References in the content below refer to the PBMEF Guide.
Definitions
Number of children and adolescents (0–14 years) with new and relapse TB or with unknown previous TB treatment history, all forms, who were notified in a reporting period.
Numerator
Denominator
Ref # |
PEDS_NOTIF
(Previously CH-5) |
Tier Level |
Core Indicator
|
Category |
Reach
|
Type |
Core Outcome
|
Unit of Measure |
Number of children/adolescents
|
Data Type |
Integer
|
Disaggregations |
Age (0–4, 5–9, 10–14)
Sex
HIV Status
|
Reporting Level |
All Core PBMEF indicators should be reported at the national level; data may also be collected subnationally for more granular monitoring.
|
Reporting Frequency |
This indicator should be reported on a semiannual basis at a minimum. More frequent monitoring on a quarterly, monthly, or real-time basis is recommended. Performance plans and reports (PPRs) for this indicator are based on calendar year (CY) periodicity to reflect national level attainment and align with the USAID congressional reporting requirements.
|
This indicator is reported from National TB Program (NTP) official records. Quarterly report on TB case registration in the basic management unit.
This standard WHO indicator can also be calculated using the WHO database variables: newrel_f014 plus newrel_m014 plus newrel_sexunk014.
The number of children with TB is an important indicator of recent transmission in a community. Comprehensive information about childhood TB enables NTPs to address the needs of children with TB and mobilize appropriate resources. TB is very challenging to diagnose in children due to the historical reliance on sputum, which may be difficult for children to produce without invasive procedures and may not have a high bacillary load, leading to false negatives and the limitations of diagnosing on a clinical basis only. This indicator measures TB notifications in children ages 0–14 years, which can be used to assess how well the country as a whole is providing appropriate screening and diagnosis services for children with TB. On average, among people with new TB diagnoses the percent contributed by children and adolescents is between 5%–15% in low- and middle-income countries and <10% in high-income countries. These thresholds can be used to identify major outliers where under- or overdiagnosis of TB among children may be of concern.
Of the global total number of people with TB notified in 2021, 6.9% were children under 15 years old. Improvements in reaching children and adolescents are needed to reach the United Nations High-Level Meeting (UNLM) targets to provide TB diagnosis and treatment with the aim of successfully treating 3.5 million children with TB, and 115,000 children with drug-resistant TB (DR-TB) by 2022. The USAID TB strategy (2023-2030) highlighted that USAID will work to strengthen TB diagnosis in children and other vulnerable populations by increasing access to innovative rapid molecular testing and improving capacity for clinical diagnosis. Mandatory notification policies calling for collaboration between NTPs, other non-NTP public health facilities, and private sector facilities and pediatric associations will help ensure comprehensive and age-disaggregated reporting of TB notifications. This is important for monitoring progress and focusing interventions and resources for children.
Childhood TB notifications should be analyzed for trends over time and as a percentage of total notifications to assess whether or not a country is on track in terms of reaching children with TB with appropriate screening and diagnosis services. Globally, children represent about 10% of all people with TB. This varies from country to country, but a percent of children that is too low (e.g., <5%) or too high (e.g., >15%) would merit further analysis to assess under- or overdiagnosis. A low percent of childhood TB detection often indicates that providers need to improve TB screening among children and may highlight a need for changes in the diagnostic algorithm to ensure children are referred appropriately for TB testing. A very high percent may indicate an over-reliance on clinical diagnosis and potential overtreatment of TB among children. Data analysis at subnational levels will help identify areas where children are potentially under or overdiagnosed, and this analysis can be used to prioritize efforts to expand diagnosis services such as stool-based testing and implement updated clinical algorithms included in the 2022 WHO guidelines on the management of TB among children and adolescents. Data should be reported annually at a minimum, but semiannual or quarterly reporting will improve the timeliness of data for decision making. The number of childhood TB notifications can further be broken down by age categories to show the percent of childhood TB occurring in children under 5 years of age, between 5 and 9, and children between the ages of 10 and 14 years old.