Tuberculosis Among Artisanal Miners in the Mulongo Health Zone, Democratic Republic of Congo: Unmatched Case-Control Study

BACKGROUND Tuberculosis (TB) remains a major global health challenge, with 10.6 million new cases and 1.3 million deaths reported in 2022. Artisanal miners in sub‑Saharan Africa are particularly vulnerable due to poverty, overcrowded living conditions, and high HIV prevalence. In the Democratic Republic of Congo (DRC), TB prevalence among miners is high, yet determinants remain insufficiently studied. OBJECTIVE This study aimed to identify sociodemographic, behavioral, and clinical factors associated with TB among artisanal miners in the Mulongo health zone, Haut‑Lomami Province, DRC. METHODS We conducted an unmatched case-control study among miners aged ≥15 years. Data were collected using a validated questionnaire covering socioeconomic, behavioral, and biomedical variables. Interviewers were blinded to TB status to minimize bias. Determinants were assessed using bivariate and multivariable logistic regression. RESULTS Poverty was strongly associated with TB (adjusted odds ratio [aOR] 3.16, 95% CI 1.95-5.11; P<.001). Primary education was associated with increased TB risk (aOR 2.78, 95% CI 1.04-7.44; P=.04), while secondary education showed a borderline association (aOR 2.53, 95% CI 0.93-6.89; P=.07). Higher education was protective (aOR 0.62, 95% CI 0.40-0.95; P=.03). Poor knowledge of TB transmission (aOR 2.11, 95% CI 1.16-3.83; P=.02), cause (aOR 1.79, 95% CI 1.00-3.20; P=.049), and diagnosis (aOR 2.49, 95% CI 1.48-4.17; P=.001) were consistently linked to higher vulnerability. HIV infection was significantly associated with TB (aOR 4.65, 95% CI 1.00-21.74; P=.049). Overcrowding was more frequent among TB cases, but in adjusted models, the association was borderline (aOR 1.65, 95% CI 0.95-2.85; P=.07). Tobacco use (aOR 1.47, 95% CI 0.83-2.61; P=.18), alcohol consumption (aOR 1.18, 95% CI 0.70-1.98; P=.54), and nutritional status (aOR 1.36, 95% CI 0.78-2.37; P=.28) were not significantly associated with TB. CONCLUSIONS TB among artisanal miners appears to be driven primarily by poverty, limited education, poor knowledge, and HIV infection. Overcrowding showed a suggestive but nonsignificant association. Integrated interventions should prioritize poverty alleviation, improved housing, tailored health education, and strengthened TB and HIV services, while further studies are needed to clarify the role of overcrowding and other contextual factors.