Treatment-Decision Algorithm of Child TB: Evaluation of WHO Algorithm and Development of Indonesia Algorithm

Clinical algorithms for child tuberculosis (TB) are a valuable guide for healthcare workers to initiate treatment. We evaluated the agreement of pediatric TB diagnosis using the current Indonesia diagnostic algorithms with the 2022 WHO treatment decision algorithm and developed a new Indonesia algorithm for child TB based upon our findings and expert opinion. We conducted a retrospective study at 10 hospitals in Indonesia, involving children (0-10 years), who were evaluated for TB diagnosis in 2022. A panel of child TB experts used participants' records to make a diagnosis using the 2022 WHO algorithm and the 2016 Indonesian algorithm. We assessed agreement between the diagnosis made by the attending doctor and those determined by the expert panel. A new Indonesia guideline was developed based on the findings and consensus of various stakeholders. Of 523 eligible children, 371 (70.9%) were diagnosed with TB by the attending doctors, 295 (56.4%) by the WHO algorithm, and 246 (47%) by the Indonesia algorithm. The Cohen's Kappa of TB diagnosis was: attending doctor vs. WHO algorithm (0.27), attending doctor vs. Indonesia algorithm (0.45), and WHO algorithm vs. Indonesia algorithm (0.42). A review of both algorithms revealed challenges for implementation. An algorithmic approach for child TB diagnosis may not be universally applicable or implementable due to variable access to diagnostic tests and the wide variety of clinical presentations.