There are two situations in which TB treatment should be provided for children. These are:
- TB disease treatment for children who are sick with TB
- Latent TB treatment for children to prevent them from developing TB disease.
TB disease treatment for children who are sick with TB
Achieving successful treatment of TB in children depends on a number of different factors including:1“Out of the Dark: Meeting the Needs of Children with Tuberculosis”, MSF Access to Essential Medicines October 2011 www.msfaccess.org/
- The child must be promptly diagnosed
- TB treatment must be started promptly
- The correct TB drugs must be provided
- The dosage of the TB drugs must be adjusted according to the child’s weight
- Support must be provided to ensure that the TB drugs are taken correctly
- There must be a continuous supply of quality assured TB drugs.
TB treatment for a child must always be carried out under the supervision of an experienced health professional. The World Health Organisation treatment guidelines and any National Treatment Program guidelines must always be followed.2"Best practices in child and adolescent tuberculosis", Geneva, World Health Organisation, 2018, https://apps.who.int/iris/bitstream/handle/10665/274373/9789241514651-eng.pdf
Treatment of TB disease in children, is fundamentally the same as in adults. A combination of TB drugs need to be taken for a number of months.
Usually this will involve four drugs adjusted according to the weight of the child.
It is always important that the complete course of drugs is completed.
Treatment of latent TB infection
There are several possible treatment regimens for latent TB. The drugs used include:
Child friendly formulations of TB drugs & FDCs
Young children who are unable, or unwilling to swallow large number of tablets each day need child friendly formulations to treat their TB. Ideally these should be in solid fixed dose combination (FDC) forms that are then dispersible in liquids, and can easily provide for dosing across different weight groups.
FDCs are when several drugs are combined together with a specific dosage of each drug included in one tablet. A major advantage of FDCs is that they improve patient adherence as fewer tablets need to be taken and a single drug cannot be taken on its own. At the same time there appears to be no loss of effectiveness. Although there is still some discussion about the benefit of FDCs for the treatment of TB in adults, there would appear to be little dispute about the benefit of FDCs for the treatment of TB in children.
New FDCs for TB treatment for children
In 2015 the TB Alliance announced that in early 2016 some new TB drugs for children would be available. 3“Child friendly TB drugs on the way”, www.sbs.com.au/news/article/2015/09/01/child-friendly-tb-drugs-way
“Children with the disease will no longer have to take crushed tablets intended for adult sufferers, meaning that they will get the proper dosage”.
“For the first time, we have appropriate treatment for the million children who have tuberculosis, with a formulation of drug that is easy for kids to take, that tastes good and that will hopefully make the disease much easier to treat”.
Progress on scale-up of new Childhood TB Medicines
More than one million courses of treatment have already been ordered. Ninety three countries have started to use the improved medicines. These countries account for three quarters of the global pediatric TB burden.6"Child-friendly medicines", TBAlliance, https://www.tballiance.org/child-friendly-medicines
But with TB in children resulting in one million children becoming ill with TB each year, and therefore one million courses of TB treatment being needed each year, there is still some way to go before all children who need it will be receiving the improved medicine.
Children's TB Treatment Statistics - South Africa
South Africa is one of the countries that needs to make progress with providing treatment for children under 5 with symptoms of TB.
In 2018/19 the national TB child under 5 years started on treatment rate was only 10.2%. The Western Cape had the highest rate at 32.8% and the Free State the lowest at only 2.2%.
Five of the six districts in the Western Cape ranked among the 10 best performing districts in 2018/19. Eighteen districts had a rate below 5%. Lejweleputswa (Free State) only started 1.0% of children under 5 years with TB symptoms on treatment.
It is considered to be:
"of great concern that only 10.5% of children under 5 years with TB symptoms received TB treatment in 2018/19. The country is not on track to reach the Universal Health Coverage targets for TB effective treatment. The initial loss-to-follow-up rate for children under 5 is unacceptably high".
|Province||Percentage of Symptomatic Children Started on TB Treatment 2018/2019|
TB Client 5 years and Older Started on Treatment Rate
In 2018/19 the national TB client 5 years and older started on treatment rate was 97.8%. Much higher than the TB child under 5 years started on treatment rate of only 10.2%. The national target for TB clients 5 years and older started on treatment rate is 100%.
Across provinces the rate varied between 106.6% in North West and 77.1% in Free State. Free State also had the lowest TB child under 5 years started on treatment rate in 2018/19. Five of the nine provinces had a rate exceeding 100%. This could be due to date quality problems or inclusion of non bacteriologically confirmed patients.
|Province||Percentage of TB Clients 5 Years & Older Started on TB Treatment 2018/19|
This page was last updated in February 2021.
Author Annabel Kanabus
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