Prevalence, risk factors, and rifampicin resistance pattern of Mycobacterium tuberculosis in Sekota town, Northwest Ethiopia

Abstract

Background

Tuberculosis (TB) is a significant cause of morbidity and mortality globally, particularly in developing countries. However, in some parts of Ethiopia there is limited information on the prevalence, associated risk factors and the level of drug resistant TB. Therefore, this study aimed to determine TB prevalence, identify associated risk factors, and assess rifampicin resistance in Sekota Town, northwest Ethiopia.

Methods

A cross-sectional study was conducted from March to June 2023 at Tefera Hailu Memorial Hospital in Sekota town. Morning sputum and fine needle aspirate samples from pulmonary and extrapulmonary cases, respectively, were collected from 422 individuals who visited the hospital during the study period, and the samples were tested for Mycobacterium tuberculosis using the GeneXpert MTB/RIF molecular assay. A structured questionnaire was used to collect socio-demographic and clinical data.

Results

The overall prevalence of all forms of TB in this study was 19.90 %. Of the overall TB cases, 52.4 % were pulmonary (EPTB), whereas 47.6 % were extra-pulmonary (PTB). Among TB positive cases, the prevalence of rifampicin resistant TB was determined to be 2.4 %. Students (adjusted odds ratio (AOR) = 4.66; 95 % CI: 1.11–19.61), pastoralists (AOR = 2.75; 95 % CI: 1.19–6.33), and merchants (AOR = 13.96; 95 % CI: 1.20–162.40) had higher odds of TB infection. Regular alcohol consumption (AOR = 2.62; 95 % CI: 1.10–6.24) and contact with TB patients (AOR = 3.95; 95 % CI: 2.02–7.33) were associated with increased odds of TB infection. HIV sero-positives and those over the age of 45 years were also found to be more likely to be infected with TB. The prevalence of rifampicin-resistant TB among confirmed cases was 2.4 %.

Conclusion

The study revealed a high prevalence of TB, with risk factors including HIV infection, alcohol use, contact with TB patients, and high-risk occupational and social groups such as students, merchants, and pastoralists. Targeted TB prevention and control efforts focusing on these high-risk populations are needed to reduce the disease burden in the study area.

1. Introduction

Tuberculosis (TB) is a major cause of morbidity and mortality in the world, especially in low-resource countries in sub-Saharan Africa and Asia (Litvinjenko et al., 2023; Yen et al., 2020). In 2023, TB was reported as the world's leading cause of death from a single infectious agent, surpassing COVID-19 which had been the leading cause of death for three consecutive years (WHO, 2024). In line with this, the COVID-19 pandemic has negatively impacted access to TB care and treatment, as the number of people who had access to TB treatment in 2020 showed a 21 % reduction compared to 2019 data (Organization GWH, 2021).

Over the past few decades, there have been global initiatives to combat TB (WHO, 2015; Nations U, 2012). One of the initiatives is the Millennium Development Goals (MDGs), which were endorsed by the United Nations in 2000 and aims to combat various diseases (Nations U, 2012). One specific MDG target was to reverse global TB incidence by 2015 (WHO, 2015; Nations U, 2012). While the MDG achieved remarkable progress in reducing the TB burden, the disease remains a leading cause of mortality in the world (Deribew et al., 2018).

The World Health Organization (WHO) End TB Strategy aimed to end the global TB epidemic by 2030. The strategy has been built on three pillars: (i) people-centered care and prevention; (ii) bold policies and supportive systems; and (iii) intensified research and innovation. Adapting and implementing this global strategy in Ethiopia is crucial for strengthening TB prevention and control efforts (WHO, 2015; Nations U, 2012).

The country is one of the 30 high TB and TB/HIV burden countries globally (Organization GWH, 2021). In 2021, the estimated TB incidence in Ethiopia was 143,000, and an estimated 21,000 people died from TB. The country reported 104,606 TB case notifications, of which 51 % were bacteriologically confirmed pulmonary TB cases tested for rifampicin resistance (RR-TB). A total of 518 individuals were diagnosed with drug-resistant TB (DR-TB) (WHO, 2015).

