Background: Tuberculosis (tb) causes significant morbidity and mortality worldwide. In Nigeria, the exact prevalence is not known but a progressive increase of the disease has been observed, with "epidemic states" reported in certain clusters. Even with the newer diagnostic tests for tb, diagnostic difficulties still occur. As a result, several diagnostic criteria have been adopted to aid the diagnosis of tuberculosis in these children. The main objective of this study was to identify Tb in children who were either living with adults who have Tb or in the environment of adults with Tb. Methodology: This was a prospective cross-sectional study conducted in Eku and Oria communities in Ethiope East Local Government Area of Delta State. Eku housed the Tuberculosis and Leprosy Referral Hospital where adults with tb were admitted in the first two months of their treatment. 128 children under 19 years of age were studied over a 3-month period. After obtaining relevant information from every child, a full physical examination and certain laboratory investigations were done. Results: There were 68 males and 60 females. The prevalence of Tb was 68% in those children living among adults with tb within the hospital and 50.6% in those living in the environment or community (p = 0.05). The prevalence of Tb in Bacille Calmette Guerin (BCG) immunized children was 66.2% as against 46.7% in those not vaccinated. Twenty-six of the infected children (57.8%) had only pulmonary disease while 45.7% had affectation of 2 or more organs. The positive predictive values of elevated erythrocyte sedimented rate (ESR), elevated white blood cells (WBC) count and positive gastric aspirates (GA) in diagnosing tb were 60.3%, 70.5% and 0% respectively, while that of abnormal chest X-ray (CXR) and positive Mantoux reaction were 93.6% and 93.7% respectively. Conclusion: The alarming prevalence of tb in these children was not surprising considering their contacts with the tb patients and was representative of simi-* Corresponding author. A. U. Ewa et al.81 lar high incidence areas as a whole. Active case finding efforts should be intensified for childhood contacts of adults with Tb for early identification of children with tuberculosis.