Ref Number = ASPR0045
Toward zero tuberculosis: global and national challenges on child tuberculosis
Rina Triasih
Department of Paediatric, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, Indonesia 
E-mail: rina_triasih@yahoo.com
Despite the development in the diagnosis, the availability of effective chemotherapy and the established global tuberculosis (TB) control program, TB remains a significant cause of morbidity and mortality worldwide. The global End TB strategy aims to reduce the global TB epidemic, with a vision of ?A world free of TB; zero deaths, disease and suffering  due to TB?. The target is to reduce TB deaths by 95% and to cut new cases by 90% between 2015 and 2035, and to ensure that no family is suffering from catastrophic expenses due to TB.  This is an ambitious target which need comprehensive effort not only on finding and treating new cases, but also in giving TB preventive treatment.
 There has been increasing recognition of child TB as an important component of the global TB burden, nevertheless children with TB are still given low priority in most national TB programs (NTPs). The estimated number of global TB cases among children in 2017 was 1 million (10% of all TB cases), but 55% of them were not reported to the NTPs. In addition, less than 10% of 25,000 estimated cases of drug resistant (DR) TB were diagnosed and had access to treatment. Preventive treatment has been shown to be of importance in reducing the burden of TB cases, nevertheless the uptake was very low. Less than 300,000 (23%) children under 5 (out of 1.3 million eligible household contacts under 5 years of age) receive TB preventive treatment. Confirmed bacteriological diagnosis in the recent era of increasing cases of DR TB is of importance for children. This has been widely acknowledged as one of the most challenges in the diagnosis of TB in children. However, children are commonly neglected in research for the development of new diagnostic tools. Similarly, very limited trials of new first- and second-line drugs of TB have involved children. 
 Indonesia is amongst the highest TB burden countries in the world. With the high number of adult TB cases, children in Indonesia are at high risk to get TB infection and to develop TB disease. The NTP has had some good efforts on child TB program in Indonesia, such formation of child TB working group in 2005, the development and updates of the national guideline on the management of child TB,  conducting operational research, and trainings for health workers, including paediatricians. Nevertheless, case detection rate of child TB has not been as expected with high variation among provinces. This may be due to problems related to diagnosis as well as recording and reporting. Preventive treatment of TB has been introduced since 2016, but the uptake is as low as 20%. 
 Pediatricians who are dealing with children everyday have potential role to contribute in achieving the target of End TB strategy, either as an individual or as organisation. Paediatrician ?beyond the hospital? is needed, paediatric specialist training program should not only aims to make a smart paediatrician, but also as an agent of change, and more collaboration among regional and international organisations of paediatricians is needed.
Keywords: tuberculosis, children, challenges, global and national
Disclaimer: The Views and opinions expressed in the articles are of the authors and not of the journal.
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