Ethiopia has shown progress in meeting several of the MDGs (Health FDRoEMo, 2015). The country has implemented a Health Sector Transformation Plan (HSTP) to combat diseases of public health importance, including TB (Health FDRoEMo, 2015). One of the HSTP's key agenda items is the information revolution to inform decision-makers and enable prompt action. However, the country currently lacks a strong health information system to accurately capture TB data and track the progress of TB interventions (Eshetie et al., 2017). The studies conducted to determine the TB burden in Ethiopia so far have also been conducted in limited areas of the country (Deribew et al., 2018). Moreover, most studies have focused on specific age groups, TB forms, or high-risk populations (Berju et al., 2019; Geremew et al., 2023; Usmael et al., 2023). More research is therefore needed in regions with limited data on TB prevalence, associated risk factors, and drug resistance to better understand the disease burden and inform prevention efforts. Sekota is one such town with scarce information on both pulmonary and extrapulmonary TB. Accordingly, this study was conducted to determine the prevalence and associated risk factors of TB in Sekota town, northwest Ethiopia. Accordingly, this study was conducted to determine the prevalence and associated risk factors of TB in Sekota town, northwest Ethiopia.

2. Materials and methods

2.1. Study area and population

This study was conducted in Sekota town, northwest Ethiopia (Fig. 1). The town is about 870 km from Ethiopia's capital city, Addis Ababa. Sekota town is located at 12062′31.5 N latitude and 3,900,372′07.4E longitude. The annual average rainfall and temperature in the town are 7.9 mm and 27 °C, respectively. Sekota town has a rainy season, which runs from July to August. The town has a total population of 41,696 (188,46 males and 228,50 females) (Wikimedia Foundation, 2023). The town has one government hospital (Tefera Hailu Memorial Hospital, where this study was conducted), four private clinics, and one health center.

Fig. 1.

Map of the study area, Sekota town, Waghemra zone, Amhara region, Ethiopia.

2.2. Study design, population and eligibility criteria

A cross-sectional study was conducted at Tefera Hailu Memorial Hospital in Ethiopia from March to June 2023. The study included all presumptive TB cases who visited the hospital during this period. Patients under the age of five, those who were seriously ill, or individuals already receiving TB treatment were excluded from the study.

2.3. Sample size determination

The sample size was determined using a single population proportion formula, considering 50 % proportion, 95 % confidence level, and a 5 % margin of error as follows:

$$n=\frac{{\mathrm{z}}^{2}p\left(1-p\right)}{d^2}$$

Considering a 10 % non-response rate, the sample size was estimated to be 422. The proportion of TB was unknown in the study area, so a 50 % proportion was used. This prevalence estimate increases the sample size for the study, consequently leading to achieve a greater power of the study. This means that the study has a high chance of detecting differences between groups if exist.

2.4. Data collection

2.4.1. Socio-demographic data

Socio-demographic data were collected using a structured questionnaire. The questionnaire was first developed in English and then translated into Amharic, the local language. The questionnaire was used to collect information on sex, age, level of education, residence, contact with TB patients (living in the same room or being exposed to aerosols at home or work), and household size. For participants under 16 years of age, their parents or guardians were interviewed. The questionnaire was pretested before the actual data collection. Data were checked daily to ensure consistency and accuracy.

2.4.2. Sputum and fine needle aspirate specimen collection

Early morning sputum specimens were collected from presumptive TB individuals. Approximately 2–4 mL of sputum was obtained from each participant suspected of having pulmonary TB and stored in a 15-mL Falcon tube. For cases suspected of extra-pulmonary TB, the hospital's pathologist collected 2–4 mL of pus, lymph node aspirates, or pleural fluid samples. All samples were processed immediately using the GeneXpert MTB/RIF assay.

