References in the content below refer to the PBMEF Guide.
Definitions
Number of children and adolescents (0–14 years) with rifampicin-resistant (RR)-TB/multidrug-resistant (MDR)-TB notified during the reporting period; pre-extensively drug-resistant (pre-XDR) TB, and extensively drug-resistant (XDR) TB should not be reported in addition to the RR/MDR-TB notifications. RR/MDR-TB: is TB caused by Mycobacterium Tuberculosis (M. tuberculosis) strains that are resistant to rifampicin; MDR-TB strains are resistant to at least both rifampicin and isoniazid.
Note: pre-XDR/XDR notifications should not be added to RR/MDR-TB notifications to avoid double counting of DR-TB notifications.
Children who are diagnosed with pre-XDR and XDR-TB will already have been identified and recorded as having RR/MDR-TB. The number of RR/MDR-TB notifications should therefore equal the total number of DR-TB notifications.
Numerator
Denominator
Ref # |
PEDS_MDR_NOTIF
(Previously CH-13) |
Tier Level |
National Level Indicators
|
Category |
Reach
|
Type |
Outcome
|
Unit of Measure |
Number of children and adolescents
|
Data Type |
Integer
|
Disaggregations |
Age (0–4, 5–9, 10–14)
|
Reporting Level |
National Level indicators should be reported at the national level; data may also be reported subnationally or at the project level if national data is not available.
|
Reporting Frequency |
This indicator should be reported on an annual basis at a minimum. More frequent monitoring on a quarterly or monthly basis is recommended.
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Data sources may include the TB register, RR/MDR-TB register, or laboratory information and electronic medical record systems (LIMS, EMR) available at the health facility and district level.
Understanding the burden of DR-TB in children is key for any National TB Program (NTP) to respond accordingly. Researchers have estimated that between 25,000 and 32,000 children develop MDR-TB every year. MDR-TB, a form of TB that is resistant to 2 of the most potent anti-TB drugs (rifampicin and isoniazid), is a major contributor to antimicrobial resistance. Children acquire DR-TB mainly through transmission from household and/or close contact with an infectious adult or adolescent with MDR-TB. The diagnosis of DR-TB can be challenging, especially in young children, as they cannot easily produce a sputum sample for bacteriological testing, and because tests lack sensitivity to detect the low number of bacilli in samples of children. The World Health Organization (WHO) now recommends the use of less invasive, non-sputum based, samples to test with rapid molecular diagnostics, to confirm the diagnosis of RR-TB, such as stool and naso-pharyngeal aspirates.
Child and adolescent DR-TB notification measures a country’s ability to detect drug resistance among children (0–14 years) who have TB disease. Data on DR-TB child and adolescent notifications are also valuable for planning second-line drug (SLD) procurement and prioritizing supervision. Child-friendly SLD formulations are difficult to manufacture; supply at a global level is fragile. Thus, accurate data on the number of children and adolescents notified with DR-TB is especially critical for ensuring the medications are available.
Child and adolescent DR-TB notifications can be analyzed as a trend over time to show the total number of children with TB detected within a given country. The number of child and adolescent DR-TB notifications can further be broken down by age categories to show the percent of children and adolescents with DR-TB occurring in children under 5 years of age and children between the ages of 5 and 14. Childhood and adolescent DR-TB notifications can be compared to the total number of DR-TB notifications within a country to see what percent of people who have DR-TB are children. Data can also be collected at the subnational level and used to learn from the geographic distribution of children with DR-TB; for example, to identify outbreaks of DR-TB. Data should be reported annually at a minimum but semiannual or quarterly reporting will improve the timeliness of data for decision making.
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