Introduction

Tuberculosis (TB) remains one of the leading causes of morbidity and mortality from infectious diseases worldwide, particularly in low- and middle-income countries.1 Despite substantial progress achieved through global and national TB control efforts, the disease continues to pose a major public health challenge (World Health Organization, 2024). Children represent a substantial yet often under-recognized proportion of the global TB burden, accounting for an estimated 10–15% of all TB cases.2 Each year, many children develop active TB, and a considerable proportion of these cases remain undiagnosed or are diagnosed late, contributing to avoidable morbidity and mortality (World Health Organization, 2024). Pediatric tuberculosis refers to tuberculosis occurring in children and young adolescents, commonly defined as individuals aged 0–14 years. It includes pulmonary and extrapulmonary forms of tuberculosis. Pediatric tuberculosis presents specific diagnostic and programmatic challenges. Tuberculosis remains one of the leading causes of morbidity and mortality from infectious diseases worldwide. According to the World Health Organization Global Tuberculosis Report 2024, an estimated 10.8 million people developed TB in 2023. The Democratic Republic of the Congo is among the high TB burden countries and accounted for approximately 3.1% of the estimated global TB burden in 2023. In such settings, childhood TB remains particularly difficult to detect because children often present with non-specific symptoms and bacteriological confirmation is frequently unavailable or negative. This situation contributes to delayed diagnosis, under-notification, and preventable morbidity and mortality among children.1

In children, TB often manifests with non-specific clinical signs and symptoms, is frequently paucibacillary, and is difficult to confirm bacteriologically. As a result, diagnosis commonly relies on a combination of clinical assessment, radiological findings, and epidemiological context rather than microbiological confirmation. These challenges are particularly pronounced in resource-limited settings, where access to diagnostic tools and specialized pediatric expertise is limited, especially at primary healthcare level.3,4

Beyond clinical and diagnostic constraints, social and behavioral factors play a crucial role in shaping pediatric TB outcomes. Caregivers are central to the recognition of symptoms, interpretation of illness, and decision-making regarding care-seeking for children. Evidence from sub-Saharan Africa and Asia suggests that caregivers may not initially suspect TB when children present with suggestive symptoms and may attribute illness to spiritual, environmental, or social causes.5,6

Studies conducted in sub-Saharan Africa and Asia have documented that caregivers often do not initially suspect TB when children present with suggestive symptoms and may attribute illness to spiritual, environmental, or social causes. In southern Mozambique, Mindu et al reported that even caregivers of children with confirmed TB frequently misinterpreted early symptoms, leading to complex care-seeking itineraries involving pharmacies, traditional healers, or religious practices prior to engagement with formal health services.5 Such patterns may contribute to diagnostic delays and prolonged transmission within households and communities.

Healthcare providers constitute another key determinant of pediatric TB detection and management. As frontline actors within the health system, their knowledge, attitudes, and practices may influence clinical suspicion, referral decisions, and adherence to national TB guidelines. Studies conducted in Tanzania, Uganda, and Cameroon have reported gaps in healthcare providers’ knowledge and practices related to pediatric TB, particularly at primary healthcare level.3,7,8 These gaps include difficulties in recognizing childhood TB presentations, limited familiarity with diagnostic algorithms, and inconsistent implementation of contact investigation and preventive strategies.3,8

Studies on knowledge, attitudes/perceptions, and practices (KAP) among healthcare providers have revealed considerable variability in knowledge levels and practices across settings. In Cambodia, An et al identified multiple barriers to childhood TB case detection, including insufficient training, limited diagnostic capacity, and systemic constraints within health facilities.9 Similar findings have been reported in Cameroon and other high-burden settings, where healthcare providers with limited exposure to pediatric TB cases exhibited lower confidence and suboptimal practices.4,8