2.4.3. Detection of Mycobacterium tuberculosis using Gene Xpert MTB/RIF assay

The GeneXpert MTB/RIF system (Cepheid, USA) was used to test sputum and fine needle aspirate samples in the hospital's laboratory. For the GeneXpert MTB/RIF assay, approximately 0.5 mL of sputum sediment suspended in phosphate-buffered saline was treated with the sample reagent (1.5 mL). The mixture was then shaken by hand in accordance with the test instructions. The mixture was vortexed for 30 s to ensure all bacteria were re-suspended. The sample was incubated for 15 min at 20–30 °C as recommended by the manufacturer. The sample solution was then transferred to the Xpert cartridge with a Pasteur pipette and loaded into the Xpert machine for analysis. The results were visualized and printable in the view results window. The assay indicates whether MTB was detected. In some cases, the result was “invalid,” and the test was repeated. If M. tuberculosis (MTB) is detected, the results were confirmed whether resistance to rifampicin (RIF) was detected, not detected, or indeterminate.

2.4.4. HIV-test

As part of the routine diagnostic procedure, all the study participants were underwent for HIV testing following the national algorithm suggested by Ethiopia's Federal Ministry of Health. Participants provided informed consent and could decline testing t. Rapid HIV testing was performed sequentially using the HIV (1 + 2) rapid test strip and Stat-Pak. Reactive samples on the initial test were confirmed using Stat-Pak. Discordant results were resolved using a third confirmatory test, the HIV1/2 Uni-Gold recombinant assay Laboratory procedures were carried out in accordance with established protocols.

2.5. Quality assurance

Internal quality control of the Xpert system was performed using M. tuberculosis H37Rv (rifampicin-sensitive strain). This includes Probe Check Control (PCC) to detect probe-related system issues and Sample Process Control (SPC) to monitor errors during sample processing. Specimens with invalid results or sample errors were excluded from analysis, following the Cepheid package insert. Standard operating procedures were followed throughout.

2.6. Ethical consideration

The project was granted approval by the University of Gondar, College of Natural and Computational Science research ethics committee (Ref. No.CNCS/02/03/545/2023). A letter of support was submitted to relevant authorities in the study area, and official approval was granted. Before data collection, respondents gave informed consent and had the option to decline in participating in the study. In case of participants under the age of 16 years, consent was obtained from parents or guardians.

2.7. Data analysis

The data were analyzed using SPSS software version 25 (Armonk, NY: IBM Corp.). Logistic regression was used to compute the crude odds ratio (COR) and adjusted odds ratio (AOR) for the association between socio-demographic and clinical characteristics and TB infection. Multivariable logistic regression includes variables with p < 0.25 from univariable logistic regression. P-values <0.05 were considered statistically significant.

3. Results

3.1. General characteristics of study participants

The study included 422 participants (215 men and 207 women), while 53.3 % lived in urban and 46.7 % in rural areas. The majority of the study participants were pastoralists (43.80 %). Age-group showed that 59.0 % were within 26 and 45 years, illiterate (42.20 %), and married (66.40 %). 56.40 %, 35.50 %, and 8.10 % of the participants had 4–6, 1–3, and ≥ 7 family size, respectively. About 4.50 % of participants were from families with a history of TB, and 2.60 % were HIV seropositive (Table 1).

Table 1.

Socio-demographic and clinical characteristics of study participants at Tefera Hailu Memorial Hospital, northwest Ethiopia, 2023 (N = 422).

Variables	Category	Frequency	Percentage
Age (Years)	6–15	5	1.18
	16–25	34	8.06
	26–45	249	59.00
	>45	134	31.75
Sex	Male	215	50.90
	Female	207	49.10
Residence	Urban	225	53.30
	Rural	197	46.70
Livelihood	Civil servant	56	13.30
	Pastoral	185	43.80
	Merchant	21	5.00
	Student	74	17.50
	Housewife	86	20.40
Level of education	Illiterate	178	42.20
	Primary	65	15.40
	Secondary	105	24.90
	Higher	74	17.50
Marital status	Married	280	66.40
	Single	142	33.60
Family size	1–3	150	35.50
	4–6	238	56.40
	≥7	34	8.10
HIV sero status	Non-reactive	411	97.40
	Reactive	11	2.60
Alcohol use	Regularly	71	16.80
	Sometimes	258	61.10
	Never	93	22.00
Contact with other TB patients	Yes	4	0.95
	No	206	48.82
	unknown	212	50.24
Family history of TB	Yes	19	4.50
	No	403	95.50

TB:Tuberculosis.

