08.06.2026
Drug-resistant tuberculosis threatens children in low- and middle-income countries
A comprehensive global analysis reveals a marked increase in drug-resistant tuberculosis (DR-TB) among children. Girls in particular face a higher risk of death—highlighting significant gaps in diagnosis, treatment, and equitable access to healthcare.
The study, conducted by an international research consortium from China, the United States, and Germany and based on Global Burden of Disease data from 204 countries, shows that the number of cases of multidrug- or rifampicin-resistant tuberculosis (MDR/RR-TB) in children increased more than threefold between 1990 and 2021. At the same time, cases of extensively drug-resistant tuberculosis (XDR-TB) rose by more than thirty-four-fold over the same period. Deaths associated with these severe forms of the disease also increased substantially, underscoring the growing global threat tuberculosis poses to children.
Although the overall number of childhood tuberculosis cases has declined over recent decades, drug-resistant forms now account for an increasing proportion of infections and deaths. Countries with low and middle incomes are particularly affected, especially in South Asia, sub-Saharan Africa, and parts of Eastern Europe and Central Asia.
Alarmingly, the study also found that girls consistently experience higher incidence and mortality rates than boys. In addition, increases in drug-resistant disease have been more pronounced among girls. Researchers attribute these disparities in part to structural inequalities in access to nutrition, healthcare, and early diagnosis, as well as increased vulnerability associated with HIV exposure and social disadvantage.
Children under five years of age remain the most vulnerable group, accounting for nearly half of all cases and more than three-quarters of deaths from drug-resistant tuberculosis. Despite global initiatives to expand access to treatment, only about one in five children with MDR/RR-TB had received appropriate therapy by 2022, leaving the majority untreated or unreported.
Prof. Dr. med. Dr. h.c. Christoph Lange
DZIF TTU TB (ClinTB)
T +49 4537 / 188-3010 (Sekretariat)
F +49 4537 / 188-6030
clange@fz-borstel.de
“Current tuberculosis control strategies are largely designed around adult disease and fail to meet the specific needs of children. Without targeted investment in child-friendly diagnostics, new medicines, and gender-equitable access to healthcare, the goal of eliminating childhood tuberculosis deaths will remain out of reach. Our findings highlight the urgent need for strengthened global action to improve early detection of paediatric tuberculosis, expand treatment coverage, and address the previously underestimated risks faced by girls worldwide,” said Professor Christoph Lange, Medical Director at the Research Center Borstel and one of the study’s senior authors.
Reference:
Liu X, Mijiti P, Xia L, LaCourse SM, Talafuhan W, Kay AW, Yang Y, Liu H, Ye D, Martinez L, Lu S, Shen A, Mandalakas AM, Li F, Lange C, Huang Z. Global burden of drug-resistant tuberculosis in children: A systematic analysis for the Global Burden of Disease Study. Eur Respir J. 2026 Jun 4:2501648. doi: 10.1183/13993003.01648-2025. Epub ahead of print. PMID: 42242755.