In the absence of laboratory tests, countries should adopt treatment decision algorithms for tuberculosis (TB) in children, as recommended by the World Health Organization (WHO).
This is one of the urgent measures proposed by Doctors Without Borders/Médecins Sans Frontières (MSF) in its recent report on the state of TB care for children in 14 high-burden countries.
In a media orientation in Manila on November 29, MSF said that the Philippines is among eight countries accounting for two-thirds of global TB cases. The other countries are India, China, Indonesia, Pakistan, Nigeria, Bangladesh, and the Democratic Republic of the Congo.
The report, titled TACTIC: Test, Avoid, Cure TB in Children, underscores that children with TB remain neglected in global efforts to combat the disease. It reveals significant gaps in national TB policies, with only one country achieving full alignment with WHO guidelines, seven achieving more than 80% alignment, and four falling below 50%.
Critically, only five of the surveyed countries—Afghanistan, Central African Republic, Democratic Republic of Congo, Guinea, India, Mozambique, Niger, Nigeria, Pakistan, Philippines, Sierra Leone, Somalia, Republic of South Sudan, and Uganda—have updated guidelines to enable TB treatment in children based on clinical symptoms when bacteriological tests are unavailable. Even fewer countries have allocated resources to implement these guidelines effectively.
The WHO’s 2022 recommendations, including treatment decision algorithms and short, oral treatment regimens, are pivotal in drastically improving TB diagnosis and care for children.
“TB is curable, also in children,” said Stijn Deborggraeve, Diagnostics Advisor at the MSF Access Campaign. “Yet countries are lagging in adopting these solutions. Every delay means more children die unnecessarily.”
The report also highlights the pressing need for newer, child-friendly TB drug formulations and shorter, all-oral treatment regimens. Despite their availability, bureaucratic barriers and funding gaps hinder their procurement, leaving children to endure unsuitable and potentially harmful treatment options.
Dr. Cathy Hewison, Head of the MSF TB working group, emphasized the urgency of addressing these barriers.
“It’s unfortunate that child-friendly formulations of TB drugs are still not available in many countries due to bureaucratic barriers and funding gaps,” she said.
“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,” she added.
The WHO estimates that 1.25 million children and young adolescents fall ill with TB annually, yet only half receive diagnosis and treatment. The global TB crisis has worsened, with the disease reclaiming its position as the world’s deadliest infectious killer in 2023, according to the Global Tuberculosis Report 2024 shared by MSF.
The time to act is now, MSF insists. Policymakers, donors, and global health agencies must accelerate efforts to implement WHO’s recommendations and eliminate the disparities in TB care for children.