The interaction between caregiver knowledge and healthcare provider practices plays a central role in shaping care-seeking pathways and diagnostic trajectories for pediatric TB. Discrepancies between community-level understanding of TB and biomedical frameworks may contribute to delayed presentation at health facilities, while gaps in provider knowledge may further compound diagnostic delays once children enter the health system. Evidence suggests that improving alignment between caregiver awareness and provider competence is essential for strengthening early detection and appropriate management of childhood TB.4,6

In the Democratic Republic of the Congo (DRC), tuberculosis remains a major public health concern, and pediatric TB is believed to be substantially underdiagnosed (World Health Organization, 2024). Although national TB control programs have expanded diagnostic and treatment services, locally available evidence on knowledge, perceptions, and care-seeking practices related to pediatric TB remains limited, particularly at community and healthcare provider levels in rural and semi-rural health zones. Most available evidence in the DRC has focused on the overall TB burden, service delivery, or adult TB, leaving important gaps in understanding how caregivers and frontline healthcare providers perceive and respond to suspected pediatric TB.

Assessing TB-related knowledge, perceptions, and care-seeking practices among both caregivers and healthcare providers is therefore critical for informing interventions aimed at improving early diagnosis and appropriate management of pediatric TB. Such evidence is essential for strengthening community engagement, risk communication, and provider capacity-building efforts within TB control programs.

Although tuberculosis remains a major public health problem in the Democratic Republic of the Congo, local evidence on pediatric tuberculosis remains limited, particularly in rural and semi-rural health zones. In Kabondo-Dianda, little is known about how caregivers understand pediatric tuberculosis, how they perceive its transmission, and where they seek care when a child presents symptoms suggestive of tuberculosis. Similarly, limited information is available on healthcare providers’ knowledge and reported practices related to pediatric tuberculosis in this setting.

The novelty of this study lies in its simultaneous description of caregivers’ and healthcare providers’ knowledge, perceptions, and care-seeking practices in a rural health zone where pediatric tuberculosis-related evidence is scarce. This dual perspective provides context-specific descriptive information that may help guide community education and frontline provider capacity-building.

Study Objective

The objective of this study was to assess the knowledge, perceptions, and care-seeking practices related to pediatric tuberculosis among caregivers of children and healthcare providers in the Kabondo-Dianda Health Zone, Democratic Republic of the Congo. Specifically, the study aimed to describe knowledge levels regarding tuberculosis transmission and prevention, document prevailing perceptions of the disease, examine care-seeking practices for suspected pediatric tuberculosis, and explore descriptive patterns between tuberculosis knowledge scores and care-seeking practices.

MethodsStudy Setting

The study was conducted in the Kabondo-Dianda Health Zone, located in Haut-Lomami Province in the southeastern Democratic Republic of the Congo (DRC). The health zone comprises 19 health areas and is predominantly rural and semi-rural. The population mainly relies on subsistence farming, small-scale trading, and informal economic activities. Living conditions are characterized by limited access to clean water, inadequate sanitation, and constrained health infrastructure, factors that may influence tuberculosis transmission and care-seeking behaviors.

The Kabondo-Dianda Health Zone includes five health facilities designated as Tuberculosis Diagnostic and Treatment Centers (CSDTs) by the Provincial Tuberculosis Coordination Unit. These facilities serve as the primary points for tuberculosis diagnosis, treatment, and follow-up, including pediatric tuberculosis services.

Study Design and Population

This was a descriptive cross-sectional study. The study was designed to describe knowledge, perceptions, and care-seeking practices related to pediatric tuberculosis among caregivers and healthcare providers. It was not designed to test hypotheses, estimate causal relationships, or determine statistically significant associations between knowledge and care-seeking practices. The study was not designed to test causal relationships or estimate statistically representative associations. Its purpose was to generate context-specific descriptive evidence to inform community education and provider capacity-building interventions in the Kabondo-Dianda Health Zone. The study population consisted of caregivers (parents or legal guardians) of children residing in the Kabondo-Dianda Health Zone and healthcare providers involved in child health and tuberculosis services within public health facilities. In this study, healthcare providers referred to nurses, clinicians, and other health workers employed in public health facilities in the Kabondo-Dianda Health Zone and involved in child health, outpatient consultation, or tuberculosis-related services.

