240 Children a Day: Tuberculosis Mortality at Ages 0–19 Years and the Widening Estimation Divide, 1990–2023

Objectives: Tuberculosis (TB) in children is preventable and curable yet weakly diagnosed, notified, and monitored only to age 14 years. We analyzed the 0–19-year TB burden in the Global Burden of Disease Study (GBD) 2023. Methods: We aggregated deaths and incident cases (95% uncertainty intervals [UIs]), 1990–2023, for four age bands across 204 countries, 21 regions and five Socio-demographic Index (SDI) quintiles; computed trends, pandemic-window changes with Monte Carlo–propagated uncertainty, and fixed-2021 SDI gradients, benchmarking against WHO estimates and End TB 2025 milestones. Results: In 2023, TB caused 87,764 deaths (95% UI 65,765–109,764) at ages 0–19 years—about 240 daily—and 1,665,272 incident cases; deaths fell 65.5% since 1990. Low- plus low-middle-SDI countries carried 90.3% of deaths across a 531-fold mortality gradient. GBD 0–14-year mortality was 39.9% of the like-for-like WHO estimate (66,146 vs 166,000); incidence agreed closely (80.8%). Deaths fell 23.9% over 2015–2023 against the 75% milestone. Adolescents aged 15–19 years improved slowest. Conclusions: Measurement systems disagree 2.5-fold on pediatric TB deaths, milestones are off track three-fold, and the burden concentrates where monitoring is weakest. Reconciling estimation, extending monitoring to ages 15–19 years, and concentrating resources on high-burden countries are prerequisites for ending TB in children.