CHEST RADIOGRAPH ACCURACY IN DIAGNOSING PEDIATRIC PULMONARY TUBERCULOSIS (PTB): A SYSTEMATIC REVIEW AND META-ANALYSIS In endemic regions, tuberculosis (TB) is the major cause of morbidity and mortality among children under the age of five, accounting for a significant proportion of the global death toll among such children. Approximately 35% of pediatric TB cases are appropriately diagnosed, frequently resulting in a protracted or untreated illness. This study assessed the diagnostic value of chest radiograph examination in diagnosing pediatric pulmonary TB. The PRISMA 2020 guidelines were used to conduct this systematic review and meta-analysis of 379 articles identified in four databases. The software Meta-Disc 1.4 was used to assess the diagnostic accuracy of the pooled samples but due to insufficient data, the computed tomography (CT) and magnetic resonance imaging (MRI) examinations were removed from further investigation. Six articles containing comprehensive chest X-ray (CXR) data were analyzed with pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), and diagnostic odds ratio (DOR) of 0.88 (95% confidence interval [CI]: 0.84-0.91), 0.50 (95% CI: 0.46-0.53), 3.07 (95% CI: 1.68-5.58), 0.29 (95% CI: 0.14-0.60), and 17.41 (95% CI: 3.38-89.41), respectively. The summary receiver operating characteristic (sROC) curve area under the curve (AUC) was 0.8242. In conclusion, CXR demonstrated high sensitivity, moderate specificity, excellent PLR, NLR, and DOR for diagnosing pediatric pulmonary TB.