Barriers and facilitators to pediatric tuberculosis management in India: a systematic review

Matthew Willis; Joelle Van de Wetering; Heynes Brown; Ewelina Julia Barnowska; Sophie Cw Stuetzle; Mohammed Nadiruzzaman; Anil Fastenau

doi:10.1186/s12879-025-10863-0

Barriers and facilitators to pediatric tuberculosis management in India: a systematic review

Matthew Willis^*, Joelle Van de Wetering, Heynes Brown, Ewelina Julia Barnowska, Sophie Cw Stuetzle, Mohammed Nadiruzzaman, Anil Fastenau

^*Corresponding author for this work

Research output: Contribution to journal › (Systematic) Review article › peer-review

Abstract

BACKGROUND: Pediatric tuberculosis (TB) is a significant public health concern in India, contributing to 28% of the global pediatric TB burden. Despite its impact on child health, strategies to control TB have inadequately addressed pediatric cases, resulting in suboptimal management. Understanding the barriers and facilitators influencing the management of pediatric TB in India is crucial for improving healthcare practices and outcomes for affected children. METHODS: This systematic review aims to analyze existing literature to identify barriers and facilitators to the management of pediatric TB in India. A search of three databases; Embase, PubMed and Web of Science, was conducted to identify relevant studies published from 01/01/2012 to 07/09/2024. Studies focusing on barriers and facilitators in pediatric TB management were included in this review. RESULTS: The search strategy yielded 1132 original articles, with 24 articles meeting the selection criteria for inclusion. In this review, the prevalent barrier at the individual level encompasses parental knowledge gaps, financial constraints, and the preference for private healthcare services. At the community level, barriers included gender inequality, stigmatization and discrimination, interconnected living environment, and traditional practices. At the health system level, the most significant barriers included the insufficient knowledge and training among healthcare providers, diagnostic complexities, non-child-friendly tools and techniques, limited availability and accessibility of resources, inadequate monitoring, and practices in the private healthcare sector. The facilitators identified in this review included the collaboration between different sectors and the utilization of the Xpert MTB/RIF diagnostic test. DISCUSSION: This systematic review provides a comprehensive understanding of the multifaceted challenges influencing the management of pediatric TB in India. By identifying the barriers and facilitators at different levels, the review offers valuable insights into the complexities of the diagnosis, treatment, and prevention of pediatric TB. A better understanding of these complexities is essential for improving pediatric TB management in India and worldwide.

Original language	English
Article number	495
Number of pages	14
Journal	BMC Infectious Diseases
Volume	25
Issue number	1
DOIs	https://doi.org/10.1186/s12879-025-10863-0
Publication status	Published - 10 Apr 2025

Keywords

Pediatric
Pediatric tuberculosis
Systematic review
Tuberculosis
Tuberculosis management
Humans
India/epidemiology
Tuberculosis/diagnosis epidemiology drug therapy therapy prevention & control
Child
Health Services Accessibility
Disease Management
Health Knowledge, Attitudes, Practice
Health Personnel

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title = "Barriers and facilitators to pediatric tuberculosis management in India: a systematic review",

abstract = "BACKGROUND: Pediatric tuberculosis (TB) is a significant public health concern in India, contributing to 28% of the global pediatric TB burden. Despite its impact on child health, strategies to control TB have inadequately addressed pediatric cases, resulting in suboptimal management. Understanding the barriers and facilitators influencing the management of pediatric TB in India is crucial for improving healthcare practices and outcomes for affected children. METHODS: This systematic review aims to analyze existing literature to identify barriers and facilitators to the management of pediatric TB in India. A search of three databases; Embase, PubMed and Web of Science, was conducted to identify relevant studies published from 01/01/2012 to 07/09/2024. Studies focusing on barriers and facilitators in pediatric TB management were included in this review. RESULTS: The search strategy yielded 1132 original articles, with 24 articles meeting the selection criteria for inclusion. In this review, the prevalent barrier at the individual level encompasses parental knowledge gaps, financial constraints, and the preference for private healthcare services. At the community level, barriers included gender inequality, stigmatization and discrimination, interconnected living environment, and traditional practices. At the health system level, the most significant barriers included the insufficient knowledge and training among healthcare providers, diagnostic complexities, non-child-friendly tools and techniques, limited availability and accessibility of resources, inadequate monitoring, and practices in the private healthcare sector. The facilitators identified in this review included the collaboration between different sectors and the utilization of the Xpert MTB/RIF diagnostic test. DISCUSSION: This systematic review provides a comprehensive understanding of the multifaceted challenges influencing the management of pediatric TB in India. By identifying the barriers and facilitators at different levels, the review offers valuable insights into the complexities of the diagnosis, treatment, and prevention of pediatric TB. A better understanding of these complexities is essential for improving pediatric TB management in India and worldwide.",

keywords = "Pediatric, Pediatric tuberculosis, Systematic review, Tuberculosis, Tuberculosis management, Humans, India/epidemiology, Tuberculosis/diagnosis epidemiology drug therapy therapy prevention & control, Child, Health Services Accessibility, Disease Management, Health Knowledge, Attitudes, Practice, Health Personnel",

