Children and Adolescents

Roadmap

Roadmap towards ending TB in children and adolescents, second edition. Geneva: World Health Organization; 2018 (https://apps.who.int/iris/bitstream/handle/10665/275422/9789241514798-eng.
pdf?sequence=1&isAllowed=y).

WHO operational handbooks

WHO operational handbook on tuberculosis. Module 1: prevention – tuberculosis preventive treatment. Geneva: World Health Organization; 2020 (https://www.who.int/publications/i/item/9789240002906).

1. Global tuberculosis report 2021. Geneva: World Health Organization; 2021 (https://apps.who.int/iris/handle/10665/346387, accessed 1 December 2021).


2. Snow KJ, Sismanidis C, Denholm J, et al. The incidence of tuberculosis among adolescents and young adults: a global estimate. Eur Respir J. 2018;51(2):1702352.


3. WHO consolidated guidelines on tuberculosis. Module 5: management of tuberculosis in children and adolescents. Geneva: World Health Organization; 2022 (https://apps.who.int/iris/bitstream/handle/10665/352522/9789240046764-eng.pdf).

WHO provides guidance on the principles²⁹ and recommendations for nutritional care and support of people with TB as part of their regular TB care.

Five guiding principles are key for providing nutritional care and support as an integral part of TB care and prevention (105):

Children and adolescents with TB disease frequently present with failure to thrive or weight loss (see Chapter 4). Severe malnutrition is one of the key risk factors for TB in children. Children receiving therapeutic nutritional treatment or nutritional supplementation but still not gaining weight, or continuing to lose weight, should be considered as having a chronic disease such as TB and evaluated accordingly (6).

By reducing cell-mediated immunity, undernutrition increases the risk of TB, while the catabolic effect of TB disease results in weight loss and wasting, creating a vicious cycle (105, 228). Globally, about 45% of deaths in children aged under 5 years are attributable to undernutrition (228). Undernutrition may be acute or chronic and categorized as moderate or severe.

TB is a common cause or comorbidity in children with clinically diagnosed pneumonia. A systematic review on TB in acute respiratory infection found that M. tuberculosis was identified in around 5–10% of children with pneumonia aged under 5 years in TB endemic countries (223). Limited data from clinical and autopsy studies suggest that TB was also associated with mortality in these children. Prevalence studies, including the multisite PERCH study (224), confirm these findings.

As part of the review for the background question on adolescents, a group of experts was convened to propose actions for optimizing adolescent engagement in TB care. The proposed actions focused on two areas: reforming current practices that are harmful to adolescents with TB; and developing an adolescent-specific plan within each NTP to provide high-quality adolescent-centred TB services.
Box 7.6 summarizes the proposed interventions.

Adolescents on treatment for TB disease are at risk for poor adherence in terms of missed doses and loss to follow-up. Predictors of poor treatment adherence for drug-susceptible TB include TB/HIV coinfection, age 15–19 years, prior TB treatment and male gender.