Predictors of Knowledge of Childhood Tuberculosis among Parents attending Outpatient Clinic in Federal Medical Center, Birnin Kudu, Jigawa State

West African Journal of Allied Health Sciences Advancing Allied Health Research in West Africa www.wajahs.org eISSN: 3115‑4581 pISSN: 3115‑4573 Original Article Volume 1, Issue 2, December 2025 Predictors of Knowledge of Childhood Tuberculosis among Parents attending Outpatient Clinic in Federal Medical Center, Birnin Kudu, Jigawa State Umma Idris Abdullahi1,*, Ahmad Ayuba Umar2, 1Department of Paediatrics, Federal Medical Centre, Birnin Kudu, Jigawa State, Nigeria 2Department of Community Medicine, Ahmadu Bello University, Zaria, Kaduna State, Nigeria *Corresponding author: [email protected] Abstract Background: Childhood tuberculosis (TB) is a major global public health concern contributing to signiicant child morbidity and mortality in Nigeria. Early diagnosis and prompt treatment are linked to public awareness of the disease. Parents play a crucial role in recognizing symptoms and seeking care for their children; however, limited knowledge about TB undermines control efforts. This study aimed to assess the level and predictors of TB knowl‑ edge among parents attending the Federal Medical Center, Birnin Kudu, Jigawa State. Methodology: This was a descriptive cross‑sectional study that used a structured, pre‑tested questionnaire. Information collected included socio‑demographic characteristics and knowledge of TB transmission, symptoms, prevention, and treatment. Data were analyzed using descriptive statistics, and multiple regression analysis was applied to identify predictors of good TB knowledge. Results: A total of 196 parents were recruited with a mean age of 33.05 ±9.07 years. Only 27% had good knowledge of TB. Educational status at the post‑primary level (AOR = 2.2, 95% CI = 1.9–3.1), male gender (AOR = 1.9, 95% CI = 1.4–3.2), employment status (AOR = 3.9, 95% CI = 3.9–5.4), and Hausa‑Fulani ethnicity (AOR = 0.39, 95% CI = 0.14–0.48) were signiicant predictors of good knowledge of TB. Conclusion: There is subop‑ timal knowledge of TB among parents in Birnin Kudu. Female gender, post‑primary education, and ethnicity were found to inluence the knowledge of TB. Targeted community health education and advocacy are urgently needed to improve TB literacy. Furthermore, integrating TB education into maternal and child health services and school health programs could enhance early case detection, reduce transmission, and advance Nigeria’s TB elimination goals. Keywords: Parental knowledge; Childhood; Paediatric; Tuberculosis; Predictors; Jigawa; Nigeria © Trans‑Saharan Publishers 2025. This is an Open Access article distributed under the terms of the Creative Commons Attribution licence (CC BY 4.0), which permits unrestricted re‑use, provided the original work is properly cited. DOI: 10.5281/zenodo.17771049 Received: Oct 4, 2025 Revised: Nov 1, 2025 Accepted: Nov 8, 2025 Introduction Nigeria is one of the four countries—alongside In‑ donesia, India, and China—with the highest bur‑ den of childhood tuberculosis (TB). The annual number of TB cases accounted for by children has been on the rise globally, with an estimated 192,000 child deaths reported in 2019 Maphalle et al., 2022. Nigeria ranks among the 30 high TB‑ burden countries globally and contributes signii‑ cantly to the disease’s incidence and mortality in sub‑Saharan Africa. The national TB incidence is 219 per 100,000 population, and children consti‑ tute about 6% of reported cases World Health Orga‑ nization, 2025. The persistent transmission of TB in Nigeria is fueled by poverty, overcrowding, lim‑ ited access to healthcare, and low public awareness of the disease Ukoaka et al., 2024. Knowledge of TB is a crucial determinant of early health‑seeking behavior, adherence to treat‑ Umma & Ahmad — Childhood Tuberculosis WAJAHS Vol. 1 (2), 2025 ment, and reduction in disease transmission. Par‑ ents, as primary caregivers, play an