Paediatric Tuberculosis Diagnosis in Resource-Limited Settings: Current Challenges, Available Methods and Emerging Solutions

Tuberculosis (TB) remains a major cause of morbidity and mortality among children, particularly in resource-limited settings. Diagnosing paediatric TB is challenging due to non-specific clinical symptoms, low bacterial load, and difficulties in obtaining suitable specimens from children. This review summarizes the major challenges associated with childhood TB diagnosis and evaluates current diagnostic approaches including clinical assessment, tuberculin skin testing, chest radiography, smear microscopy, culture methods, and molecular diagnostics such as Xpert MTB/RIF. Alternative specimen collection methods, including gastric aspirates, induced sputum, stool, and nasopharyngeal samples, are also discussed. Recent innovations, including Xpert MTB/RIF Ultra and urine lipoarabinomannan assays, offer improved diagnostic opportunities but remain limited by cost and infrastructure requirements. Strengthening diagnostic capacity, expanding access to rapid molecular tests, and developing child-friendly point-of-care diagnostics are essential to improving paediatric TB detection and reducing disease burden in low-resource settings.