Competency gaps in pediatric tuberculosis care and priorities for continuing education: Evidence from a national survey in China.

BACKGROUND

Early recognition of pediatric tuberculosis (TB) depends on frontline healthcare workers' ability to identify suspected cases. In China, pediatric TB is often under-recognized, and little is known about how physicians from different specialties and healthcare settings understand the disease. Understanding these gaps is important in improving continuing medical education (CME) and strengthening pediatric TB services.

METHODS

We conducted a national, multicenter, cross-sectional survey from 2021 to 2022 using a 20-item questionnaire based on the WHO Module 5 to assess knowledge and attitudes toward pediatric TB among physicians across different regions and hospital levels. Adequate knowledge was defined as a score of ≥ 6/10. Subgroup comparisons and multivariable logistic regression were used to examine associated factors.

RESULTS

Overall, 35.6% of the 2202 participants had adequate knowledge. Gaps were found in areas relevant to routine clinical practice, including the timing of repeat tuberculin skin testing (41.3%), selection of the standard six-month treatment regimen (56.6%), and recognition of symptom-based screening triggers (32.0%). Knowledge levels varied according to years of practice, region, prior exposure to pediatric TB cases, and attitudes toward invasive diagnostic procedures. Physicians in central China had higher odds of adequate knowledge than those in eastern China (OR 1.24; 95% CI, 1.01-1.54). No significant differences were found by department or professional title, although variation across specialties was noted.

CONCLUSIONS

Practical knowledge gaps remain among physicians in pediatric TB care. These gaps may require moving beyond traditional lecture-based CME toward more practical, case-based activities that better reflect clinical practice. Enhancing training in diagnostic procedures, contact investigation, and case-based management may help improve early detection and consistency of care in China and may also be relevant to other high-burden settings.