MSF study: WHO algorithms could double the number of cases detected and treated for childhood tuberculosis
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In the frame of the World Conference on Lung Health, which takes place from November 18 to 21, Médecins Sans Frontières (MSF) released data from its operational research highlighting that using the World Health Organization (WHO) recommended treatment decision algorithms, for diagnosing tuberculosis in children can nearly double the number of children who can be initiated on lifesaving tuberculosis treatment.
The WHO algorithms are guided scoring systems that allow physicians to initiate tuberculosis treatment if the symptoms of the child are strongly indicative of tuberculosis disease, even if laboratory tests are unavailable or test results appear negative. MSF urged policymakers to adopt the WHO algorithms in their national guidelines and ensure timely implementation so that more children with tuberculosis can access life-saving diagnosis and treatment.
MSF’s Test, Avoid, Cure Tuberculosis in Children (TACTiC) research study evaluated the WHO algorithms in 1,846 children under 10 years with symptoms suggestive of pulmonary TB between August 2023 and October 2025 across five countries: Uganda, Niger, Nigeria, Guinea and South Sudan, including children facing severe acute malnutrition and children living with HIV.
The MSF data showed that the WHO algorithms identified the majority of children with tuberculosis correctly and, on average, doubled the proportion of children that can be initiated on tuberculosis treatment.
MSF findings further showed that the introduction of the WHO algorithms not only supports health care workers in the diagnosis of tuberculosis in children and are feasible to use but also increases parents’ satisfaction with timely tuberculosis care their children received.
Before, health workers relied on coughing, and as long as children weren't coughing, they thought they didn't have tuberculosis.” said Dr. Angeline Dore, focal point for the TACTiC project in Guinea.
“The WHO algorithms now tell us not to rely on coughing, there are other signs for tuberculosis as well."
An estimated 1.2 million children and young adolescents under the age of 15 years fell ill with tuberculosis in 2024.
Although the disease can be cured, tuberculosis in children often remains undiagnosed as the currently available laboratory tests are designed for adults and do not work sufficiently well in children. In addition, most laboratory tests require a sputum sample which children struggle to produce, and even when they do, the low bacterial levels in their lungs often make detection by laboratory tests impossible. The WHO Global Tuberculosis Report published last week showed that a staggering 43% of the children with tuberculosis missed diagnosis in 2024 and could not access life-saving treatment.
In 2022, WHO revised its guidance for the diagnosis, treatment and prevention in children management of tuberculosis in children to be in line with the most recent scientific evidence. Among several important updates, the new WHO guidelines recommend the use of treatment decision algorithms for the diagnosis of tuberculosis in children for settings with and without access to Xray. However, despite being recommended by the WHO, many countries have not yet adopted these algorithms in their national guidelines nor facilitated their implementation in healthcare facilities.
Too many children with tuberculosis are still slipping through the cracks in the absence of effective diagnostic tools” said Dr Helena Huerga, Principal Investigator of the TACTiC research study conducted by MSF.
“Our findings prove that WHO’s treatment decision algorithms, for which we do not need lab test results to initiate tuberculosis treatment in children, work in real-world settings and can potentially save many more children’s lives if implemented.
The science is clear - what’s now missing is the political will to put it into practice.”
With the recent global aid funding cuts that threaten to widen gaps in identifying and treating people with tuberculosis , MSF called on countries and their stakeholders, including international donors, to step up and ensure sustained funding for tuberculosis care for all, especially young children as they already face the largest gaps in accessing tuberculosis care.
In addition to timely adoption and implementation of the WHO algorithms, policymakers, donors and implementers must also anticipate and plan for an increase in supply of medicines needed to treat children to ensure that all children who are diagnosed with tuberculosis can access treatment without any delay,” said Daniel Martinez Garcia, project leader of MSF’s TACTiC project.
Editor’s Note:
The Test Avoid Cure tuberculosis in Children (TACTiC) project is a transformational project in MSF to innovate tuberculosis care for children.
The project aims to implement the latest WHO recommendations, generate evidence on their effectiveness, feasibility and acceptability and to advocate for their implementation at global and national levels.
The project covers 12 countries with a high burden of tuberculosis and where MSF provides tuberculosis care for children: Afghanistan, Central African Republic, Democratic Republic of Congo, Guinea, Mozambique, Niger, Nigeria, Pakistan, the Philippines, Somalia, South Sudan and Uganda.
Under this project, the TB ALGO PED research study was conducted to evaluate the diagnostic performance, impact and the feasibility and acceptability of implementing the WHO treatment decision algorithms for pulmonary tuberculosis in children under 10 years old.