Tuberculosis (TB)

Roadmap for Childhood TB: Toward zero deaths

Man and boy in Ethiopia.
Warren Zelman/MSH

Childhood TB: a missed opportunity to improve childhood survival

Many children who present with TB disease represent an opportunity missed by the health system to have prevented the disease. This is particularly the case for infants and young children: studies consistently show that most cases of TB in children occur in those with a known contact who has been diagnosed with TB, which is frequently a parent or another close relative of the child. Infants and young children are at particularly high risk for severe, disseminated TB disease and for TB-related mortality. And yet it is all too common to have the child of a parent who has TB to present with TB meningitis, which is frequently fatal, and if not, often results in marked and permanent disability. This could be prevented by screening children who are contacts of people diagnosed with TB and by providing preventive therapy for children younger than five years of age at the time TB is diagnosed in a parent or family member.

Childhood TB needs to be lifted out of the shadows

  • Every day, up to 200 children lose their lives to tuberculosis – a preventable and curable disease.
  • Over half a million children fall ill with TB each year and struggle with treatment that is not child friendly.
  • TB in children is often missed or overlooked due to non-specific symptoms and difficulties in diagnosis. This has made it difficult to assess the actual magnitude of the childhood TB epidemic, which may be higher than currently estimated.
  • There is an urgent need for public attention, prioritization, commitment and funding for this disease that today should never take the life of a child.

Research is urgently needed to address TB in children

  • Currently there is a lack of effective diagnostic tests that can detect TB in children, child-friendly drug formulations for treatment and care for children with TB and/or those in contact of someone diagnosed with TB.
  • Research should include children in clinical trials for testing of new diagnostics and drugs.
  • There is a need to strengthen the evidence base that supports the integration of care for childhood TB into other child care services, and also about the impact that these efforts have on TB case-finding and child survival.

The Childhood TB Roadmap – an overview

This roadmap for addressing childhood TB outlines 10 key actions to be taken at both the global and national levels:
  • Include the needs of children and adolescents in research, policy development and clinical practice.
  • Collect and report better data, including on preventive measures.
  • Develop training and reference materials on childhood TB for health care workers
  • Foster local expertise and leadership among child health workers at all levels of the health care system.
  • . Do not miss critical opportunities for intervention (e.g. use strategies such as intensified case-finding, contact tracing and preventive therapy); implement policies for early diagnosis; and ensure there is an uninterrupted supply of high-quality anti-TB medicines for children).
  • Engage key stakeholders, and establish effective communication and collaboration among the health care sector and other sectors that address the social determinants of health and access to care.
  • Develop integrated family- and community-centred strategies to provide comprehensive and effective services at the community level.
  • Address research gaps in the following areas: epidemiology, fundamental research, the development of new tools (such as diagnostics, medicines and vaccines); and address gaps in operational research, and research looking at health systems and services.
  • Close all funding gaps for childhood TB at the national and global levels.
  • Form coalitions and partnerships to study and evaluate the best strategies for preventing and managing childhood TB, and for improving tools used for diagnosis and treatment.