3.2. TB prevalence by socio-demographic and clinical factors

The overall prevalence of all forms of TB in this study was 19.90 %. TB was detected in 34 (8.05 %) women and 50 (11.80 %) men. The highest prevalence of TB was found in participants aged 26–45 years (10.66 %), followed by those aged >45 (6.63 %). Participants with 4–6 family members had a higher prevalence of TB (9.20 %) than those with 1–3 (7.60 %) and ≥ 7 (3.30 %). Ten out of eighty four (11.90 %) TB cases were HIV- positives (Table 2). Among the TB positive cases, only two individuals were detected to develop a rifampicin resistant TB making the prevalence of RR-TB to be 2.4 % (Table 3).

Table 2.

Association of socio-demographic and clinical factors with the occurrence of tuberculosis in Tefera Hailu Memorial Hospital, Sekota (N = 422).

Categories		TB Infection		COR (95 % CI), P value	AOR (95 % CI), P value
		Positive (%)	Negative (%)
Age	6–15	4(0.95)	1(0.24)	0.07 (0.007–0.614),0.02*	0.03 (0.002–0.63),0.02*
	16–25	7(1.66)	27(6.40)	1.02 (0.402–2.58),0.96	NA
	26–45	45(10.66)	204(48.34)	1.19 (0.70–2.02),0.50
	>45	28(6.64)	106(25.12)	1	1
Gender	Male	50(11.85)	165(39.10)	1.54(0.94–2.50),0.28	NA
	Female	34(8.06)	173(41.00)	1
Residence	Urban	47(11.14)	178(42.18)	1.142(0.70–1.84)0.58	NA
	Rural	37(8.77)	160(37.91)	1
Marital status	Married	31(7.35)	111(26.30)	0.83(0.50–1.37),0.48	NA
	Single	53(12.56)	227(53.79)	1
Occupation	Housewife	12(2.84)	63(14.93)	2.39(1.07–5.35),0.03*	2.06(0.66–6.41),0.21
	Student	13(3.08)	61(14.45)	2.14(0.972–4.72),0.05	4.66(1.11–19.61),0.03*
	Merchant	2(0.47)	19(4.50)	4.33(0.92–20.34),0.06	13.96(1.20–162.40),0.03*
	Pastoralists	36(8.53)	149(35.31)	1.88(1.00–3.55),0.04*	2.75(1.19–6.33),0.01*
	Civil servant	21(4.98)	46(10.90)	1	1
Education	Illiterate	36(8.53)	142(33.65)	0.84(0.41–1.69), 0.63	NA
	Primary	18(4.27)	47(11.14)	0.55(0.24–1.24), 0.15
	Secondary	17(4.03)	88(20.85)	1.1(0.49–2.437),0 0.80
	Higher	13(3.08)	61(14.45)	1
Family size	1–3	32(7.58)	118(27.96)	2.58(1.17–5.669), 0.01	2.91(0.99–8.57),0.05
	4–6	38(9.00)	200(47.39)	3.6 (1.71–7.92), 0.001*	4.61(1.67–12.67),0.003*
	≥ 7	14(3.32)	20(4.74)	1	1
Alcohol use	Regularly	24(5.69)	47(11.14)	0.407(0.19–0.844),0.01*	2.62(1.10–6.24),0.02*
	Sometimes	44(10.43)	214(50.71)	1.01(0.53–1.895),0.97	NA
	Never	16(3.79)	77(18.25)	1
Contact with TB patient	Unknown	3(0.71)	1(0.24)	0.123(0.012–1.20),0.07	0.30(0.01–6.78),0.45
	Yes	24(5.69)	182(43.13)	2.7(1.65–4.70),0.00*	3.95(2.02–7.73),<0.01*
	No	57(13.51)	155(36.73)	1
HIV status	Non-Reactive	74(17.54)	337(79.85)	1
	Reactive	10(2.3)	1(0.23)	0.018(0.01–0.1),<0 0.01*	0.03(0.01–0.25),0.002*
Family history of TB	Yes	18(4.27)	1(0.24)	91.90(12.0–0.700.4),<0.01	182.73(12.44–2683.1),<0.01*
	No	66(15.64)	337(79.85)	1

NA; not applicable (variables with p values ≥0.25 from univariable logistic regression. Were not included in the multivariate logistic regression analysis), *; significant difference, COR; crude odds ratio, AOR; adjusted odds ratio; 95 % CI; 95 % confidence interval.

