# Active Case Finding (ACF) of Tuberculosis Among School Students: Insights From a Tribal District in Seoni, Madhya Pradesh, India

## TL;DR

A school-based program in India's tribal areas helped identify tuberculosis cases by screening families of students, showing promise for broader use.

## Contribution

This study evaluates a novel school-based active case finding strategy for TB detection in tribal communities.

## Key findings

- 30% with appetite loss and 26% with weight loss underwent TB testing, showing strong symptom associations.
- Only four individuals were diagnosed with TB, with TB history and generalized weakness as significant predictors.
- Age, symptom count, and TB history were significant predictors of testing and diagnosis.

## Abstract

Background: Tuberculosis (TB) remains a major public health concern in India, particularly among tribal populations who face structural and socioeconomic barriers to healthcare access. Despite ongoing efforts by the National Tuberculosis Elimination Program (NTEP), many tribal districts report persistently high TB burdens. Active case finding (ACF) has demonstrated effectiveness in improving early TB detection and reducing transmission.

Objective: This study aims to assess the effectiveness of a school-based ACF initiative in identifying symptomatic individuals and potential TB cases within the tribal communities of Seoni district, Madhya Pradesh.

Materials and methods: A cross-sectional record review was conducted from March to April 2024 across nine educational institutions in Seoni district. School students, oriented by NTEP staff, screened their family members using a 12-question format that addresses TB symptoms and risk factors. Data from 2,210 individuals were compiled and analyzed using Jamovi version 2.3.28 (Computer Software; retrieved from https://www.jamovi.org).

Results: Thirty percent with appetite loss and 26% with >5 kg weight loss underwent TB testing, with these symptoms showing strong associations with testing (p < 0.001). Only four individuals were diagnosed with TB. History of TB in the past one to two years and generalized weakness were significant predictors of diagnosis. Logistic regression revealed age, symptom count, and TB history as significant predictors of testing and diagnosis.

Conclusion: School-based ACF is a feasible and promising strategy for TB detection in tribal areas. While the diagnostic yield was low, the model showed potential for broader implementation and community mobilization. Further studies are warranted to evaluate the long-term impact and optimize the implementation.