Table 1.
Programmatic indicators that may give an indication of how well childhood tuberculosis is being diagnosed and reported
| Indicator | Approximate expected value1 | Likely interpretation if: | |
|---|---|---|---|
| Too high | Too low | ||
| Proportion of overall burden found in children | 5%–20%, increasing with overall TB incidence | Over-diagnosis of childhood TB | Under-diagnosis of childhood TB |
| Proportion of treated paediatric cases with a confirmed diagnosis | 20–30%, increasing with age and resources | Not enough children treated on clinical grounds | Not enough effort made to confirm the diagnosis |
| Proportion of paediatric cases that are sputum smear-positive2 | 10% in 0–14 age group as a whole | Not enough children treated on clinical grounds | Not enough effort made to confirm the diagnosis |
| Proportion paediatric cases that are under-5 years | Slightly over 50% | Too many young children being treated clinically | Only older children with ‘classic’ symptoms being treated or only children with confirmed disease treated |
| Proportion of paediatric cases that are EPTB | 10% in 0–14 age group as a whole; 25% in 0–4 age group | Children with various clinical characteristics (such as cervical lymphadenopathy) being diagnosed with TB when many do not have TB | Only confirmed cases (which are frequently PTB) classified as TB |
TB: tuberculosis; EPTB: extrapulmonary tuberculosis
1
These expected values provide a rule-of-thumb or guide only. Enormous variability in these parameters has been described in studies across different settings
2
Since 2013, cases are now reported to WHO according to whether bacteriologically confirmed, which includes confirmation by smear microscopy, culture and GeneXpert