The tuberculosis (TB) epidemic remains one of the most daunting public health challenges of the 21st century. Fuelled mainly by poverty, global population growth, the human immunodeficiency virus (HIV) epidemic and the emergence of drug resistant TB, more people suffer and die from TB each year than ever before. The TB, disease burden is carried almost exclusively by the developing world. Children in TB-endemic countries suffer severe TB-related morbidity and mortality, but this is rarely appreciated due to diagnostic difficulties and poor data collection (1). Children were previously neglected as TB control efforts focused almost exclusively on the diagnosis and treatment of adults with sputum smear-positive TB. However, the formulation of the millennium developmental goals and other recent developments raised awareness about the preventable TB disease burden suffered by children in developing countries. In response the World Health Organization (WHO) produced a guidance document on Child TB in 2006 and the Global Drug Facility (GDF), for the first time, made child friendly TB drug formulations available to poor countries in 2007.

Increased awareness and drug availability renewed the focus on the diagnostic difficulties experienced in resource-limited settings. Children tend to develop pauci-bacillary TB and are rarely sputum smear positive. M. tuberculosis culture is more sensitive than smear microscopy, but it remains an insensitive test (culture yields of 30–40% are generally reported in children with probable TB) and is severely hampered by the difficulty of specimen collection, cost and a time delay of 2–6 wk. Immunologic approaches have not been very fruitful. The tuberculin skin test (TST), as well as novel interferon-gamma release assays, fail to make the all important distinction between latent infection and active disease (2).

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