Tuberculosis in Nigerian Children: What You Need to Know 

By Ibironke Taiwo. BNSc., RN. Freelance Health Writer. Medically reviewed by A. Odutola, MB, BS, PhD.

A healthcare provider counselling a mother and her ill child about Tuberculosis. Image source: 

 

Highlights

• Tuberculosis is a serious threat to children’s health  in Nigeria, especially in communities with poor living conditions

• Children get TB when they come in contact with someone that has active TB

• TB in children is hard to detect early because signs like cough, fever or weight loss can look like signs of other common illnesses

• Early diagnosis and treatment are keys to good treatment results

 

Introduction

Tuberculosis is a threat to children’s health in Nigeria especially in low socio-economic areas marked by poverty, overcrowding and lack of access to healthcare. Even with global intervention in the prevention and control of TB, it is still underdiagnosed and often overlooked in some Nigerian communities. This is not a good one at all, because children under the age 5 are more vulnerable to this disease.

Detecting TB in children can be quite difficult because the symptoms often resemble that of other common illnesses like flu and without early detection or treatment, TB can easily spread and cause damage to the lungs, brain, bones and other parts of the body.

Understanding how TB spreads, its early signs, and knowing how to prevent or get your child treated is very important. This article explains everything you need to know, causes, risk factors, diagnosis, treatment and prevention. With the right knowledge of TB and timely action, the burden of TB among Nigerian children can be reduced.

 

What is tuberculosis?

Tuberculosis commonly affects the lungs and it's caused by a bacteria called Mycobacterium Tuberculosis. Image source. Click on image to enlarge.

 

Tuberculosis also known as TB is an infectious disease caused by a bacteria (germ) known medically as Mycobacterium tuberculosis. These germs majorly infect the lungs, but it can also infect other parts of the body such as the brain, kidney, abdomen, or the spine.

TB can spread from one person to another via the air that you breathe. It easily spreads in crowded places and among those with HIV/AIDS or weakened immune systems. This is because their body is not strong enough to fight the germs.  

Some people are infected with the TB bacteria but they cannot transmit it to others and they may not even get sick. This is because the germs are not active in their body yet. The moment these germs become active and start multiplying in their system they can spread it to others. As such TB has different stages (see Table 1): 

Stages of TB Infection. Click on image to enlarge
 

1. Primary Stage: This is the stage where the TB germs enter the body. The immune system tries to fight off the germs but it is not likely to destroy them all, so germs that are not killed keep multiplying. There are little to no symptoms at this stage. 

2. Latent Stage:  At this stage the immune system is still trying to keep the germs from spreading. Your child will not show any symptoms and if they do, they may be flu-like. Also they are not contagious. But the germs are still alive in their body waiting to be activated. There is a high chance of the germs being activated if the infection is not treated or if your child has HIV, have had previous infection, has unusual X-ray or weakened immune system. 

3. Active Stage: This is when the germs are activated as your child’s protective system is weakened by infections such as HIV, poor nutrition, etc. Your child will appear severely sick and can spread the disease to others when they cough or sneeze. Active TB can also spread from your child’s lungs to other parts of their body. This is known as extrapulmonary TB 

Children under the age of 5 get sick from TB more quickly than adults. This is because their immune systems are not strong enough to fight the germs. Diagnosing TB in children can be quite challenging because the symptoms often mimic those of other common illnesses in children. 

 

How common is tuberculosis in Nigerian children?

Nigeria is estimated to have one of the highest burden of TB and HIV-associated TB in the world.

One review and meta-analysis involving 22 studies carried out from 2008 – 2023 and including a population of 1.16 million, found a pooled prevalence of tuberculosis in Nigerian children aged 0 – 18 years (mean age is 8.44 ± 2.34 years) of nearly 21% (1 in 5 children).

Lung TB was the most common form. Disseminated (multi-organ and multi- system) and extrapulmonary involvements (lymph nodes, spine, brain, meninges and abdomen) were also significant. There was wide variation in prevalence across regions of the country.

