Risk Factors for Intrathoracic Tuberculosis in Children From Economic Migrant Populations of Two Dominican Republic Bateyes

OBJECTIVE:The objective of the current study was to identify risk factors for intrathoracic tuberculosis among children living in migrant populations in the Dominican Republic. DESIGN:Cross-sectional study. SETTING:Dominican Republic bateyes, economic migrant communities of Haitian origin. PARTICIPANTS:Children 18 months to 18 years of age. MAIN EXPOSURE:Unpasteurized milk consumption. OUTCOME MEASURES:Probable or possible intrathoracic tuberculosis. Probable intrathoracic tuberculosis was defined as any child with a tuberculin skin test ≥10 mm (or >5 mm in the presence of a known immunocompromising condition or household contact with intrathoracic tuberculosis) or malnutrition in the setting of an abnormal chest radiograph with features of tuberculosis or lymph node disease. The diagnosis of “possible intrathoracic tuberculosis” was assigned if an abnormal chest radiograph had features that did not meet the definition of “probable intrathoracic tuberculosis.” RESULTS:Probable or possible tuberculosis was diagnosed in 83 (20.8%) of 400 children. Unpasteurized milk consumption was identified as an independent risk factor for intrathoracic tuberculosis (adjusted odds ratio, 3.2; 95% confidence interval1.4–7.4) even after adjusting for Bacille Calmette-Guérin vaccination, household size, tuberculosis contacts and age and under varying assumptions about children diagnosed with “possible” tuberculosis. CONCLUSIONS:Our data raise the possibility that the high prevalence of tuberculosis in the Dominican Republic bateyes may be attributable to Mycobacterium bovis rather than Mycobacterium tuberculosis infection.