Sampling Strategy and Sample Size

A non-probabilistic convenience sampling approach was used. This approach was chosen because no complete sampling frame of eligible caregivers was available in the Kabondo-Dianda Health Zone. Caregivers who were available in the selected communities during the data collection period and who agreed to participate were included. Healthcare providers were recruited from public health facilities involved in child health or tuberculosis-related services. The selected health facilities were those designated as Tuberculosis Diagnostic and Treatment Centers by the Provincial Tuberculosis Coordination Unit in the Kabondo-Dianda Health Zone. These facilities were included because they serve as the main points for tuberculosis diagnosis, treatment, follow-up, and referral, including for children with suspected tuberculosis.

No formal sample size calculation was performed because the study was exploratory and descriptive. The final sample included all eligible and consenting participants who were available during the data collection period, namely 163 caregivers and 27 healthcare providers. Therefore, the findings should be interpreted as descriptive and context-specific, rather than statistically representative of all caregivers or healthcare providers in the health zone.

Inclusion and Exclusion Criteria

Caregivers were eligible for inclusion if they were parents or legal guardians of children residing in the Kabondo-Dianda Health Zone and consented to participate in the study. Healthcare providers were eligible if they were involved in child health or tuberculosis-related services within the health zone.

Individuals who declined participation or were unable to complete the interview were excluded.

Data Collection

Data were collected using a structured questionnaire administered through face-to-face interviews by trained data collectors. The questionnaire was developed based on the study objectives and focused on four domains: sociodemographic characteristics, knowledge of tuberculosis transmission and prevention, perceptions of tuberculosis transmission, and care-seeking practices. The tool was reviewed by members of the research team with experience in public health and tuberculosis control to assess content relevance and clarity. Before data collection, the questionnaire was checked for comprehensibility and consistency. However, no formal psychometric validation was conducted. This limitation was considered when interpreting the knowledge scores and perception-related findings. Data collection was conducted during a defined period in 2024 to ensure consistency across participants.

Data Management

Completed questionnaires were reviewed daily for completeness and consistency before data entry. Questionnaires with major missing information on key study domains were excluded from analysis. For isolated missing responses, available data were analyzed descriptively, and no statistical imputation was performed because the study was descriptive. Data were coded, entered, and cleaned using Microsoft Excel. Quality control checks included verification of questionnaire completeness, review of inconsistent responses, checking for duplicate entries, verification of coding errors, and comparison of entered data with original questionnaires before analysis. Completed paper questionnaires were stored in a secure location accessible only to the research team. Electronic data were kept in a password-protected Microsoft Excel database. Personal identifiers were not included in the analytical dataset, and access to the data was restricted to authorized members of the research team.

Study Variables and Operational DefinitionsSociodemographic Variables

Sociodemographic characteristics included age, sex, marital status, level of education, main occupation, and household size.

Knowledge of Tuberculosis

Knowledge of tuberculosis was assessed using 11 items covering tuberculosis transmission and prevention. These included five items related to modes of transmission (coughing, sneezing, speaking, laughing, and singing) and six items related to prevention methods (covering the mouth when coughing or sneezing, avoiding overcrowding, ensuring good ventilation, good nutrition, BCG vaccination, and adherence to treatment protocols).

Each correct response was scored as 1 point, while incorrect or “don’t know” responses were scored as 0.

TB Knowledge Score

A composite tuberculosis knowledge score was calculated by summing correct responses across the 11 knowledge items, resulting in a possible score range from 0 to 11. Higher scores indicated higher levels of knowledge regarding tuberculosis transmission and prevention.