essential role in recognizing TB symptoms in children and fam‑ ily members, seeking timely medical care, and sup‑ porting treatment adherence. However, miscon‑ ceptions about TB causation, transmission, and cur‑ ability remain widespread in many communities, resulting in delayed diagnosis and increased spread of infection Bashorun et al., 2020. Good knowledge of TB has been reported among parents in Pakistan, Indonesia, and the Philippines, with signiicant gaps in knowledge among respondents in Thailand. Similar trends have been observed in Nigeria, where, despite on‑ going awareness campaigns, knowledge about TB remains suboptimal among the general public and caregivers Aliyu, 2019;Asuke et al., 2022;Junaid et al., 2021;Oladele et al., 2020. Low case detection and inadequate knowledge about TB due to poor awareness creation remain major challenges facing TB control efforts in Nigeria. Knowledge of TB in Nigeria also shows regional variation. Studies from Lagos Oladele et al., 2020, the South‑West, and North‑Central regions Bisal‑ lah et al., 2018 reported relatively good knowl‑ edge, whereas indings from Kano in the North‑ Western region revealed low levels of awareness Aliyu, 2019. The northern regions, particularly rural and semi‑urban communities, often exhibit lower awareness due to educational inequalities, cultural barriers, and limited exposure to health information. Factors consistently associated with higher knowledge levels include female gender, post‑secondary education, and urban residence Adane et al., 2017;Asuke et al., 2022;Ismail & Josephat, 2014;Oladele et al., 2020. In Jigawa State, available data on parental knowledge of TB are scarce, despite the region’s high TB burden and predominantly rural popula‑ tion. This study, therefore, assessed the level of knowledge of TB among parents attending the Fed‑ eral Medical Center, Birnin Kudu, Jigawa State, and identiied sociodemographic predictors of good knowledge. The indings are expected to inform targeted health education strategies, guide policy formulation, and strengthen community‑based TB control initiatives to reduce the burden of TB in Nigeria. Methods Study Design and Setting This hospital‑based cross‑sectional study was con‑ ducted at the Federal Medical Centre, Birnin Kudu, Jigawa State, from February to July 2023. Jigawa State ranks as the eighth state with the highest tu‑ berculosis (TB) burden in Nigeria, with a Bacille Calmette‑Guerin (BCG) vaccination coverage rate of 66.4% ICF, 2025. Sample Size Determination The minimum sample size was calculated using the standard formula Araoye, 2003: 𝑛 = 𝑍2𝑝𝑞 𝑑2 Where: •𝑛= desired sample size •𝑍= standard normal deviation corresponding to the 95% conidence interval (1.96) •𝑝= 0.132 (proportion of guardians with good knowledge of childhood TB in Thailand, 13.2%) Jirapaiboonsuk & Chapman, 2010 •𝑞=1−𝑝 •𝑑= degree of accuracy, set at 5% (0.05) Substituting the values: 𝑛 = (1.96)2× 0.132 × 0.868 (0.05)2= 176 However, a total of 196 parents were included in the study to improve precision and account for possible non‑response. Sampling Technique A systematic random sampling technique was em‑ ployed to select study participants from the clinic register. The list of all children visiting the clinic each day served as the sampling frame. On average, approximately 1,000 patients were seen per month. The sampling interval (𝑘) was calculated as: 𝑘 = 1000 196 = 5 Every ifth parent on the register was there‑ fore selected until the required sample size was ob‑ tained. 