Table 4.

Paediatric tuberculosis

Key messages	Why is it important?	Current challenges	Recommendations
Underdiagnosis and undertreatment of paediatric tuberculosis (TB) lead to preventable deaths. Microbiological confirmation is rarely available in children, therefore at present, a clinical diagnosis should be used to start presumptive treatment without delay.	TB remains a major, unrecognised killer in children. MSF has a possibility to make a difference now by increasing the knowledge of field teams who meet children or their caretakers. Presumptive and empirical TB treatment is safe, well tolerated and effective. Starting treatment based on clinical suspicion (not microbiology confirmation) will bridge the gap of underdiagnosis and undertreatment of TB in children in MSF projects.	Paediatric TB is a ‘silent disease’ frequently underdiagnosed, undertreated and under-reported. MSF staff are not always familiar with the different clinical presentations of TB in children and there is a gap in capacity building on this topic. Confirmatory TB diagnosis is often hard to access and can be difficult in children. Delays of starting treatment based on a microbiological diagnosis perpetuate TB undertreatment in children who may die through these unnecessary delays.	Field Know the local burden of paediatric TB. Support medical field teams on how to recognise TB in children as part of their daily work. While caring for adults with TB, consider the children exposed. Treat TB based on clinical suspicion. Operations Integrate TB activities in paediatric care. Monitor programme data and investigate if underdiagnosis is suspected depending on the local prevalence of TB. Promote capacity building and facilitate access to learning opportunities on paediatric TB including the online free course. Headquarters/research Advocate for the integration of TB in all paediatric projects. Provide support and guidance on clinical algorithm for the diagnosis and treatment of TB in paediatric projects.
Tracing the contacts of patients with TB with the offer of tuberculosis preventive treatment (TPT) should be pursued as an effective strategy to save lives in MSF projects.	Contact tracing of patients with TB is an effective way to identify those who have active TB but also those who may be harbouring latent (sleeping) TB. More lives can be saved by improving access to timely treatment or TPT.    New shorter drug regimens for TPT are showing promising results on acceptance, effectivity, safety and adherence to treatment.	Contact tracing requires resources, which is often a barrier to its roll-out in communities, especially if it is in addition to other community activities.  Standard TPT strategy is currently well established, but shortens regimens that show promising results have not been fully validated for MSF programmes.	Field Contact tracing should be performed whenever a TB case is identified. Assure systematic follow-up of children under TPT in the community. Operations Innovate and pilot TPT programmes in settings where the need is clear and share experiences with the whole MSF movement to improve future efforts. Seek partnership for TPT with community and other non-governmental organisations to reduce the resource burden and optimise programme reach. HQ/working groups Determine where TPT will be most beneficial to reduce paediatric TB burden and implement and learn from those MSF sites.

HQ, Headquarters; MSF, Médecins Sans Frontières; TB, Tuberculosis; TPT, Tuberculosis preventive treatment.