Knowledge Index

For ease of interpretation, the mean composite tuberculosis knowledge score was standardized to a 0–100 scale, referred to as the knowledge index, using the following formula:

No validated cut-off was used to classify knowledge as poor, moderate, or good. Therefore, knowledge results were interpreted descriptively using mean scores and the standardized knowledge index.

Estimation of Score Dispersion

As individual-level knowledge scores were not available, the standard deviation (SD) of the composite tuberculosis knowledge score was estimated at group level using item-level binomial variance. For each binary knowledge item, variance was calculated as , where represents the proportion of correct responses. The estimated SD was obtained by calculating the square root of the sum of variances across all items.

Perceptions of Tuberculosis

Perceptions of tuberculosis were assessed using structured questionnaire items capturing both biomedical and non-biomedical beliefs about tuberculosis transmission. Biomedical perceptions included whether respondents considered tuberculosis to be a communicable disease and whether they believed it could be transmitted through coughing or contact. Non-biomedical perceptions included beliefs related to evil spirits, domestic animals, and other culturally rooted explanations of disease transmission. Responses were summarized descriptively as frequencies and percentages for each perception item.

Care-Seeking Practices

Care-seeking practices were assessed using structured closed-ended questionnaire items. These items documented the first point of care sought when pediatric tuberculosis was suspected, the timing of consultation, and the reasons for choosing a specific care option. First points of care included health facilities, pharmacies, traditional practitioners, and churches or prayer. Timing of consultation was categorized as direct consultation, consultation after worsening of symptoms, or consultation after failure of previous treatment. Reasons for choosing care options included perceived effectiveness, accessibility, cost, availability of free treatment, and expectation of rapid recovery.

Statistical Analysis

Data were analyzed using descriptive statistics only. Categorical variables were summarized as frequencies and percentages. Knowledge scores were summarized using mean scores and estimated standard deviations. Descriptive comparisons between caregivers and healthcare providers were presented to show observed patterns only. No inferential statistical tests were performed because of the non-probabilistic sampling approach and the use of aggregated data. Consequently, differences observed between caregivers and healthcare providers were not interpreted as statistically significant associations.

Ethical Considerations

The study protocol was reviewed and approved by the Ethics Committee of the Kinshasa School of Public Health (approval number: ESP/CE/205/2024). Authorization to conduct the study was obtained from the relevant local health authorities. Participation was voluntary, and written informed consent was obtained from all participants prior to their inclusion in the study.

Confidentiality and anonymity of respondents were strictly maintained throughout data collection, data management, and analysis. The study was conducted in accordance with the principles of the Declaration of Helsinki. No specific funding was received for this study.

Results

The results are presented according to the main study domains: sociodemographic characteristics, knowledge of tuberculosis transmission and prevention, perceptions of tuberculosis transmission, care-seeking practices, and descriptive patterns between tuberculosis knowledge and care-seeking practices.

Table 1 shows that among the 163 caregivers surveyed, 69.9% were aged 30 years or older, with a median age of 37 years (IQR: 13), and sex distribution was nearly balanced. Most caregivers were married or living in a union (76.7%). Regarding education, 30.7% had completed secondary education and 6.1% had attained tertiary education, while farming was the main occupation (54.0%). Among the 27 healthcare providers, the majority were male (81.5%) and aged 30 years or older (74.1%), with a median age of 35 years (IQR: 10). Most providers were married or living in a union (85.2%), and all were formally employed in the health sector or civil service.

Table 1 Sociodemographic Characteristics of Caregivers and Healthcare Providers, Kabondo-Dianda Health Zone

Table 2 shows that knowledge of tuberculosis transmission and prevention differed between caregivers and healthcare providers. Among caregivers, coughing was the most frequently identified mode of transmission, whereas other respiratory routes, such as sneezing, speaking, singing, and laughing, were less frequently reported. Knowledge of prevention methods was also limited among caregivers. BCG vaccination and good nutrition were the most frequently identified prevention methods, each reported by 26.4% of caregivers, while covering the mouth when coughing or sneezing, avoiding overcrowding, ensuring good ventilation, and following treatment according to protocol were reported by only about one in ten caregivers. Healthcare providers more frequently identified both transmission routes and prevention measures.