8 Umma & Ahmad — Childhood Tuberculosis WAJAHS Vol. 1 (2), 2025 Data Collection Instrument Data were collected by trained interviewers using a standardized, interviewer‑administered question‑ naire. The tool was adapted from the World Health Organization’s Guide to Developing Knowledge, At‑ titude and Practice Surveys World Health Organiza‑ tion, 2008 and previous studies. The questionnaire included sections on socio‑demographic character‑ istics and knowledge, attitudes, and perceptions re‑ garding TB. The instrument was initially developed in En‑ glish, translated into Hausa (the predominant local language), and pre‑tested among a random sample of parents at the hospital to assess clarity, reliabil‑ ity, cultural acceptability, and sensitivity. Respon‑ dents in the pre‑test were excluded from the main study. Knowledge of TB was assessed using seven ma‑ jor questions covering TB symptoms, transmission, prevention, risk factors, curability, treatment, and cost. Some questions had multiple response op‑ tions, producing 14 total knowledge items. Each correct response was scored as one point, while in‑ correct or “don’t know” responses were scored as zero. Following previous studies, participants scor‑ ing ≥50% were categorized as having good knowl‑ edge, while those scoring below 50% were catego‑ rized as having poor knowledge. Data Analysis Data were initially entered into Microsoft Excel for cleaning and subsequently analyzed using IBM SPSS Statistics version 20. Descriptive statistics such as frequencies, percentages, means, medians, and standard deviations were computed as appro‑ priate. The Chi‑square test was used to assess asso‑ ciations between categorical variables. Bivariate analyses examined the relationship between socio‑demographic factors and TB knowl‑ edge levels. Variables with 𝑝 < 0.2 were entered into a multivariate logistic regression model using a block entry method. Crude and adjusted odds ra‑ tios (OR, AOR) with 95% conidence intervals (CI) were computed to identify predictors of TB knowl‑ edge. The level of statistical signiicance was set at 𝑝 < 0.05. Ethical Considerations Ethical approval was obtained from the Health Ethics and Research Committee of the Federal Med‑ ical Centre, Birnin Kudu. Informed consent was obtained from all participants prior to data col‑ lection. Conidentiality was strictly maintained, and non‑personal identiiers were used throughout data handling and analysis. Results Socio‑demographic Characteristics of Respon‑ dents A total of 196 respondents participated in the study. Of these, 70.9% were females, and the mean age was 33 years. Over half (52%) of the respondents had no formal education. The median (interquartile range, IQR) monthly income was ₦6,000 (₦20,000). The difference in median income between males and females was statistically signiicant (𝑝 < 0.001, 95% CI = 95–119). Table 1presents the socio‑ demographic characteristics of the respondents. Knowledge of Childhood Tuberculosis Only 27% of the study participants demonstrated good knowledge of tuberculosis (TB). The mean knowledge score among males (5.3 ± 3.2) was higher than that of females (4.5 ± 3.0); however, this difference was not statistically signiicant (𝑝 = 0.078, 95% CI = 4.3–9.7). The majority of participants (90.8%) had heard of TB. The most common sources of informa‑ tion were radio, family and friends, and health‑ care workers. Approximately three‑quarters of re‑ spondents (74.5%, 146/196) reported that their last child had received the Bacille Calmette‑Guerin (BCG) vaccine. See Table 2. Predictors of Knowledge of Childhood Tubercu‑ losis Bivariate analysis showed signiicant associations between knowledge of TB and several factors, in‑ cluding age group, gender, educational level, em‑ ployment status, and state of residence. In multi‑ variate logistic regression analysis, the predictors of good knowledge were: • Educational status at post‑primary level (AOR = 2.2, 95% CI = 1.9–3.1) 9 Umma & Ahmad — Childhood Tuberculosis WAJAHS Vol. 1 (2), 2025 • Male gender (AOR = 1.9, 95% CI = 1.4–3.2) • Being employed (AOR = 3.9, 95% CI = 3.9–5.4) • Hausa–Fulani ethnicity (AOR = 0.39, 95% CI = 0.14–0.48) Table 1: Socio‑demographic characteristics of respondents (n = 196) Variable Freq (n) Percent (%) Gender Male 57 29.1 Female 139 70.9 Age group (years) 18–24 42 21.4 25–44 129 65.8 45–65 25 12.8 Educational status None 102 52.0 Primary 41 21.0 Secondary 41 21.0 Post–secondary 12 6.0 Marital