The deadly gap in diagnosing children with tuberculosis

MSF is providing testing and treatment for people with TB currently in 38 countries, among them many children © Sabir Sabirov

In our clinic, every day we see children with symptoms that could be TB. We are an experienced team and have the laboratory TB tests available but for most children who come to us, we just cannot confirm the diagnosis of TB.
- Dr Lazro Fidelle, Malakal, South Sudan

Most of the time we go ahead and treat the child without any positive lab test results. However, this decision to treat must always balance the need for timely and lifesaving treatment with the need to avoid unnecessary treatment of children who may not have TB but another respiratory infection. So we welcome the updated WHO guidelines which now provide clear evidence-based clinical algorithms to diagnose TB, even when test results are not available.
- Dr Lazro Fidelle, Malakal, South Sudan

Our biggest challenge is collecting a sputum sample from the child to test for TB. While sputum is the standard specimen that we use to detect TB, small children are often not able to produce sufficient sputum to test.
- Dr Lazro Fidelle, Malakal, South Sudan

This video features a painful procedure used to extract sputum from children with suspected TB, and illustrates the need for better diagnostic tools for children with TB. The procedure is very rarely used today, and only in the most difficult cases.
MSF works to try to improve the diagnosis of TB in children and adults. In Malakal, South Sudan, we are undertaking operational research on a new technology, POCUS (point-of-care ultrasound), to increase and improve diagnosis of TB in children.

We make do with what we have, but we are still really in desperate need of better TB tests for children that can be used in even the most remote settings and that can test TB at high sensitivity in samples that are easy to collect in children, such as mouth swabs or finger-prick blood.
- Dr Lazro Fidelle, Malakal, South Sudan

Diana Gomez, Stijn Deborggraeve and Cathy Hewison

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