Tuberculosis (TB) remains a serious public health concern in Pakistan, where it is considered endemic. Understanding the disease burden and its associated risk factors, particularly in an understudied population, is crucial for effective disease control. In this cross-sectional, hospital-based study, TB-suspected patients who visited the TB control centre of Swabi district, Khyber Pakhtunkhwa, Pakistan, during January 2023 to June 2024 were included. The aims and objectives of the study were to assess the frequency of TB and identify its associated risk factors and zoonotic TB within a population with limited access to healthcare services. After ethical approval, sociodemographic and clinical data were collected from individuals suspected of having TB, and statistical analyses were performed using the Chi-square test. A total of 1,164 individuals with suspected TB were included in our study. After microscopic and culture analysis, 232 were confirmed positive, comprising 118 males and 114 females. Of these, 218 individuals were infected by Mycobacterium tuberculosis, and 14 were infected by M. bovis. Furthermore, 10 cases were identified as multidrug-resistant tuberculosis (MDR-TB), 13 were reinfections, and 12 were extrapulmonary tuberculosis (EPTB) cases. The TB incidence was comparable across genders and different age groups; it was higher among people with comorbidities, low socioeconomic status, raising animals, and a smoking history. Notably, the detection of M. bovis in human cases and the association between animal presence and TB highlight the importance of incorporating the One Health approach strategies into TB control programs for effective control.

Keywords: Mycobacterium bovis; Mycobacterium tuberculosis; Extrapulmonary tuberculosis (EPTB); Multidrug-resistant tuberculosis (MDR-TB); One health; Risk factors; Tuberculosis (TB); Ziehl-Neelsen stain.