A new report released today by Médecins Sans Frontières (MSF), shows that children with tuberculosis continue to be left behind in the global effort to end the disease. The report, TACTIC: Test, Avoid, Cure Tuberculosis in Children, surveyed tuberculosis policy guidelines in 14 countries Afghanistan, Central African Republic, Democratic Republic of Congo, Guinea, India, Mozambique, Niger, Nigeria, Pakistan, Philippines, Sierra Leone, Somalia, Republic of South Sudan, Uganda. with a high burden of tuberculosis, revealing that many countries lag behind in aligning their national tuberculosis policies with the latest guidelines from the World Health Organization (WHO).
We urge all countries to update their national guidelines to be in line with the WHO recommendations for the care of children with tuberculosis, and to allocate the needed resources--along with developing clear plans with timelines to implement the policies and increase access to tuberculosis prevention, diagnosis and treatment of the children with tuberculosis in the country. International donors and technical support agencies must provide sufficient funding to countries to support paediatric tuberculosis policy reforms and implementation.
"Tuberculosis is curable, also in children. The WHO has updated policies to guide countries in providing the best possible care to children with tuberculosis, one of the world's deadliest infectious diseases," says Stijn Deborggraeve, diagnostics advisor at MSF's Access Campaign.
"Yet countries are lagging behind in adopting and implementing these solutions for testing, preventing, and treating tuberculosis in children. We urge countries, donors and technical agencies to put an end to this deadly status quo and step up their efforts to ensure timely diagnosis and treatment of tuberculosis in children. We can no longer afford inaction--every delay means that more children die unnecessarily," says Deborggraeve.
Of the 14 policy indicators measured in our report, only one country's policies are fully aligned with WHO guidance, while seven countries have more than 80% alignment, and four countries still fall below 50% alignment. The largest gaps were found in policies related to diagnosing tuberculosis in children. For example, only 5 out of 14 countries have adapted their guidelines to initiate tuberculosis treatment in children when symptoms strongly indicate the disease, even if bacteriological tests are negative. Additionally, only 4 of these 5 countries have the necessary resources to implement this guidance effectively.
The WHO estimates that 1.25 million children and young adolescents (0-14 years) fall ill with tuberculosis each year, but that only half of these children are diagnosed and treated. Based on the latest scientific evidence, WHO revised its guidance in 2022 for the management of children and adolescents with TB and made several key recommendations, including the use of treatment decision algorithms that allow many children to be diagnosed based on symptoms alone in absence of lab confirmation, and offering short oral regimens to treat and prevent tuberculosis in children. If adopted and implemented, this would drastically improve the diagnosis and quality of care for children with tuberculosis.
"Since we started implementing the WHO recommendations for children in Bombali district, we have begun to find and treat many more children with tuberculosis," said Joseph Sesey, clinical officer with MSF in Makeni, Sierra Leone.
"These new recommendations have helped us avoid misdiagnosing children: doctors who were hesitant to start children on tuberculosis treatment without positive tuberculosis test results now feel more confident diagnosing tuberculosis based on clinical symptoms alone by using the WHO recommendations," he says. "I have noticed a significant reduction of deaths among children with tuberculosis in many health centres."
However, the work does not stop with policy reforms. For example, new, shorter, all-oral regimens are now recommended by the WHO for both drug-susceptible and drug-resistant tuberculosis treatment in children, but their rollout in countries remains slow. Additionally, while new and child-friendly tuberculosis drugs are available for drug-susceptible and drug-resistant tuberculosis, these are not always procured by countries.
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"It's unfortunate that child-friendly formulations of tuberculosis drugs are still not available in many countries due to bureaucratic barriers and funding gaps," says Dr Cathy Hewison, head of MSF's working group on tuberculosis. "As a result, children with tuberculosis are forced to swallow crushed and bitter medicines without appropriate weight-based doses, putting them at grave risk of side effects and treatment failure."
"This neglect must end now," she says. "We call on governments, donors, and global health organisations to act with urgency, ensuring no child dies or suffers from a preventable, treatable disease like tuberculosis. The tools and treatments we have must reach the children who need them most - now."