status Married 180 91.8 Divorced or widowed 16 8.2 Ethnicity Hausa–Fulani 183 93.4 Others 13 6.6 Main source of income Farming 55 28.1 Trading 96 49.0 Salaried 5 2.5 Unemployed 40 20.4 Religion Islam 190 96.9 Christianity 6 3.1 Monthly income (₦) Less than 5,000 69 35.2 5,000–20,000 96 49.0 21,000–50,000 10 5.1 51,000–80,000 5 2.6 More than 80,000 16 8.2 Table 2: Knowledge of childhood TB among the participants Variable F(n) (%) Heard of TB a) Yes 178 90.8 b) No 18 9.2 Information source* a) Radio 133 68.6 b) Family/friends 133 68.6 c) Health workers 104 53.8 d) TV 31 15.8 e) Others 6 3.1 Cause of TB* a) Bacteria/germs 24 12.2 b) Dust/smoke 20 10.2 c) Cold air 17 8.7 d) Food shortage 16 8.4 e) Spiritual 14 7.2 f) Don’t know 105 53.3 Transmissible a) Yes 123 62.8 b) No 13 6.6 c) I don’t know 60 30.6 Transmission* a) Airborne 109 55.9 b) Sharing utensils 27 13.8 c) Shaking hands 28 14.4 d) I don’t know 29 14.9 TB preventable a) Yes 92 46.9 b) No 23 11.7 c) I don’t know 81 41.3 TB prevention* a) BCG vaccination 41 21.1 b) Avoid infected person 33 15.0 c)No overcrowding 42 21.5 d) Ventilated room 19 9.7 e) Close mouth cough 29 14.8 f) Not shake infected person 25 12.8 Common symptoms* a) Cough 112 57.1 b) Weight loss 98 50.0 c) Fever 83 42.3 d) Sputum 76 38.8 e) I don’t know 75 38.2 Is TB treatable? a) Yes 143 73.0 b) No 9 4.6 c) I don’t know 44 22.4 Cost of TB treatment a) Free 52 26.7 b) Costly 24 12.3 c) I don’t know 119 61.0 Note: * = Multiple response question. F = Frequency. 10 Umma & Ahmad — Childhood Tuberculosis WAJAHS Vol. 1 (2), 2025 Table 3: Predictors of Good Knowledge of Childhood TB Characteristics Crude OR Adjusted OR 95% CI p‑value Age 1.0 0.9 0.4–2.19 0.45 Males vs Females 1.5 1.9 1.4–3.2 0.04 Ethnicity 2.8 1.39 1.14–1.45 <0.001 Post‑primary education 1.9 2.2 1.9–3.1 <0.001 Employed 3.5 3.9 3.2–5.4 <0.001 OR = Odds Ratio; CI = Conidence Interval These variables were found to be statistically signiicant predictors of good knowledge of child‑ hood TB. A summary of these indings is provided in Table 3. Discussion Overall, only 27% of the respondents demonstrated good knowledge of childhood tuberculosis (TB). This poor level of knowledge highlights a substan‑ tial information gap among parents, which poses a challenge to early case detection, treatment ad‑ herence, and TB control efforts within the commu‑ nity. The low level of knowledge observed may be attributed to limited education, rural residency, in‑ adequate community health campaigns, and preva‑ lent misconceptions about the disease. Indeed, this study found that misconceptions regarding TB were common among respondents. Low levels of TB knowledge among parents have also been reported elsewhere Jirapaiboonsuk & Chapman, 2010;Suhada et al., 2015, emphasiz‑ ing that knowledge deicits remain a widespread challenge in developing countries despite ongoing health education efforts. This inding contrasts with reports from Jos, North‑Central Nigeria Asuke et al., 2022, the Philippines, and Indonesia Putra et al., 2020;Saputra et al., 2020, where higher levels of parental knowledge were observed. The dispar‑ ity may be due to the higher educational attainment and greater exposure to health education programs in those settings compared to Birnin Kudu, where more than half of respondents lacked formal edu‑ cation. Radio, family and friends, and healthcare work‑ ers were the primary sources of information on TB among respondents—similar to indings reported in previous Nigerian studies Adane et al., 2017;Ba‑ batunde et al., 2015;Oladele et al., 2020. This un‑ derscores the role of media, social networks, and health professionals as effective channels for dis‑ seminating information on TB awareness, preven‑ tion, and transmission. However, limited access to healthcare services and poor health‑seeking behav‑ iors may further restrict exposure to accurate TB in‑ formation. Interestingly, 74% of respondents who had heard of TB were aware that the disease can occur in children. This