Tuberculosis: MSF findings show WHO algorithms could double the number of children diagnosed and treated
Governments must act now to ensure no child is left behind in the response against this deadly disease.
At the World Conference on Lung Health this week, Doctors Without Borders/Médecins Sans Frontières (MSF) released data from our operational research showing the benefits of using the World Health Organization’s (WHO) recommended treatment decision algorithms for diagnosing tuberculosis (TB) in children. Our findings show that these algorithms can nearly double the number of children who can be started on lifesaving TB treatment.
They are guided by scoring systems that allow physicians to start TB treatment if a child’s symptoms strongly indicate TB, even if laboratory tests are unavailable or test results appear negative. We urge policymakers to adopt the WHO algorithms in their national guidelines and ensure timely implementation so that more children with TB can access life-saving diagnosis and treatment.
MSF’s research study, Test Avoid Cure Tuberculosis in Children (TACTiC), evaluated the WHO algorithms in 1,846 children under 10 with symptoms suggestive of pulmonary TB. The study ran from August 2023 to October 2025 in five countries: Uganda, Niger, Nigeria, Guinea and South Sudan. It included children facing severe acute malnutrition and those living with HIV. MSF’s data showed 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 supports healthcare workers in the diagnosis of TB in children, and that they are feasible to use. At the same time, they also increases parents’ satisfaction with timely TB care their children received.
“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.”
Helena Huerga, physician and principal investigator of MSF’s TACTiC research study
“Before, health workers relied on coughing and as long as children weren’t coughing, they thought they didn’t have tuberculosis,” says Angeline Dore, physician and 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.”
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 (a thick mucus made in the lungs), which children struggle to produce. 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 children with TB missed diagnosis in 2024 and could not access life-saving treatment.
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-ray. 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 Helena Huerga, physician and 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.”
Recent global assistance funding cuts threaten to widen gaps in identifying and treating people with TB. MSF call on countries and other agencies 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 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.