While developed countries have made significant progress in preventing TB, the same cannot be said for less developed countries like Nigeria, where the attributed increase in children aged 0 to 14 make up 10% and more of TB cases in Nigeria.

The high occurrence rate of tuberculosis in Nigerian children is largely due to a combination of factors including,

• lack of early immunisation
• poverty
• overcrowding and poor housing
• stigma and delayed access to adequate medical care
• food insecurity
• malnutrition
• co-occurring infectious disease such as HIV

 

How does your child get infected with Tuberculosis?

Here is how your child can get infected.

The Mycobacterium Tuberculosis germ that causes Tb is spread through the air just like the common cold or flu. 

How children catch tuberculosis. Click on imge to enlarge.

 

When a person with active TB coughs, sneezes, sings, spit or even talks, the tiny droplets carrying M.Tuberculosis are released into the air. If your child breathes in this air they get infected with TB.

These germs can stay in the air for hours and they thrive better in poorly ventilated places like small rooms, crowded classrooms, buses or homes where the windows are closed/limited.

Your child is also likely to get TB from their peers at school, friends, or family members who have active TB, especially if they spend lots of time indoors.  

It should be noted that TB cannot be spread via personal items like spoons, clothes, plates, cups, toilets or toys. This is because M. Tuberculosis does not do well to survive on surfaces

 

What raises the risk of your child catching Tuberculosis?

The factors that can raise the risk of your child getting infected with Tuberculosis (TB) include:  

• Close contact with someone who has active TB, especially if the person is not receiving treatment. This is the most common risk factor
• Staying in overcrowded areas 
• Poor housing conditions
• Weakened immune system due to HIV or other chronic disease
• Malnutrition. This reduces the body’s ability to fight against infection
• Lack of education or awareness about TB. Children with great educational background are likely to have a better knowledge of how TB spreads
• Passive smoking and exposure to indoor air pollution. This affects the lung health and increases the chances of being infected.
• Traveling to or living in regions where TB is very common such as Asia, Africa, and Latin America
• Lack of vaccination with the Bacillus Calmette-Guérin (BCG) vaccine. This vaccine protects your child from being infected with TB
• Children under the age of 5 years old are more at risk due to underdeveloped immune systems

 

How to know if your child has Tuberculosis

Sick African child coughing into a tissue with common symptoms of Tuberculosis listed in the foreground. Photo is AI generated from Freepik

 

The symptoms of tuberculosis vary in children. This variation is based on their age and the severity of the infection. However when a child has active TB they may show one or more of the following signs:

• Persistent cough lasting more than 2 - 3 weeks. These coughs may also come with mucus or blood in it 
• Consistently high temperature
• Your child may wake up soaked in sweat
• Poor growth. This is seen when your child is not meeting normal developmental milestones
• Weight loss
• Tiredness 

When the TB spreads beyond the lungs. Your child may begin to have the following symptoms

• Swollen lymph nodes, especially at the sides and base of the neck
• Body pain
• Pain and swelling in bones and joints
• Feeling sick or unwell most of the time
• Rash on the legs, face or other parts of the body

 

How can tuberculosis be detected in my child?

Because TB symptoms can look like those of other illnesses, especially lung-related ones, it's important to take your child to a doctor for proper diagnosis and care if you notice a cough that would not go away or other symptoms. Also if they have been around someone with active TB, they need to get tested to either begin treatment or get TB ruled out.

TB diagnosis can be very challenging, but can be made through the following processes:

1. Medical History:

Your child’s past and present health details are required here. Their age matters here as well since children under 2 years are more vulnerable to TB. The doctor will ask about your child’s current illness, previous infections, feeding conditions, any known TB case in the family, if your child has had an acute food poverty, or has been in contact with someone who has TB. Be sure that all the medical information given are accurate as this will help your doctor to give the best care to your child.

2. Physical Examination

This includes the doctor feeling your child with hands, checking for discolouration of the skin, and changes in structure, especially of the chest and abdomen (belly). The doctor will also use a stethoscope (a thin plastic tube with ear tubes and a small membrane covered cup at each end) to listen to sounds in your child’s chest during breathing and to hear the beat of the heart. 

