title: Modifiable risk factors associated with tuberculosis disease in children in Pune, India.
abstract: METHODS
  India accounts for the largest burden of tuberculosis (TB) worldwide, with 26% of the world's cases.
  
  
  OBJECTIVE
  To assess the association between novel modifiable risk factors and TB in Indian children.
  
  
  METHODS
  Cases were children aged ≤ 5 years with confirmed/probable TB based on World Health Organization definitions (definition 1). Controls were healthy children aged ≤ 5 years. Logistic regression was performed to estimate the adjusted odds ratio (aOR) of being a TB case given exposure, including indoor air pollution (IAP; exposure to tobacco smoke and/or biomass fuels) and vitamin D deficiency. Cases were re-analyzed according to a new consensus research definition of pediatric TB (definition 2).
  
  
  RESULTS
  Sixty cases and 118 controls were enrolled. Both groups had high levels of vitamin D deficiency (55% vs. 50%, P = 0.53). In multivariable analysis, TB was associated with household TB exposure (aOR 25.41, 95%CI 7.03-91.81), household food insecurity (aOR 11.55, 95%CI 3.33-40.15) and IAP exposure (aOR 2.67, 95%CI 1.02-6.97), but not vitamin D deficiency (aOR 1.00, 95%CI 0.38-2.66). Use of definition 2 reduced the number of cases to 25. In multivariate analysis, TB exposure, household food insecurity and IAP remained associated with TB.
  
  
  CONCLUSIONS
  Household TB exposure, exposure to IAP and household food insecurity were independently associated with pediatric TB.
authors.affiliation: Johns Hopkins University, Baltimore, Maryland, USA; Maine Medical Center, Portland, Maine, USA.
authors.forename: J
authors.initials: J
authors.lastname: Jubulis
authors.affiliation: Byramji Jeejeebhoy Medical College (BJMC), Pune, India.
authors.forename: A
authors.initials: A
authors.lastname: Kinikar
authors.affiliation: BJMC Clinical Trials Unit, Pune, India.
authors.forename: M
authors.initials: M
authors.lastname: Ithape
authors.affiliation: BJMC Clinical Trials Unit, Pune, India.
authors.forename: M
authors.initials: M
authors.lastname: Khandave
authors.affiliation: Byramji Jeejeebhoy Medical College (BJMC), Pune, India.
authors.forename: S
authors.initials: S
authors.lastname: Dixit
authors.affiliation: BJMC Clinical Trials Unit, Pune, India.
authors.forename: S
authors.initials: S
authors.lastname: Hotalkar
authors.affiliation: BJMC Clinical Trials Unit, Pune, India.
authors.forename: V
authors.initials: V
authors.lastname: Kulkarni
authors.affiliation: BJMC Clinical Trials Unit, Pune, India.
authors.forename: V
authors.initials: V
authors.lastname: Mave
authors.affiliation: BJMC Clinical Trials Unit, Pune, India.
authors.forename: N
authors.initials: N
authors.lastname: Gupte
authors.affiliation: BJMC Clinical Trials Unit, Pune, India.
authors.forename: A
authors.initials: A
authors.lastname: Kagal
authors.affiliation: Johns Hopkins University, Baltimore, Maryland, USA.
authors.forename: S
authors.initials: S
authors.lastname: Jain
authors.affiliation: BJMC Clinical Trials Unit, Pune, India.
authors.forename: R
authors.initials: R
authors.lastname: Bharadwaj
authors.affiliation: Johns Hopkins University, Baltimore, Maryland, USA.
authors.forename: A
authors.initials: A
authors.lastname: Gupta
mesh_terms: D000367:Age Factors; D016902:Air Pollution, Indoor / Q000009:adverse effects; D016022:Case-Control Studies; D002675:Child, Preschool; D005260:Female; D005523:Food Supply; D006801:Humans; D007194:India / Q000453:epidemiology; D007223:Infant; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D011446:Prospective Studies; D012111:Residence Characteristics; D012307:Risk Factors; D014376:Tuberculosis / Q000175:diagnosis / Q000453:epidemiology* / Q000635:transmission; D014808:Vitamin D Deficiency / Q000453:epidemiology