Table 3.

Number of TB positive cases by sex, TB form, disease category, and rifampicin-sensitivity profile (N = 84).

Sex	TB form		Disease category		Rifampicin sensitivity profile
	PTB, n(%)	EPTB, n(%)	New, n(%)	Retreatment, n(%)	RS-TB, n(%)	RR-TB, n(%)
Male	31(36.9)	19 (22.6)	46(54.8)	4(4.8)	48((57.1)	2 (2.4)
Female	9 (10.6)	25(29.4)	28(32.9)	6(7.1)	34 (40.0)	0 (0.0)
Total	40(47.6)	44(52.4)	74(88.1)	10(11.9)	82(97.6)	2 (2.4)

TB = tuberculosis, PTB = pulmonary TB, EPTB = extrapulmonary TB, RS-TB = TB caused by rifampicin sensitive Mycobacterium tuberculosis, RR-TB = TB caused by rifampicin-resistant Mycobacterium tuberculosis.

3.3. Association of TB infection with socio-demographic and clinical factors

Participants aged 6–15 years had lower odds of contracting TB than those aged over 45 (AOR = 0.03; 95 % CI: 0.002–0.63). Compared to those who were civil servants, participants who were students (AOR = 4.66; 95 % CI: 1.11–19.61), pastoralists (AOR = 2.75; 95 % CI: 1.19–6.33), and merchants (AOR = 13.96; 95 % CI: 1.20–162.40) were more likely to be infected with TB. Regular alcohol users were 2.62 (95 % CI: 1.10–6.24) times more likely to be infected with TB than non-users. Participants who had contact with TB patients (AOR = 3.95; 95 % CI: 2.02–7.73) were more likely to be infected with TB than those who had not had contact with TB patients (Table 2).

Of the total TB cases detected, 74 (88.1 %) were newly diagnosed, whereas 10 (11.9 %) were previously treated cases. Of the TB cases, 52.4 % were extrapulmonary (EPTB) and 47.6 % were pulmonary (PTB). Rifampicin-resistant TB was detected in two male participants (2.4 %) (Table 3).

4. Discussion

Accurate assessment of TB burden is important to inform evidence -based preventative and control policies. This study aimed to assess the prevalence and risk factors of TB in Sekota, northwest Ethiopia. The study found high prevalence (19.90 %) of TB among the study participants. Among the study participants, HIV sero-positive individuals, individuals aged over 45 years, and regular alcohol consumers were more likely to be infected with TB. The study also found increased odds of TB among individuals with a family history of TB, students, and those who had contact with TB patients.

The TB prevalence in this study was higher than that reported in Addis Ababa, Ethiopia, where the prevalence was 15.1 % (Arega et al., 2019). Alelign et al. (Alelign et al., 2019a) also reported a lower prevalence of TB (6.3 %) in Gondar, Ethiopia. In contrast, a higher prevalence of TB was reported in Nigeria (37.7 %) (Adejumo et al., 2018). A meta-analysis in Sudan also found a 30 % pooled prevalence of TB (Badawi et al., 2024). These differences in TB prevalence could be due to variations in study populations as well as differences in TB prevention and control activities between the countries.

The finding that TB infection was higher in individuals aged over 45 in this study is consistent with the findings of other studies (Zhu et al., 2018; Lin et al., 2013). Natural lung aging can cause molecular and physiological changes that impair lung function and weaken the immune response to TB (Guerra-Laso et al., 2013; Chalise, 2019; Cho and Stout-Delgado, 2020). As people age, the lung environment changes, which can compromise cellular immunity, a key defense against TB (Cho and Stout-Delgado, 2020; Torrelles et al., 2022). Comorbidities common in the elderly, such as diabetes and cancer, have been shown to exhibit reduced innate and adaptive, which are critical for fighting TB (Schaaf et al., 2010; Byng-Maddick and Noursadeghi, 2016). The factors indicated above may account for the higher TB prevalence in this age group. TB prevention and control efforts in the study area may benefit from focusing more on individuals above the age of 45 years.