author = "Matthew Willis and Wetering, {Joelle Van de} and Heynes Brown and Barnowska, {Ewelina Julia} and Stuetzle, {Sophie Cw} and Mohammed Nadiruzzaman and Anil Fastenau",

year = "2025",

month = apr,

day = "10",

doi = "10.1186/s12879-025-10863-0",

language = "English",

volume = "25",

journal = "BMC Infectious Diseases",

issn = "1471-2334",

publisher = "BioMed Central Ltd",

number = "1",

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TY - JOUR

T1 - Barriers and facilitators to pediatric tuberculosis management in India

T2 - a systematic review

AU - Willis, Matthew

AU - Wetering, Joelle Van de

AU - Brown, Heynes

AU - Barnowska, Ewelina Julia

AU - Stuetzle, Sophie Cw

AU - Nadiruzzaman, Mohammed

AU - Fastenau, Anil

PY - 2025/4/10

Y1 - 2025/4/10

N2 - BACKGROUND: Pediatric tuberculosis (TB) is a significant public health concern in India, contributing to 28% of the global pediatric TB burden. Despite its impact on child health, strategies to control TB have inadequately addressed pediatric cases, resulting in suboptimal management. Understanding the barriers and facilitators influencing the management of pediatric TB in India is crucial for improving healthcare practices and outcomes for affected children. METHODS: This systematic review aims to analyze existing literature to identify barriers and facilitators to the management of pediatric TB in India. A search of three databases; Embase, PubMed and Web of Science, was conducted to identify relevant studies published from 01/01/2012 to 07/09/2024. Studies focusing on barriers and facilitators in pediatric TB management were included in this review. RESULTS: The search strategy yielded 1132 original articles, with 24 articles meeting the selection criteria for inclusion. In this review, the prevalent barrier at the individual level encompasses parental knowledge gaps, financial constraints, and the preference for private healthcare services. At the community level, barriers included gender inequality, stigmatization and discrimination, interconnected living environment, and traditional practices. At the health system level, the most significant barriers included the insufficient knowledge and training among healthcare providers, diagnostic complexities, non-child-friendly tools and techniques, limited availability and accessibility of resources, inadequate monitoring, and practices in the private healthcare sector. The facilitators identified in this review included the collaboration between different sectors and the utilization of the Xpert MTB/RIF diagnostic test. DISCUSSION: This systematic review provides a comprehensive understanding of the multifaceted challenges influencing the management of pediatric TB in India. By identifying the barriers and facilitators at different levels, the review offers valuable insights into the complexities of the diagnosis, treatment, and prevention of pediatric TB. A better understanding of these complexities is essential for improving pediatric TB management in India and worldwide.

AB - BACKGROUND: Pediatric tuberculosis (TB) is a significant public health concern in India, contributing to 28% of the global pediatric TB burden. Despite its impact on child health, strategies to control TB have inadequately addressed pediatric cases, resulting in suboptimal management. Understanding the barriers and facilitators influencing the management of pediatric TB in India is crucial for improving healthcare practices and outcomes for affected children. METHODS: This systematic review aims to analyze existing literature to identify barriers and facilitators to the management of pediatric TB in India. A search of three databases; Embase, PubMed and Web of Science, was conducted to identify relevant studies published from 01/01/2012 to 07/09/2024. Studies focusing on barriers and facilitators in pediatric TB management were included in this review. RESULTS: The search strategy yielded 1132 original articles, with 24 articles meeting the selection criteria for inclusion. In this review, the prevalent barrier at the individual level encompasses parental knowledge gaps, financial constraints, and the preference for private healthcare services. At the community level, barriers included gender inequality, stigmatization and discrimination, interconnected living environment, and traditional practices. At the health system level, the most significant barriers included the insufficient knowledge and training among healthcare providers, diagnostic complexities, non-child-friendly tools and techniques, limited availability and accessibility of resources, inadequate monitoring, and practices in the private healthcare sector. The facilitators identified in this review included the collaboration between different sectors and the utilization of the Xpert MTB/RIF diagnostic test. DISCUSSION: This systematic review provides a comprehensive understanding of the multifaceted challenges influencing the management of pediatric TB in India. By identifying the barriers and facilitators at different levels, the review offers valuable insights into the complexities of the diagnosis, treatment, and prevention of pediatric TB. A better understanding of these complexities is essential for improving pediatric TB management in India and worldwide.

KW - Pediatric

KW - Pediatric tuberculosis

KW - Systematic review

KW - Tuberculosis

KW - Tuberculosis management

KW - Humans

KW - India/epidemiology

KW - Tuberculosis/diagnosis epidemiology drug therapy therapy prevention & control

KW - Child

KW - Health Services Accessibility

KW - Disease Management

KW - Health Knowledge, Attitudes, Practice

KW - Health Personnel

U2 - 10.1186/s12879-025-10863-0

DO - 10.1186/s12879-025-10863-0

M3 - (Systematic) Review article

SN - 1471-2334

VL - 25

JO - BMC Infectious Diseases

JF - BMC Infectious Diseases

IS - 1

M1 - 495

ER -

Barriers and facilitators to pediatric tuberculosis management in India: a systematic review

Abstract

Keywords

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