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An ecosystem approach toward\u00a0identifying risk factors for PTB may identify targeted interventions.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n Data were collected as part of a prospective cohort study of children presenting at a primary care facility or tertiary hospital with possible TB. Characterization of the childhood ecosystem included proximal, medial, and distal determinants. Proximal determinants included child characteristics that could impact PTB outcomes. Medial determinants included relational factors, such as caregiver health, which\u00a0might impact interactions with the child. Distal determinants included macro\u2010level determinants of disease, such as socioeconomic status and food insecurity. Children who started on TB treatment were followed for up to 6\u2009months. Multivariate regression models tested independent associations between factors associated with PTB in children.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Of 1202 children enrolled, 242 (20%) of children had confirmed PTB, 756 (63%) were started on TB treatment, and 444 (37%) had respiratory conditions other than TB. In univariate analyses, childhood malnutrition and caregiver smoking were associated with treated or confirmed PTB. In multivariate analyses, proximal factors, such as male gender and hospitalization, as well as low socioeconomic status as a distal factor, were associated with PTB.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Interventions may need to target subgroups of children and families with elevated proximal, medial, and distal risk factors for PTB. Screening for risk factors, such as caregiver's health,\u00a0may guide targeting. The provision of social protection programs to bolster economic security may be an important intervention\u00a0for attenuating childhood exposure to risk factors.<\/jats:p>\n <\/jats:sec>","DOI":"10.1002\/ppul.25369","type":"journal-article","created":{"date-parts":[[2021,3,25]],"date-time":"2021-03-25T16:28:04Z","timestamp":1616689684000},"page":"2212-2222","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["The child ecosystem and childhood pulmonary tuberculosis: A South African perspective"],"prefix":"10.1002","volume":"56","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2234-1629","authenticated-orcid":false,"given":"Teresa","family":"DeAtley","sequence":"first","affiliation":[{"name":"Department of Behavioral and Social Sciences Brown University School of Public Health Providence Rhode Island 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Cape South Africa"},{"name":"Faculty of Infectious and Tropical Diseases, Department of Immunology and Infection London School of Hygiene and Tropical Medicine London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark P.","family":"Nicol","sequence":"additional","affiliation":[{"name":"Division of Infection and Immunity, Division of Medical Microbiology, School of Biomedical Sciences University of Western Australia Perth Australia"},{"name":"University of Cape Town and National Health Laboratory Services Cape Town Western Cape South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katherine","family":"Sorsdahl","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Mental Health, Alan J Flisher Centre for Public Mental Health University of Cape Town Cape Town Western Cape South 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