Factors Influencing Pulmonary TB Transmission Among Household Contacts of TB Cases : Systematic Review

Abstract

Tuberculosis (TB) remains a major global health problem, with Indonesia ranked second worldwide in TB incidence, estimated at 1,090,000 cases and 125,000 deaths annually. Household contacts are at particularly high risk due to prolonged exposure, making this setting crucial for transmission control. This study applied a systematic literature review based on PRISMA 2020 guidelines. Eligible studies (2020–2025) included case–control, cohort, and cross-sectional designs conducted in Indonesia and comparable settings. Populations consisted of household contacts of pulmonary TB cases. Eight articles have been analyzed. Data collection methods varied, including interviews, diagnostic tests and structured questionnaires. Statistical analyses commonly used logistic regression, yielding odds ratios (OR), confidence intervals (CI), and p-values. Key risk factors included poor ventilation, room crowding, and prolonged daily contact (≥5 hours), Biological risks were age <5 years (OR 8.38, CI 95%), malnutrition (OR 8.88), diabetes mellitus, and HIV infection, Social determinants included low education, inadequate hygiene, and weak family support, Protective factors were good nutrition, BCG vaccination, health education, and strong social support. Pulmonary TB transmission among household contacts is multifactorial, influenced by environmental, biological, and social-behavioral determinants. Actionable implications include improving home ventilation, reducing overcrowding, strengthening contact tracing, and enhancing family-based health education.