Factors associated with non-attendance at initial tuberculosis screening among contacts in Kudat, Sabah

Tuberculosis (TB) contact screening is a key strategy for early case detection and prevention of transmission. However, non-attendance at initial TB screening among contacts remains a persistent challenge, particularly in high-burden settings such as Sabah, Malaysia. This study aimed to determine factors associated with non-attendance at initial TB screening among contacts in Kudat, Sabah.

A case-control study was conducted using primary and secondary data from the National Tuberculosis Registry involving 468 TB contacts registered between June and December 2023. Cases were contacts who failed to attend initial screening within one month, while controls attended screening within the same period. Data were analysed using descriptive statistics and multiple logistic regression.

Multivariable logistic regression analysis revealed that factors associated with lower odds of non-attendance included contacts of male TB index patients (OR: 0.30, 95% CI: 0.194-0.470), contacts of extrapulmonary TB index patients (OR: 0.09, 95% CI: 0.050-0.179), and higher attitude scores (OR: 0.88, 95% CI: 0.818-0.952). In contrast, contacts with secondary education had higher odds of nonattendance compared to those with no formal education (OR: 1.86, 95% CI: 1.080-3.209).

Non-attendance at initial TB screening among contacts was associated with index case sex and TB form, contact education level, and attitudes towards TB. Targeted interventions addressing behavioural and structural barriers are essential to improve TB contact screening uptake in high-burden settings.