Table 2 Knowledge of Tuberculosis Transmission and Prevention Among Caregivers and Healthcare Providers

Table 3 shows that 55.2% of caregivers considered tuberculosis to be a communicable disease, compared with 88.9% of healthcare providers. Non-biomedical perceptions were also reported among caregivers, including transmission by evil spirits and domestic animals. These findings indicate that biomedical and non-biomedical explanations of tuberculosis coexist in the study setting. The high proportion of respondents reporting transmission by domestic animals should be interpreted cautiously. This response may reflect confusion between general disease transmission, environmental exposure, and tuberculosis-specific transmission. Similarly, the reporting of evil spirits as a perceived mode of transmission suggests the persistence of cultural or spiritual explanations of illness. These findings describe reported perceptions and should not be interpreted as biomedical evidence of actual tuberculosis transmission routes.

Table 3 Perceptions of Tuberculosis Transmission Among Caregivers and Healthcare Providers

Table 4 shows that fewer than half of caregivers reported seeking care first at a health facility. Pharmacies, traditional practitioners, and churches or prayer were also reported as first points of care. Delayed consultation was common among caregivers, particularly after worsening of symptoms or failure of another treatment. In contrast, healthcare providers more frequently reported health facilities as the first point of care, although delayed consultation was also reported in this group.

Table 4 Descriptive Patterns Between Tuberculosis Knowledge and Care-Seeking Practices

Table 5 shows that caregivers had a mean tuberculosis knowledge score of 2.7 ± 1.28 out of 11, corresponding to a knowledge index of 24.5 out of 100. Healthcare providers had a mean knowledge score of 8.3 ± 1.36, corresponding to a knowledge index of 75.5 out of 100.

Table 5 Tuberculosis Knowledge Scores Among Caregivers and Healthcare Providers

Table 6 shows that caregivers had lower tuberculosis knowledge scores and reported less frequent first care-seeking at formal health facilities compared with healthcare providers. Caregivers also reported higher proportions of delayed consultation and informal care-seeking. However, caregivers and healthcare providers represent distinct groups with different roles, training, and exposure to tuberculosis-related information. Therefore, these findings should be interpreted as descriptive patterns only and not as statistically significant differences.

Table 6 Descriptive Distribution of Tuberculosis Knowledge Scores and Care-Seeking Practices by Participant Group

Discussion

This study provides descriptive evidence on knowledge, perceptions, and care-seeking practices related to pediatric tuberculosis among caregivers and healthcare providers in the Kabondo-Dianda Health Zone, Democratic Republic of the Congo. The main findings were that caregivers had low tuberculosis knowledge scores, healthcare providers had higher knowledge scores, biomedical and non-biomedical perceptions coexisted, and delayed or informal care-seeking was common, particularly among caregivers. Because caregivers and healthcare providers represent distinct groups with different roles, training, and exposure to tuberculosis-related information, the findings should not be interpreted as a direct comparison between equivalent groups. These findings should be interpreted in light of the descriptive design, convenience sampling, and absence of inferential statistical testing.

Knowledge of Pediatric Tuberculosis Among Caregivers

One of the main findings of this study was the low level of tuberculosis knowledge among caregivers. Caregivers had a mean tuberculosis knowledge score of 2.7 out of 11, corresponding to a knowledge index of 24.5 out of 100. Although coughing was frequently identified as a mode of tuberculosis transmission, other respiratory routes, including sneezing, speaking, laughing, and singing, were less commonly recognized. Knowledge of prevention measures was also limited, particularly regarding covering the mouth when coughing or sneezing, avoiding overcrowding, ensuring good ventilation, and following treatment according to protocol.