In agreement with previous studies (Tibebu and Hebo, 2019; Yuan et al., 2022; Mekonnen et al., 2018), this study found that students and merchants have higher odds of TB infection. This might be due to the fact that social settings such as schools and markets are characterized by overcrowding situations which ultimately increases the risk of TB transmission through aerosols among students and merchants. However, TB transmission in the above social settings might also be influenced by other confounding factors such as socioeconomic status and malnutrition. Contact with TB patients increases the risk of TB infection, while poor ventilation and crowding exacerbate TB transmission (Nduba et al., 2015). In Ethiopia, classrooms and dormitories are highly congested, which increases the transmission of TB (Mekonnen et al., 2018). Merchants also engage more with their clients, making them more likely to be exposed to TB through interaction with clients. The higher odds of TB infection among merchants and students in this study may be explained by the factors described above.

This study indicated that those who drink alcohol regularly have higher odds of TB infection, which is consistent with previous studies (Imtiaz et al., 2017; Lasebikan and Ige, 2020). Alcohol can weaken immunity and predispose people to infections, including TB (Lönnroth et al., 2008; Rehm et al., 2009). Alcohol also impairs macrophage activity against new infections (Joshi et al., 2005). For instance, in the case of TB, alcohol reduces macrophage adhesion to Mycobacterium tuberculosisand decreases phagocytosis (Dannenberg Jr, 1989). Alcohol also causes malnutrition, which impairs the maintenance of innate and acquired immunity that can defend against TB infection (Szabo and Saha, 2015; Lieber, 1988; Nabok, 2023). In addition, alcohol consumption often involves spending time in environments such as bars, where TB tends to spread widely (Lönnroth et al., 2008; Rehm et al., 2009; Classen et al., 1999). The aforementioned factors may have contributed to the increased TB infection in individuals who regularly consume alcohol in this study.

The high TB infections among individuals who regularly consume alcohol in this study highlight the need for an effective strategy to mitigate the impact of alcohol on TB infection. The strategy may include improving public awareness about the health risks associated with regular alcohol consumption. It may also include ensuring the proper implementation of government alcohol policies in the study area. For instance, the Ethiopian parliament passed a bill to raising the legal age for alcohol purchase and usage from 18 to 21, and there should be monitoring to ensure that these policies are properly implemented in the study area (Wikimedia Foundation, 2023; The Reporter, 2019). Advocating for government and non-governmental support for alcohol policy implementation in the study area should also be part of the strategy. Increasing alcohol taxes at the country level may also reduce demand for alcohol and help to reduce the TB burden in the study area.

Participants in this study were more likely to contract TB if they had a family history of the disease. Other studies found an increased risk of TB among those who had TB patients in their family, which is similar to the findings of this study (Adane et al., 2020; Tefera et al., 2019; Little et al., 2018). Several factors influence the likelihood of contracting TB, including the individual's immunity, the infectiousness of the TB patient, the proximity of contact with other TB patients, and the duration of interaction with the infection source (Seid et al., 2022). Individuals in this study who had family members with TB may have been exposed to and spent more time with TB patients, increasing their risk of TB.

The finding in this study that individuals with a family history of TB or who had contact with TB patients had higher odds of TB infection underscores the importance of implementing effective preventative measures in these groups. The approach might involve educating the public about the importance of good ventilation in their homes, as TB can remain suspended in the air for many hours. It is also important to raise awareness among TB patents in the study area about factors that increase the risk of TB, such as covering the mouth and nose when coughing or sneezing. There is also a need for health care practitioners to engage and educate TB patients on the importance of taking medication properly and the measures that should be taken while undergoing TB treatment.

