New diagnostic approach to improve childhood TB detection

KAMPALA - Diagnosing tuberculosis (TB) in children remains a challenge due to its symptoms often resembling those of other respiratory illnesses.

Clinicians frequently struggle to differentiate TB from similar conditions, making early and accurate diagnosis difficult.

To address this, the World Health Organization (WHO) introduced treatment decision algorithms in 2022. These algorithms integrate various diagnostic components, including symptoms, clinical examinations, and test results, to help guide clinicians in initiating TB treatment in children.

Dr Moorine Sekadde, a paediatrician with the Ministry of Health's National Tuberculosis and Leprosy Programme and an investigator in the OPTIC TB trial, said the Makerere University Lung Institute, in collaboration with the National Tuberculosis and Leprosy Programme, the University of Bergen in Norway, the National Institute of Medical Research in Tanzania, Kampala International University (Uganda), and Bukavu University in the Democratic Republic of Congo, is conducting a study to assess the performance of these algorithms.

The study is supported by the European Developing Clinical Trials Partnership. The new diagnostic approach specifically targets children under 10 years old, a demographic particularly vulnerable to TB complications.

Researchers and clinicians anticipate that the findings will improve childhood TB diagnosis, ultimately leading to better treatment outcomes and saving lives.

Speaking at the OPTIC TB annual general meeting, held at Four Points by Sheraton from March 26-27, 2025, Dr Stavia Turyahabwe, commissioner for disease prevention and control at the Ministry of Health, highlighted the adoption of stool testing as one of the latest methods to improve TB detection in children, particularly those who struggle to produce sputum.

Currently, about 12,000 children aged 0 to 18 years develop TB annually.

Dr Moorine Sekadde, a paediatrician working with the Ministry of Health national tuberculosis and leprosy program, also an investigator of OPTIC TB trial, speaking after the second session of Annual General Meeting at Four Points by Sheraton. (Credit: Violet Nabatanzi)

Turyahabwe explained that since children tend to swallow their sputum, stool samples can be analysed using the GeneXpert test to detect TB bacteria they may have ingested. This innovation enhances diagnostic accuracy and simplifies testing for younger patients.

Prof. Bruce Kirenga, director of the Makerere University Lung Institute, noted that the trial is a cluster-randomised study, meaning it does not target individual children but rather health facilities that treat children.

“This is an implementation study, meaning the strategy we are evaluating in the clinical trial has already been proven to work. In areas where it was tested, the strategy increased the number of children receiving TB treatment and reduced the impact of TB by enabling early diagnosis. We are confident in its effectiveness, but it has never been confirmed in a clinical trial,” Dr Kirenga said.

Sekadde explained that children commonly acquire TB from people in close contact with them, such as a breastfeeding mother. If a mother has TB, she can transmit it to her child.

She added that certain factors make children more prone to TB, including their young age, as their immune systems are not yet fully developed, making them more vulnerable to infections.

“If a child has HIV, they are at an even higher risk of contracting TB because their immune system is weakened. Similarly, children suffering from severe malnutrition are also at greater risk due to a compromised immune system,” she said.

Symptoms of TB in children

Sekadde outlined the symptoms of TB in children, which include a persistent cough lasting more than two weeks, prolonged fever lasting over two weeks, and stunted growth compared to healthy children.

She warned that caregivers should be vigilant if their child is not growing well, particularly if they have been exposed to someone with TB, as this significantly increases the likelihood of infection.