Epidemiological insights into paediatric tuberculosis trends in the Western Cape, South Africa.

Background and objectives: Paediatric tuberculosis (TB) remains a major public health concern in high-burden settings like the Western Cape (WC), South Africa. We analysed geographic differences in TB burden among children and adolescents, described temporal trends, and quantified gaps in the TB care cascade. Methods: We analysed TB episodes recorded in the WC Provincial Health Data Centre (PHDC) from 2017-2023, stratified by 5-year age groups, and compared them to adult episodes. 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 to national notifications. Incidence rates were calculated using mid-year population estimates. Results: In 2023, TB incidence rates of diagnosis in the WC were 722.4, 189.1, 171.2, and 523.4 per 100,000 population ages 0-4, 5-9, 10-14, and 15-19 years. Children aged 0-4 years accounted for 47.9% of paediatric TB episodes. In the Cape Winelands district in 2023, TB incidence among 0-4-year-olds was double that of adults in the district and 2-4 times higher than 0-4-year-olds in other districts. Among PHDC-recorded episodes, 17.3% were not reported at national level. Treatment success was low, with only 70.3% of diagnosed children and adolescents completing treatment in 2023. Conclusions: Our findings highlight geographic variation in paediatric TB burden in the WC, emphasizing the need to address local drivers to inform targeted interventions. Gaps in the paediatric TB care cascade remain major concerns. Strengthening integrated data systems beyond TB treatment registers, could improve surveillance, health system planning, and patient outcomes.