Impact case study database

Dr Seddon and colleagues estimated that, globally each year, 1.2 million children develop TB of which 250,000 die. Until the described modelling work was undertaken, this burden was not recognised. These estimates have underpinned global and national estimates of burden. From 2015 onwards they have been directly incorporated into the annual World Health Organization (WHO) estimates of childhood TB disease and mortality [ A]. As a result of this research, for the first time, childhood TB is now recognised as one of the top 10 causes of under 5 mortality [ B] – it was previously unrecognised. As under 5 mortality is seen as a key metric in the funding agenda for research and operational investment globally, this is crucial for childhood TB funding [ B].

The burden estimates in children from this modelling work and reported by WHO have been used by Ministries of Health and National TB Programmes to carry out national and regional service evaluations. A recent example is the FIKIA Project in Kenya, which seeks to increase case-finding in children. It uses as its justification the fact that the WHO estimates suggest that 10-15% of the overall TB burden is in children, while in Kenya, only 8.7% is in children. This has led to the use of enhanced case-finding to look for these missing children [ C]. A similar justification for case-finding is seen in national TB guidelines, for example [ D] which cites reference (1) above. The burden estimates have also led to childhood TB being prioritised in global and national TB planning due to increased perception of burden of disease and death. In the 232-page WHO Global TB Report in 2010 the terms “child” or “children” were used 5 times. In the same report in 2020 they were used 163 times [ A]. The WHO carries out reviews of country TB Programmes and it is now mandatory to include a reviewer with paediatric TB expertise on these panels. These reviewers use the modelled estimates to evaluate the discrepancies between expected and diagnosed cases of childhood TB.

The estimates from Dr Seddon’s work have been cited in multiple advocacy materials, especially in the run up to the first UN high level meeting on TB in September 2018 [ E]. When competing for scarce resources for both child TB service implementation and research, burden estimates have proved crucial. For example, Dr Seddon’s work has been included in WHO advocacy material (‘ At least 1 million children fall ill with tuberculosis (TB) each year. Children represent about 11% of all TB cases’) [ F] and the 2018 revised Roadmap for childhood TB (‘ *We now know that 10% of all TB affects and manifests in children – over half of that among children under five years of age.*’) [ B], as well as the 2018 Union advocacy document, the silent epidemic [ G]. The estimates have resulted in changes to attitudes and awareness around childhood TB for the public as well as for policymakers – this body of work has influenced the development of strategic research priorities [ H] and best practices [ I] for childhood TB at a WHO level.

Dr Seddon has also worked with industry to develop new drugs for children. The TB Alliance is a product development partnership that works to develop new TB drugs. They received a grant of USD16,700,000 from Unitaid in 2013 to develop child-friendly drug formulations. A key first step was to develop market estimates for TB in children to strengthen negotiations with drug companies [ J]. Dr Seddon and Dr Dodd worked with Unitaid and TB Alliance to ensure that their estimates could be used for these negotiations (acknowledged in [ J]). The first ever fixed-dose, fully dispersible, palatable TB drug formulation was subsequently developed by Macleods and these formulations have now been rolled out to >90 countries, making it much easier to treat children with TB [ J].

Finally, children with TB ultimately benefit from the increased funding and prioritisation of diagnosis and treatment. This has benefits for families and communities in high TB burden countries. The number of children diagnosed with TB and notified to WHO increased from 327,000 in 2011 to 523,000 in 2019 [ A]. In 2015, 87,242 children <5 years were given preventive therapy following household exposure to TB. In 2019, this figure was 433,196 [ A].