Drug-resistant tuberculosis in children in Indonesia: A population-based analysis of the 2023 Indonesian Health Survey

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Objective: To analyze the prevalence and risk factors of drug- resistant tuberculosis (DR-TB) among Indonesian children. Methods: This study analyzed data from the 2023 Indonesian Health Survey, which included children aged 0-14 years and household heads nationwide. Binary logistic regression was used to identify factors associated with DR-TB. Results: A total of 423 participants were included in the final analysis. The national prevalence of pediatric DR-TB was 15.9%, with substantial variation across provinces. In the multivariable logistic regression analysis, rural residence (aOR 2.68; 95% Cl 1.23-5.84), poor TB treatment adherence (aOR 17.353; 95% Cl 3.098-97.206), and household TB contact (aOR 5.628; 95% Cl 1.113-28.450) were independently associated with higher odds of DR- TB. Wealth index was significantly associated with DR-TB overall ( P =0.018), but no significant differences were observed between individual wealth categories after adjustment. Household TB contact was associated with higher odds of DR-TB (a OR 5.628; 95% Cl 1.113-28.450). Conclusions: Pediatric DR-TB in Indonesia has a substantial prevalence and marked geographic variation. Rural residence, poor TB treatment adherence, and household TB contact were key factors associated with DR-TB, highlighting the need to strengthen treatment adherence, household contact investigation, and targeted interventions.