These findings suggest important gaps in community-level understanding of pediatric tuberculosis in the Kabondo-Dianda Health Zone. Such limited knowledge may be relevant to how caregivers recognize and interpret symptoms suggestive of tuberculosis in children. However, because this study did not test statistical associations, it cannot determine whether low knowledge directly contributed to delayed use of formal health services. Similar findings have been reported in other high tuberculosis burden settings, where caregivers’ limited knowledge of childhood tuberculosis transmission and prevention has been associated with delayed care-seeking and difficulties in early diagnosis.10,11 In the present study, however, this relationship was not tested statistically and should be considered as a contextual interpretation rather than a demonstrated association.

Knowledge of Pediatric Tuberculosis Among Healthcare Providers

In contrast to caregivers, healthcare providers had higher tuberculosis knowledge scores, with a mean score of 8.3 out of 11 and a knowledge index of 75.5 out of 100. They more frequently identified both respiratory transmission routes and prevention measures, including BCG vaccination, good ventilation, good nutrition, and adherence to treatment protocols. This finding was expected because healthcare providers are more likely to have received formal training and to be exposed to tuberculosis-related information through health services.

However, this result should be interpreted cautiously because the number of healthcare providers included in the study was small. Moreover, the study did not perform inferential statistical tests; therefore, the observed difference between caregivers and healthcare providers should be understood only as a descriptive pattern, not as evidence of a statistically significant difference. Nevertheless, the higher descriptive knowledge scores observed among providers indicate that they may be useful actors for community education, early clinical suspicion of pediatric tuberculosis, and caregiver counseling, provided that continued training and supervision are maintained. Previous studies have also emphasized the importance of strengthening healthcare providers’ capacity in childhood tuberculosis detection and management, especially at primary healthcare level.4,8

Perceptions and Misconceptions Related to Tuberculosis

Another important finding was the coexistence of biomedical and non-biomedical perceptions of tuberculosis transmission. More than half of caregivers recognized tuberculosis as a communicable disease and identified coughing as a possible mode of transmission. However, some caregivers also reported non-biomedical explanations, including transmission by evil spirits and domestic animals. This coexistence of biomedical and non-biomedical beliefs is important because it may influence how caregivers interpret symptoms and decide where to seek care.

In the context of pediatric tuberculosis, such perceptions may influence how illness is understood and where care is first sought. However, the present study did not statistically assess the relationship between specific perceptions and delayed consultation. Caregivers who attribute illness to spiritual or non-medical causes may initially seek help from traditional practitioners, religious structures, pharmacies, or informal providers. Similar patterns have been described in sub-Saharan African settings, where cultural beliefs and alternative explanations of illness influence tuberculosis-related care-seeking behavior.5,12 In the present study, these misconceptions should therefore be considered as important targets for community-based tuberculosis education.

Care-Seeking Practices and Delayed Use of Formal Health Services

The study also found that care-seeking practices were suboptimal among caregivers. Fewer than half of caregivers reported seeking care first at a health facility. Pharmacies, traditional practitioners, and churches or prayer were also reported as first points of care. Delayed consultation was common, particularly after worsening of symptoms or failure of previous treatment. These findings indicate that many caregivers do not immediately use formal health services when pediatric tuberculosis is suspected.

This pattern may reflect several contextual factors, including limited knowledge, misconceptions about tuberculosis, financial barriers, distance to health facilities, perceived quality of care, and trust in alternative sources of care. However, these possible explanations were not statistically tested in the present study and should be interpreted as contextual interpretations rather than demonstrated determinants. Although healthcare providers more frequently reported health facilities as the first point of care, some also reported delayed consultation, suggesting that access barriers and contextual factors may influence care-seeking behavior even among individuals working in the health sector. These findings are consistent with studies from other African settings showing that caregivers often move through pluralistic care pathways before reaching tuberculosis diagnostic services.11,13

Descriptive Patterns Between Knowledge and Care-Seeking Practices

Descriptive patterns showed that healthcare providers had higher tuberculosis knowledge scores and reported more frequent first care-seeking at health facilities than caregivers. Caregivers, who had lower knowledge scores, more frequently reported delayed or informal care-seeking.

