Governments and donors are failing children with TB

Gaps in TB care for children

MSF’s report found that only one country’s policies are fully aligned with WHO guidance, while seven countries have more than 80 percent alignment, and four countries fall below 50 percent alignment. The largest gaps in care were found in policies related to diagnosing TB in children. For example, only five out of 14 countries have adapted their guidelines to initiate TB treatment in children when symptoms strongly indicate TB disease, even if bacteriological tests are negative. Additionally, only four of these five countries have the necessary resources to implement this guidance effectively.

WHO estimates that 1.25 million children and young adolescents (0-14 years old) fall ill with TB 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. This includes the use of treatment decision algorithms that allow many children to be diagnosed based on symptoms alone in the absence of lab confirmation, and offering short oral regimens to treat and prevent TB disease in children. If adopted and implemented more widely, these would drastically improve the diagnosis and quality of care for children with TB.

Results show a significant reduction of deaths with implementation

“Since we started implementing the WHO recommendations for children in Bombali district, we have begun to find and treat many more children with TB,” said Joseph Sesey, a 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 TB treatment without positive TB test results now feel more confident diagnosing TB based on clinical symptoms alone by using the WHO recommendations. After implementing the WHO recommendations, I have noticed a significant reduction of deaths among children with TB in many health centers.”

However, the work does not stop with policy reforms. New, shorter, all-oral regimens are now recommended by WHO for both drug-susceptible (DS-) and drug-resistant TB (DR-TB) treatment in children, but their rollout in countries remains slow due to high prices and other barriers. Additionally, while new and child-friendly TB drugs are available for DS- and DR-TB, these are not always available in all countries.

“It's unfortunate that child-friendly formulations of TB drugs are still not available in many countries due to bureaucratic barriers and funding gaps,” said Dr. Cathy Hewison, head of MSF’s TB working group. “As a result, children with TB 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. We call on governments, donors, and global health organizations to act with urgency, ensuring no child dies or suffers from a preventable, treatable disease like TB. The tools and treatments we have must reach the children who need them most—now."