In this study, participants who were HIV seropositive were at a higher risk of TB infection than those who were HIV seronegative, which is consistent with prior studies (Fenta et al., 2020; Datiko et al., 2008; Melkamu et al., 2013). TB is an opportunistic infection that, like other opportunistic infections, frequently occurs when immunity is impaired by conditions or diseases (Castro, 1995). HIV is a disease that causes immunological compromise, increasing HIV patients' risk of opportunistic infections (Beck, 2005; Sadiq et al., 2024). This may explain the increased risk of TB in this study's participants who were HIV seropositive. Thus, there is a need for HIV and TB prevention measures in the study area. The measure may include HIV counseling and testing, behavioral modification, and early antiviral therapy.

The low prevalence of RR-TB, 2 (2.4 %), in this study is consistent with another study conducted in Debre Markos, Ethiopia, which found only 2 (0.52 %) RR-TB cases (Liyew Ayalew et al., 2020). However, more RR-TB cases have been found in other areas of Ethiopia (Alelign et al., 2019b; Bedewi et al., 2017; Ali et al., 2016). The discrepancy in anti-TB drug resistance levels between this study and earlier studies could be attributed to a variety of factors, including the study population. The lower prevalence of RR-TB in this study could be explained by the fact that the majority of the TB cases detected were newly diagnosed TB cases. On the other hand, the low prevalence of RR-TB in the present study might be due to the successful national TB control strategy. The country is out of the list of the 30 high burden drug resistant TB countries globally and the rate of drug resistant TB incidence per 100, 000 people remains as low as 2 % (WHO, 2024). Hence, the low prevalence of RR-TB in the study area (2.4 %) is in line with the recent national data (2 %) reflecting the successful effort in the control of drug resistant TB.

The extremely high adjusted odds ratio observed for family history of TB (AOR = 182.73; 95 % CI: 12.44–2683.1) likely reflects the very small number of participants with a positive family history who were TB-negative (n = 1), resulting in sparse data in this subgroup. While this finding supports a strong association between family history and TB infection, the exceptionally wide confidence interval indicates substantial statistical instability and imprecision. Therefore, although the result aligns with the expected effect, it should be interpreted with caution, and future studies with larger samples in this category are needed to provide more reliable estimates.

In the risk factor analysis, the occupation category of Merchants showed a very high adjusted odds ratio (AOR = 13.96; 95 % CI: 1.20–162.40), indicating a strong apparent association with TB infection. However, the extremely wide confidence interval reflects substantial uncertainty in this estimate, which is likely due to the very small number of TB-positive Merchants in the study (n = 2). While the point estimate suggests a potentially important effect, the low precision warrants caution in interpretation. This limitation should be considered when assessing the role of occupation as a risk factor, and future studies with larger numbers of individuals in underrepresented categories are needed to provide more reliable estimates.

This study has a few limitations. First, it did not consider all of the potential factors that could increase the risk of TB infection. Second, it was conducted in a healthcare setting and may not accurately reflect the prevalence of TB in the general population. Hence, future community based studies should be conducted to complement the findings of the present study. Moreover, the study did not consider elucidating the transmission dynamics of the bacterial strains circulating and causing TB among the population using more advanced molecular techniques. Hence, future studies need to address the role of all other unmeasured confounding factors such as socio-economic status and malnutrition in TB infection in the general population using more robust molecular diagnostic techniques.

In conclusion, the study found a high prevalence of all forms TB among patients at Tefera Hailu Memorial Hospital in Sekota town, northwest Ethiopia. Hence, targeted prevention and control strategies focusing on high-risk groups such as students, merchants, pastoralists, regular alcohol users, and individuals in contact with TB patients are needed to reduce the disease burden in the study area.

CRediT authorship contribution statement

Getaneh Mengistu: Writing – original draft, Investigation, Formal analysis, Conceptualization. Zinaye Tekeste: Writing – review & editing, Formal analysis, Data curation. Daniel Mehabie: Writing – review & editing, Data curation. Solomon Tesfaye: Writing – review & editing, Formal analysis, Data curation. Amir Alelign: Writing – review & editing, Validation, Supervision, Formal analysis, Data curation, Conceptualization.

Declaration of competing interest

The authors declare they have no any conflict of interest.