These observations should be interpreted cautiously. The study did not use individual-level inferential analysis to test whether tuberculosis knowledge was statistically associated with care-seeking practices. Therefore, the findings should not be presented as evidence that higher knowledge leads to more appropriate care-seeking. Rather, they indicate descriptive differences between the two participant groups and generate hypotheses for future studies. Further research using probability-based sampling, individual-level data, and inferential statistical methods would be needed to assess whether knowledge is associated with timely use of formal health services.

Strengths and Limitations

A key strength of this study is the inclusion of both caregivers and healthcare providers, allowing a broader descriptive assessment of pediatric tuberculosis-related knowledge, perceptions, and care-seeking practices from both community and health-system perspectives. This dual perspective provides useful local evidence from a rural health zone where pediatric tuberculosis-related data remain limited.

However, several limitations should be acknowledged. First, the descriptive cross-sectional design does not allow causal inference. Second, the use of convenience sampling limits the representativeness and generalizability of the findings. Participants may not fully reflect all caregivers and healthcare providers in the Kabondo-Dianda Health Zone, particularly those who were not available during the data collection period or who did not attend the selected facilities. Therefore, the results should be interpreted as context-specific descriptive evidence rather than estimates representative of the entire health zone. Third, no formal sample size calculation was performed, and the small number of healthcare providers restricts the interpretation of comparisons between caregivers and providers. Fourth, the analysis was limited to descriptive statistics, and no inferential tests were conducted. Therefore, observed differences between groups should not be interpreted as statistically significant associations. Fifth, although the questionnaire was developed according to the study objectives and reviewed for clarity and relevance, no formal psychometric validation was performed. Finally, self-reported care-seeking practices may have been affected by recall bias or social desirability bias.

Despite these limitations, the study provides context-specific descriptive information that may help guide community education, culturally appropriate communication, and provider capacity-building interventions in the Kabondo-Dianda Health Zone.

Implications for Pediatric Tuberculosis Control

The findings have practical implications for pediatric tuberculosis control in the Kabondo-Dianda Health Zone. First, community-based education should be strengthened to improve caregivers’ understanding of tuberculosis transmission, prevention, early symptoms, and the importance of timely consultation at health facilities. Second, communication strategies should be culturally appropriate and should directly address misconceptions related to spiritual causes and non-biomedical explanations of tuberculosis. Third, healthcare providers should continue to receive training on pediatric tuberculosis recognition, counseling, referral, and community engagement.

Overall, improving pediatric tuberculosis detection in this setting requires both community-level interventions and health-system strengthening. Community education may help reduce delayed and informal care-seeking, while provider capacity-building may improve early identification, referral, and management of suspected pediatric tuberculosis cases.

Conclusion

This descriptive cross-sectional study showed gaps in pediatric tuberculosis knowledge, perceptions, and reported care-seeking practices in the Kabondo-Dianda Health Zone. Caregivers had low knowledge scores regarding tuberculosis transmission and prevention, and both biomedical and non-biomedical perceptions of tuberculosis were reported. Many caregivers reported delayed or informal care-seeking before using formal health services.

Healthcare providers had higher descriptive knowledge scores and more frequently reported health facilities as the first point of care. However, because no inferential statistical tests were performed, these findings should not be interpreted as evidence of statistical association or causal relationship between knowledge and care-seeking practices.

The findings suggest the need to strengthen community-based tuberculosis education, culturally appropriate communication, and continued capacity-building of frontline healthcare providers, while recognizing the descriptive and exploratory nature of the study. These findings support the need for community-based tuberculosis education, culturally appropriate communication, and continued capacity-building of frontline healthcare providers.