Post-TB lung disease evaluation in paediatric national guidelines: a scoping review of high-burden countries

SUMMARY BACKGROUND Post-tuberculosis lung disease (PTLD) is an increasingly recognised consequence of tuberculosis (TB) in children and adolescents. Although PTLD-related sequelae had long been observed, formal recognition and standardised terminology only emerged after the 2019 post-TB symposium. This review assessed the extent to which PTLD is addressed in national TB guidelines from the 51 WHO-designated high-burden countries. METHODS We conducted a scoping review of national paediatric TB guidelines published between January 2010 and June 2024. Guidelines were reviewed for PTLD-specific content or related terms (sequelae, follow-up, chronic respiratory impairment) and for guidance on recurrent TB, HIV, and comorbidities. RESULTS Forty guidelines were reviewed (11 paediatric-specific, 29 general). PTLD was mentioned in only four (10%) general guidelines: Kenya, Uganda, the Democratic Republic of Congo, and Peru. No guideline provided paediatric-specific PTLD evaluation or management recommendations. Most predated formal definitions and global guidance, which may explain the limited PTLD content. Recurrent TB (78%), HIV (100%), and nutritional assessment (95%) were consistently included, while comorbidities were inconsistently addressed. Rehabilitation and preventive vaccination were rarely mentioned. CONCLUSION Despite increasing global recognition, most guidelines predate recent evidence and lack paediatric-specific PTLD recommendations. This highlights the need to integrate structured follow-up, prevention, and rehabilitation.