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TB-D: Improving Differential Diagnosis for Childhood Tuberculosis

Team Members:
  • Matthew Hill
  • Bonolo Mathekga
  • Mete Morris
  • Melissa Schweizer
  • Collin Shale
  • Digvijay Singh
  • Soumyadipta Acharya, MD, MSE, PhD
  • Sylvia Hinrichsen, MD, PhD
  • Jonathan Golub, PhD, MPH
  • Neil Martinson, MBBCH, DCH, MFGP, MPH
  • Gavin Churchyard, MBBCH, FCP (SA), MMed, PhD


Each year, it is estimated that over one million children are infected with active tuberculosis (TB) resulting in over 233,000 deaths. Of these deaths, it is also estimated that 96% occur in children that were never treated for TB. Diagnostic testing used for adult tuberculosis has reduced sensitivity in children less than five years of age, and the clinical symptoms and signs of childhood TB overlap with many other childhood diseases. In Sub-Saharan Africa, this problem is further complicated by the current HIV epidemic as children with both HIV and TB are at risk of developing extrapulmonary TB. Childhood TB is specifically difficult to differentiate from other lower respiratory tract infections (LRTIs) in children with recent evidence indicating that childhood TB is especially missed in children presenting with symptoms of acute pneumonia.

TB-D is researching and developing a solution to assist healthcare providers in correctly differentiating childhood TB from other LRTIs. In the SubSaharan Africa context specifically, healthcare providers rely on patient history and clinical investigations in order to determine how likely a child is to have TB. Depending on the level of suspicion, healthcare providers will order diagnostic testing for children or even begin empirical treatment; however, when healthcare providers suspect a different LRTI, they may begin treatment for the wrong LRTI. This improper diagnosis leads to diagnostic delay for children with TB along with lost follow-up among children that seek alternate care sources. TB-D is developing a solution that will assist healthcare providers in correctly suspecting TB within children, resulting in increased detection and treatment of childhood TB.

Our team has conducted observations across multiple levels of care in South Africa in order to validate the need and assess current provider practices for investigating children with LRTIs. Healthcare providers across primary, outpatient, and inpatient care have confirmed the current difficulties with differentiating childhood TB from other LRTIs. Moving forward, the team will be focused on testing prototypes with users and validating the efficacy of our design in precisely identifying children with TB.

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