proportion is higher than previ‑ ously reported Jirapaiboonsuk & Chapman, 2010; Uz et al., 2014, possibly relecting modest improve‑ ments in TB‑related health education in recent years. About half of the respondents also knew that TB is transmitted through the air when an infected person coughs or sneezes—consistent with previ‑ ous research Oladele et al., 2020;Solliman et al., 2012. However, studies from India have reported signiicantly higher awareness levels (82.7%) Rohit et al., 2020, possibly due to higher literacy rates and better access to health information. Regarding prevention, less than half (46.9%) of the respondents knew that TB can be prevented. The most commonly mentioned preventive mea‑ sures were avoiding overcrowding (21.9%), BCG vaccination (21.1%), and covering the mouth while coughing (14.8%). Comparable indings have been reported from Kinshasa (14.2%) Aketi et al., 2017, Bangladesh (11%) Uz et al., 2014, and Indonesia (30%) Putra et al., 2020. In contrast, 48.7% of re‑ spondents in Iran knew that BCG vaccination pre‑ vents TB Behnaz et al., 2014. The relatively low awareness of BCG’s preventive role, despite high vaccine uptake, highlights a knowledge–practice gap. Health education programs should therefore not only promote vaccination but also emphasize its rationale and beneits to foster informed health be‑ haviors. 11 Umma & Ahmad — Childhood Tuberculosis WAJAHS Vol. 1 (2), 2025 Cough, fever, and weight loss or failure to gain weight were the most commonly identiied symp‑ toms of TB, aligning with indings from other Nige‑ rian and African studies Balogun et al., 2019;Datiko et al., 2019;Luba et al., 2019;Tobin et al., 2013. However, one‑third of respondents could not iden‑ tify any symptoms, similar to reports from Kinshasa Aketi et al., 2017. Adequate knowledge of TB symp‑ toms strongly inluences early health‑seeking be‑ havior Balogun et al., 2019, highlighting the need for sustained community sensitization. Most respondents knew that TB is treatable, but only one‑quarter were aware that TB treat‑ ment is free. Misconceptions and reliance on non‑ conventional therapies have been reported else‑ where Joshi et al., 2022;Oladele et al., 2020. Cor‑ rect knowledge that TB is curable can improve con‑ idence in treatment, increase service uptake, and reduce stigma, enabling reintegration of treated pa‑ tients into the community. In this study, increasing age, post‑primary edu‑ cation, male gender, and employment were signii‑ cant predictors of good TB knowledge. These ind‑ ings are consistent with previous studies Adane et al., 2017;Asuke et al., 2022;Konda et al., 2016, rein‑ forcing the importance of education and socioeco‑ nomic empowerment, particularly among women, to enhance health literacy and outcomes. Limitations As a hospital‑based study, the indings may not be generalizable to the wider population. Further‑ more, the cross‑sectional design limits causal infer‑ ence between predictors and knowledge outcomes. Conclusion This study demonstrated suboptimal knowledge of TB among parents in Birnin Kudu, with edu‑ cation, gender, and ethnicity emerging as signii‑ cant predictors. Persistent misconceptions high‑ light the need for intensiied and culturally sensi‑ tive awareness campaigns. Public health authori‑ ties should implement targeted TB education pro‑ grams focusing on women, parents with limited education, and marginalized ethnic groups. Inte‑ grating TB education into routine health services, such as immunization, maternal and child health programs, and school health curricula could im‑ prove community understanding and early case detection. Additionally, leveraging mass media and engaging community and faith leaders can en‑ hance message dissemination and promote behav‑ ioral change. Strengthening household‑level health literacy remains a cornerstone for achieving Nige‑ ria’s TB elimination targets and improving commu‑ nity health outcomes. 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