Tuberculosis is an important cause of morbidity and mortality in children in TB-endemic countries. The burden of child TB infection and disease represents recent and ongoing transmission in the community. Diagnosis is usually clinical and straightforward on many cases, but can be challenging, especially in those groups at greatest risk for severe, disseminated disease, such as infants, young children and children who are malnourished or infected with HIV.
Contact screening and management can identify "at-risk" children who will benefit from preventative strategies such as IPT, as well as increase the case detection of TB disease. There are diagnostic and treatment issues for children that differ from adults. The needs of children with TB are being increasingly recognised in the broader public health agenda and by NTPs, but a wide policy–practice gap remains. Operational research, and research into new diagnostics and treatment options, also provide opportunities to improve case detection and management.
The Union has been an active participant in increasing attention to the prevention and management of child TB over the last decade by working with partners from the Child TB subgroup of the WHO Stop TB Partnership. Initiatives have included developing guidelines for diagnosis and management of child TB and child TB/HIV, for child contact screening and management, for child TB treatment dosages and regimens, and for NTPs to routinely record and report child TB cases, in order to improve implementation and monitoring of progress.
The Union provides NTPs with technical assistance and training in child TB management and prevention. The importance of data from routine recording and reporting is emphasised in order to identify the policy–practice gaps and to monitor progress. Training is critical, especially in clinical diagnosis and NTP issues specific to children,. The Union has developed tools, such as its Desk Guide for diagnosis and management of TB in children, and supports operational research as an important mechanism for identifying and addressing the gaps and barriers for wider implementation of best practices.