Copenhagen — At the World Conference on Lung Health this week, Médecins Sans Frontières (MSF) released data from our operational research highlighting that using the World Health Organization (WHO) recommended treatment decision algorithms for diagnosing tuberculosis (TB) in children can nearly double the number of children who can be initiated on lifesaving TB treatment.
The WHO algorithms are guided scoring systems that allow physicians to initiate TB treatment if the symptoms of the child are strongly indicative of TB, even if laboratory tests are unavailable or test results appear negative. MSF urges policymakers to adopt the WHO algorithms in their national guidelines and ensure timely implementation, so that more children will be diagnosed with, and treated for, TB.
MSF’s Test Avoid Cure Tuberculosis in Children (TACTiC) research study evaluated the WHO algorithms in 1,846 children under 10 years old, with symptoms suggestive of pulmonary TB between August 2023 and October 2025 across five countries: Uganda, Niger, Nigeria, Guinea and South Sudan. This included children facing severe acute malnutrition and children living with HIV.
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Our data showed that the WHO algorithms identified the majority of children with TB correctly and, on average, doubled the proportion of children that can be initiated on TB treatment. MSF findings further showed that the introduction of the WHO algorithms not only supports healthcare workers in the diagnosis of TB in children and are feasible to use, but also increases parents’ satisfaction with the timely TB 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,” says 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 TB as well.”
The WHO algorithms now tell us not to rely on coughing; there are other signs for TB as well. Dr Angeline Dore, focal point for the TACTiC project in Guinea
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An estimated 1.2 million children and young adolescents under the age of 15 years fell ill with TB in 2024. Although the disease can be cured, TB 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 per cent of the children with TB missed diagnosis in 2024 and could not access lifesaving treatment.1
In 2022, WHO revised its guidance for the diagnosis, treatment and prevention of TB 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 TB in children for settings with and without access to x-rays. 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 TB are still slipping through the cracks in the absence of effective diagnostic tools,” says 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 TB 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. Dr Helena Huerga, principal investigator of the TACTiC research study
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“The science is clear – what’s now missing is the political will to put it into practice,” says Dr Huerga.
With the recent global aid funding cuts that threaten to widen gaps in identifying and treating people with TB, we are calling on countries and their stakeholders, including international donors, to step up and ensure sustained funding for TB care for all, especially young children as they already face the largest gaps in accessing TB 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 [the] supply of medicines needed to treat children, to ensure that all children who are diagnosed with TB can access TB treatment without any delay,” says Daniel Martinez Garcia, project leader of MSF’s TACTiC project.
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The Test Avoid Cure TB in Children (TACTiC) project is a transformational project in MSF to innovate TB 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 TB and where MSF provides TB 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 TB in children under 10 years old.
This percentage was calculated based on the difference between the estimated number of children who had TB and the number of children reported as having TB, as notified by authorities globally in 2024.
