References in the content below refer to the PBMEF Guide.
Definitions
Percent of children and adolescents (0–14 years) with new and relapse pulmonary TB who are bacteriologically confirmed.
Bacteriologically confirmed: Smear positive for TB or culture positive for TB by a World Health Organization-recommended rapid diagnostics test (WRD): FluoroType® MTBDR (Hain), Loopamp™ MTBC detection kit (TB-LAMP), Xpert® MTB/RIF, Xpert® MTB/RIF Ultra, Truenat® MTB or MTB Plus, RealTime MTB (Abbott), BD MAX™ MDR-TB, cobas® MTB (Roche), or LF-LAM.
Note: This is a subset of the core indicator “Percent Bacteriologically Confirmed.”
Calculation: (Numerator/Denominator) x 100
Numerator
Denominator
Ref # |
PEDS_BAC_CON
(Previously CH-11) |
Tier Level |
National Level Indicators
|
Category |
Reach
|
Type |
Outcome
|
Unit of Measure |
Percent of People
|
Data Type |
Percentage
|
Disaggregations |
Age (0–4, 5–14)
Sex
|
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.
|
Data sources may include the TB register, laboratory register, and electronic management information systems at the health facility and district level.
According to 2022 WHO consolidated guidelines on tuberculosis (Module 5: Management of tuberculosis), the recommended initial diagnostic test in children and adolescents with signs or symptoms of pulmonary TB is either a WRD (FluoroType® MTBDR (Hain), Loopamp™ MTBC detection kit (TB-LAMP), Xpert® MTB/RIF, Xpert® MTB/RIF Ultra, Truenat® MTB or MTB Plus, RealTime MTB (Abbott), BD MAX™ MDR-TB, cobas® MTB (Roche), or LF-LAM) for TB and rifampicin-resistance detection in sputum, gastric aspirate, nasopharyngeal aspirate and stool, rather than smear microscopy/culture and phenotypic DST and LF-LAM test (as a point-of-care test) for TB among children and adolescents (0–14 years) living with HIV. Of note, stool-based testing should be done using the Ultra cartridge on the Xpert platform which can detect trace amounts of M.tb (which should be interpreted as positive for children).
Improvements in reaching children and adolescents are needed to reach the United Nations High-Level Meeting (UNHLM) 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 (DR) TB by 2022. Recent advances in TB diagnosis for children, such as use of stool-based testing, will allow for more frequent bacteriological confirmation of TB among this population, which has traditionally been clinically diagnosed. These advances are important for avoiding overdiagnosis of TB based on symptoms only and for timely identification of DR-TB. National TB Programs that have prioritized TB diagnosis in children under 14 years old have begun piloting and scaling up these new approaches with USAID support, so monitoring changes in the indicator will allow stakeholders to determine whether or not they are being implemented well.
As new diagnostic approaches for childhood TB diagnosis are piloted and scaled up in high burden countries, this indicator should increase over time. This indicator can be analyzed as a trend over time and can be visualized in comparison to clinically diagnosed children and adolescents (0–14 years). It can also be compared to childhood and adolescent TB detection. Although the new diagnostic approaches are expected to improve bacteriological confirmation for children with TB, 40% to 50% of children with TB will continue to be diagnosed clinically due to suboptimal specificity.
Low bacteriological diagnosis coverage among children and adolescents 0–14 years may be due to several contributing factors, including over-reliance on clinical diagnosis by the healthcare providers, gaps in referral for specimen testing with providers who are not familiar with new approaches such as stool-based testing, weak sample transport networks, breakdown of diagnostic platforms, stockout of consumables required for testing, and weaknesses in the system for reporting results to providers. Improved supervision and training, as well as improved supply chain, can help address these issues and improve performance on this indicator.
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