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Background Blood culture, despite low sensitivity, is the gold standard for enteric fever diagnosis. Understanding predictors of blood culture positivity may help design strategies to optimize enteric fever diagnosis. Methods A cohort of 6760 children aged 0.5–15 years was followed for 3 years for enteric fever with blood cultures in an automated system, for fevers &amp;gt;3 days. Factors affecting test positivity in fevers and participant-level predictors for culture refusals were analyzed using regression models. Results Overall, 6097 suspected typhoid/paratyphoid fever (STF) episodes were reported, of which 5703 (93.5%) STFs had sampling for blood cultures, with 394 (6.5%) refusals. Salmonella enterica serovar Typhi/Paratyphi positivity was culture-confirmed in 3.8% (218/5703) of STF episodes. Older children (odds ratio [OR], 1.96 [95% CI, 1.39–2.77]), larger blood volume inoculated (OR, 2.82 [95% CI, 1.71–4.66]), higher temperatures during fever (OR, 3.77 [95% CI, 2.89–4.91]), and fevers diagnosed as suspected typhoid or acute undifferentiated fever (OR, 6.06 [95% CI, 3.11–11.78]) had a higher probability of culture positivity. Antibiotics before culture did not decrease culture positivity. Blood culture refusals were higher for children from wealthier households or with milder illness. Conclusions Performing blood cultures in older children with fever, especially those fevers with toxic presentation and increasing blood volume for inoculation are strategies to improve enteric fever detection in surveillance settings.

Factors Predicting Blood Culture Positivity in Children With Enteric Fever