Background and Objective:
The 2022 Global TB report shows that Nigeria is one of the 30 high-burden countries that have significantly contributed to the global Childhood TB epidemic. Despite significant improvements being made by the country in TB case notifications, children are being left behind as the childhood proportion remained at 7% nationally. The current security challenges in some parts of the country including the Imo state, worsen this challenge. This study aimed to determine how targeted community demand creation can contribute to TB Notification in Children in security-challenged settings.

Methods:
The hotspot identification approach was used to identify and cluster community entities; such as hospitals, patent medicine vendors, and traditional birth attendants. These centers were engaged to refer children to TB diagnosis and treatment services, over a 21-month period, (January 2021 to October 2022). The inclusion criteria considered in identifying the hot spots included proximity to living areas, schools (targeting preschool and early school-aged children), Orphanages, and childrens clinics. Targeted demand-creation activities were carried out in these clusters.

Results:
On the whole, 1,104 centers were engaged, and 162 demand-creation activities were conducted leading to the referral of 579 children. A total of 115 pediatric TB cases were placed on treatment through this intervention. The Paediatric TB notification trend within this period showed a continuous increase in childhood TB cases started on treatment.

Conclusion:
Targeted outreaches through hotspots or clusters help to reduce the security challenges posed by large crowds gathering in the communities and patients traveling long distances to access treatment. This approach is effective in ensuring pediatric TB cases are identified and started on treatment amidst the worsening security challenges in many parts of Nigeria like Imo State.