A research agenda to promote the management of childhood tuberculosis within national tuberculosis programmes

Abstract

Despite causing considerable mortality and morbidity, childhood tuberculosis (TB) is a neglected aspect of national tuberculosis programmes (NTPs), particularly in developing countries. A recently published World Health Organization (WHO) document, "Guidance for national tuberculosis programmes on the management of tuberculosis in children", addresses the effective management of children within NTPs. Taking into account this document and following a literature review, research priorities are identified to promote the integration of childhood tuberculosis into NTPs. The implications of human immunodeficiency virus (HIV) infection apply to all aspects of this agenda. The major priorities are: --The prospective evaluation of the incidence of childhood TB and the monitoring of programme performance with regard to childhood TB. A lot of data are already available within many programmes that could inform this process. --Study of the criteria to suspect and diagnose childhood TB using uniform criteria as defined in the Guidance document mentioned above. Evaluate new methodologies for this purpose. --Study the pharmacokinetics and toxicity of anti-tuberculosis drugs in children and the long-term outcome of the treatment of children. --Determine how many childhood contacts of adult pulmonary TB qualify for chemoprophylaxis in different communities. Study chemoprophylaxis for drug-resistant TB and chemoprophylaxis among certain groups of adolescents. --Document at what level children enter NTPs, the availability of qualified staff and their effectiveness in performing diagnostic investigations and ensuring quality care. Study the role of families as agents for DOTS, evaluate private sector participation in childhood TB management. --Document bacille Calmette-Guérin (BCG) immunisation complications and study management strategies.