ArticleInternational journal of environmental research and public health2025
Household Clustering of High-Risk Contacts in Smear-Positive TB Patient Families: Evidence for Hotspot Households and Risk Stratification in Rural Eastern Cape.
Article in International journal of environmental research and public health, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundHousehold contacts of smear-positive tuberculosis (TB) patients face an elevated risk of infection and disease progression, particularly young children and individuals living in overcrowded households. Despite WHO recommendations for systematic contact screening and provision of TB preventive therapy (TPT), implementation remains suboptimal in high-burden rural areas. This study aimed to develop a practical framework for identifying and prioritizing high-risk families by examining demographic predictors, household clustering, and machine learning-based risk models.
methodsA total of 437 household contacts linked to smear-positive index cases were assessed and classified as high or low risk. Statistical analyses included descriptive measures, χ
resultsOf the 437 contacts, 290 (66.4%) were classified as high risk. A younger age was strongly associated with high-risk status (χ
conclusionsTB risk is highly clustered at the household level, with large families and young children carrying disproportionate vulnerability. Combining demographic risk assessment, household-level visualization, and predictive modeling provides a practical, data-driven approach to prioritizing households during contact investigation. These findings support the WHO's family-centered strategy and underscore the need to strengthen clinical governance and community-engaged education to optimize TB prevention in resource-limited rural settings.
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