Thank you for the question.
In order to diagnose TB we need to try to get a specimen. Usually we try first to get a sputum specimen. So for an adult that's not usually a problem if they're coughing, but to have a young child cough and produce sputum that we can test in a lab, that becomes difficult. That's one issue.
Another is that children are more likely to develop extrapulmonary TB. That's TB outside of the lungs. Again whether it's meningitis, whether it's in their lymph nodes, whether it's in their kidneys or other parts of their body, it's difficult to get a specimen for testing. That's the first part of the battle.
The second part is that for drug-resistant TB, children are forced to use adult formulations. So we take these four to five to six different drugs used for adults, and if they come in a capsule form you have to open the capsule, you have to mix the powder with water, you have to give them half in the morning, half at night. Children are invariably either underdosed or overdosed. There are problems both with diagnosis and treatment of TB, especially drug-resistant TB in children.