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      Quality matters: Redefining child TB care with an emphasis on quality

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          Abstract

          Children have been neglected in the fight against tuberculosis (TB) for decades. Despite being the number one infectious disease killer, TB does not feature on the child survival agendas partly due to absent and inaccurate data. Quality is a missing ingredient in TB care in children, yet high rates of unfavorable TB outcomes highlight its importance in this age group. Quality care is particularly important for TB affected children in the absence of a point of care sensitive and specific diagnostic test. Using the current models of child TB care, it will take another 200 years to end TB. Without focusing on the quality of child TB care, the ambitious country specific United Nations High Level Meeting for TB targets will carry minimal impact. High TB burden countries must also adopt Universal Health Care (UHC) and ensure that quality TB care is made free and equitable for all children, adolescents and their affected families. We advocate for the importance of evaluating the quality of child TB care, and provide a basic framework for quality in child TB with special attention given to creating differentiated service delivery models for children and families affected by TB.

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          Most cited references38

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          The cascade of care in diagnosis and treatment of latent tuberculosis infection: a systematic review and meta-analysis.

          WHO estimates that a third of the world's population has latent tuberculosis infection and that less than 5% of those infected are diagnosed and treated to prevent tuberculosis. We aimed to systematically review studies that report the steps from initial tuberculosis screening through to treatment for latent tuberculosis infection, which we call the latent tuberculosis cascade of care. We specifically aimed to assess the number of people lost at each stage of the cascade.
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            Building a tuberculosis-free world: The Lancet Commission on tuberculosis

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              The global burden of tuberculosis mortality in children: a mathematical modelling study

              Summary Background Tuberculosis in children is increasingly recognised as an important component of the global tuberculosis burden, with an estimated 1 million cases in 2015. Although younger children are vulnerable to severe forms of tuberculosis disease, no age-disaggregated estimates of paediatric tuberculosis mortality exist, and tuberculosis has never been included in official estimates of under-5 child mortality. We aimed to produce a global mortality burden estimate in children using a complementary approach not dependent on vital registration data. Methods In this mathematical modelling study, we estimated deaths in children younger than 5 years and those aged 5–14 years for 217 countries and territories using a case-fatality-based approach. We used paediatric tuberculosis notification data and HIV and antiretroviral treatment estimates to disaggregate the WHO paediatric tuberculosis incidence estimates by age, HIV, and treatment status. We then applied systematic review evidence on corresponding case-fatality ratios. Findings We estimated that 239 000 (95% uncertainty interval [UI] 194 000–298 000) children younger than 15 years died from tuberculosis worldwide in 2015; 80% (191 000, 95% UI 132 000–257 000) of these deaths were in children younger than 5 years. More than 70% (182 000, 140 000–239 000) of deaths occurred in the WHO southeast Asia and Africa regions. We estimated that 39 000 (17%, 23 000–73 000) paediatric tuberculosis deaths worldwide were in children with HIV infections, with 31 000 (36%, 19 000–59 000) in the WHO Africa region. More than 96% (230 000, 185 000–289 000) of all tuberculosis deaths occurred in children not receiving tuberculosis treatment. Interpretation Tuberculosis is a top ten cause of death in children worldwide and a key omission from previous analyses of under-5 mortality. Almost all these deaths occur in children not on tuberculosis treatment, implying substantial scope to reduce this burden. Funding UNITAID, National Institutes of Health, and National Institute for Health Research.
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                Author and article information

                Contributors
                Journal
                J Clin Tuberc Other Mycobact Dis
                J Clin Tuberc Other Mycobact Dis
                Journal of Clinical Tuberculosis and Other Mycobacterial Diseases
                Elsevier
                2405-5794
                02 November 2019
                December 2019
                02 November 2019
                : 17
                : 100130
                Affiliations
                [a ]The Indus Hospital, Department of Pediatrics, Korangi Crossing, 4th Floor IHRC, Karachi, Pakistan
                [b ]Interactive Research and Development, Pakistan
                [c ]Baylor International Pediatric AIDS Initiative (BIPAI) at Texas Children's Hospital, Baylor College of Medicine, Houston, TX, United States
                [d ]Baylor College of Medicine Children's Foundation-Tanzania, Mbeya, Tanzania
                [e ]The Global Tuberculosis Program, Texas Children's Hospital, Department of Pediatrics, Baylor College of Medicine, Houston, TX, United States
                [f ]The International AIDS Society. Geneva. Switzerland
                Author notes
                [* ]Corresponding author. farhana.maqbool@ 123456ird.global
                Article
                S2405-5794(19)30074-9 100130
                10.1016/j.jctube.2019.100130
                6880125
                31788571
                09c1b4d9-79af-4416-85ca-4f372872c5e3
                © 2019 Published by Elsevier Ltd.

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

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                quality care,tuberculosis,children,tb/hiv
                quality care, tuberculosis, children, tb/hiv

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