seeking was often delayed, with 38.7% (63/163) consulting only after treatment failure and 25.8% (42/163) after symptom worsening. Health care providers showed higher knowledge scores but limited diagnostic engagement: only 18.5% (5/27) reported routine use of GeneXpert, and 3.7% (6/163) of pediatric cases received HIV screening. Misconceptions were significantly associated with lower knowledge scores among guardians (P=.03). CONCLUSIONS: Pediatric TB underreporting in Kabondo Dianda reflects both systemic and behavioral determinants. Applying the knowledge, attitude, and practice framework highlights how cultural beliefs, limited preventive knowledge, and weak diagnostic engagement interact to hinder early detection and management. Strengthening community education, training health care providers on latent TB and HIV coinfection, and improving diagnostic infrastructure are essential to reduce morbidity and mortality among children in rural Democratic Republic of the Congo.