Children and Adolescents

Roadmap

Roadmap towards ending TB in children and adolescents, second edition. Geneva: World Health Organization; 2018 (https://apps.who.int/iris/bitstream/handle/10665/275422/9789241514798-eng.
pdf?sequence=1&isAllowed=y).

WHO operational handbooks

WHO operational handbook on tuberculosis. Module 1: prevention – tuberculosis preventive treatment. Geneva: World Health Organization; 2020 (https://www.who.int/publications/i/item/9789240002906).

1. Global tuberculosis report 2021. Geneva: World Health Organization; 2021 (https://apps.who.int/iris/handle/10665/346387, accessed 1 December 2021).


2. Snow KJ, Sismanidis C, Denholm J, et al. The incidence of tuberculosis among adolescents and young adults: a global estimate. Eur Respir J. 2018;51(2):1702352.


3. WHO consolidated guidelines on tuberculosis. Module 5: management of tuberculosis in children and adolescents. Geneva: World Health Organization; 2022 (https://apps.who.int/iris/bitstream/handle/10665/352522/9789240046764-eng.pdf).

WHO provides guidance on the principles²⁹ and recommendations for nutritional care and support of people with TB as part of their regular TB care.

Five guiding principles are key for providing nutritional care and support as an integral part of TB care and prevention (105):

Children and adolescents with TB disease frequently present with failure to thrive or weight loss (see Chapter 4). Severe malnutrition is one of the key risk factors for TB in children. Children receiving therapeutic nutritional treatment or nutritional supplementation but still not gaining weight, or continuing to lose weight, should be considered as having a chronic disease such as TB and evaluated accordingly (6).

As part of the review for the background question on adolescents, a group of experts was convened to propose actions for optimizing adolescent engagement in TB care. The proposed actions focused on two areas: reforming current practices that are harmful to adolescents with TB; and developing an adolescent-specific plan within each NTP to provide high-quality adolescent-centred TB services.
Box 7.6 summarizes the proposed interventions.

Adolescents on treatment for TB disease are at risk for poor adherence in terms of missed doses and loss to follow-up. Predictors of poor treatment adherence for drug-susceptible TB include TB/HIV coinfection, age 15–19 years, prior TB treatment and male gender.

The review identified specific challenges of providing TB care to adolescents around substance abuse, late presentation to care and treatment adherence. Adolescence is a time when individuals may engage in reward-seeking and risk-taking behaviours, including substance use. This may increase the risk of developing TB disease, more severe disease or more unfavourable treatment outcomes. Further research is required to better understand how to co-manage TB and substance use in adolescents.

Stigma and hierarchical models of care such as facility-based treatment may undermine adolescent agency.²⁷ Threats to social networks related to TB and its treatment and the increase in mental health challenges may impact adolescent resilience.²⁸ Some adolescents with TB, however, demonstrate resilience by forming strong relationships with peers who are on treatment or by finding a sense of purpose or meaning from their illness experience (see web annex 4

Adolescents experience disruptions to their education due to TB and its treatment. The time needed for facility-based treatment support can interfere with education, and the need for education may in turn disrupt engagement with TB services. Disruption or delays in education may be further affected by prolonged isolation or hospitalization. As a result, TB and associated treatment may have a significant impact on adolescents’ future livelihoods (see web annex 4).