Global burden of drug-resistant tuberculosis in children: A systematic analysis for the Global Burden of Disease Study.

BACKGROUND

Paediatric tuberculosis (TB), particularly drug-resistant TB (DR-TB), is associated with significant mortality. However, the global burden of childhood TB remains poorly understood.

METHODS

We analysed incident cases, deaths, and age-standardised incidence and mortality rates among children (0-14 years) with multidrug-resistant/rifampicin-resistant tuberculosis (MDR/RR-TB) and extensively drug-resistant tuberculosis (XDR-TB) using the Global Burden of Disease (GBD) 2021 database. Data were stratified by age, sex, region, country, and HIV/AIDS status. Annual and average annual percentage changes were assessed using joinpoint regression analysis. Secondary analyses compared adult and paediatric TB trends in the End TB era and evaluated the potential impact of the COVID-19 pandemic on childhood TB. Sensitivity analyses were performed using the recently released GBD 2023 database.

RESULTS

In 2021, an estimated 32 515 (95% UI: 20 968-51 288) paediatric MDR/RR-TB incident cases and 1193 (806-1814) XDR-TB cases occurred globally, with 5887 (2467-11 332) and 253 (109-508) corresponding deaths, respectively; all estimates were lower than counterfactual projections for 2021 in the absence of COVID-19. Since 2005, age-standardised incidence and mortality rates for MDR/RR-TB and mortality rate for XDR-TB have slowly trended downwards, while their proportional contributions to total incident cases and deaths have increased. Children who are female, younger, from low sociodemographic regions, and HIV-coinfected are disproportionately affected. No significant impact of the End TB Strategy on paediatric TB trends was observed after 2015. Cross-dataset comparisons showed concordant principal findings.

CONCLUSIONS

The global burden of paediatric DR-TB is substantial, with marked disparities across vulnerable populations and regions. Targeted intervention should be tailored to strategically address regional development status, HIV prevalence, and local health policies.