A stethoscope

 

Although physical examination cannot solely confirm or rule out TB, it can help to evaluate your child’s overall wellbeing, provide clues for diagnosis, and identify signs such as redness and swelling over the infected lymph nodes. It can also reveal possible factors that may affect treatment. 

3. Tests

There are several diagnostic tests for TB:

1. Blood Test: Your child’s blood sample is mixed with TB specific antigens (substances that your child’s immune system can recognise and react to). Because these substances are not present in the BCG, the blood test is more accurate for those who have received the BCG vaccine. The blood test also gives accurate results at one lab visit and is favoured for those who might not likely return for reading on follow up.

2. Mantoux Tuberculin Skin Test: The skin test requires a standardised solution called purified protein derivative (PPD) being injected under the skin to help diagnose TB infection.

How to perform and read a Mantoux Tuberculin Skin Test (TST). Photo credit.

 

After 48-72 hours, the injection site is examined for a reaction, specifically swelling and hardness that also tend to itch a lot. A positive reaction indicates that the person has been exposed to TB bacteria and has developed a sensitivity to them. It doesn’t confirm active TB disease is present. A positive Mantoux text could be due to latent infection or prior BCG vaccination. 

Your child’s doctor and other healthcare providers will interpret the Mantoux test result accurately while they take the medical history and personal risk factors into account.

3. Chest Radiograph (X-ray): This is done to differentiate between latent TB infection and pulmonary TB disease. It views your child’s chest region from the back to the front checking for abnormalities. Presence of lesions anywhere in the lungs may indicate TB disease. However the X-ray cannot still confirm diagnosis because the lesions may be due to other respiratory issues so it must be used alongside other tests. 

4. Bacteriologic Tests: Body fluids such as urine, blood, sputum and cerebrospinal fluid may be collected by your child’s doctor for testing in the laboratory for the identification of Mycobacterium tuberculosis.

• Acid-Fast Bacilli (AFB) Smear: The specimen collected is smeared onto a glass, stained and examined under a microscope. The result is classified as 4+, 3+, 2+, or 1+ according to the number of the Mycobacterium tuberculosis bacteria stained and seen under the microscope. The more the numbers seen the more the severity of the infection. 

• TB Culture and Identification: Culture, especially of coughed out sputum (fluid from the throat) is the gold standard for laboratory confirmation of TB disease in many African countries as it helps to identify the bacteria causing lung tuberculosis and test for drug sensitivity. The test takes about six to eight weeks to grow the bacteria in specialised conditions on a solid or in liquid medium. A positive culture confirms the diagnosis of TB disease while the negative may or may not rule it out.

• Nucleic Acid Amplification (NAA): This test is used to rapidly amplify the genetic footprint (DNA and RNA) to detect the presence of M.Tuberculosis bacteria within hours instead of using the culture method which may take weeks.
• Drug Susceptibility Test: This is done to determine the drugs that will be effective for treating the TB disease. 

 

How is tuberculosis treated in children?

Even if your child has been diagnosed with inactive TB, where there are no significant symptoms or discomfort, it is still highly recommended that you get them treated to prevent them from developing active TB in the future.

When your child has active TB, they typically need a combination of antibiotics such as isoniazid, rifampin, pyrazinamide and ethambutol. 

The treatment usually lasts for four to six months based on the severity of the disease, form of TB or presence of underlying health conditions like HIV.

Irrespective of the treatment regime, only a qualified healthcare provider should prescribe the medication. Do not self-medicate as TB treatment must be carefully tailored to each case or severity. Also in some situations, your child may need to be observed directly by a healthcare provider when taking their medications.

Ensure your child takes the full course of medication prescribed to them. If not, the child can become sick again. Also an incomplete use of medication can cause the bacteria to be drug resistant. The moment TB becomes resistant to drugs they become harder, more expensive and take longer time to treat.

 

Challenges of Tuberculosis treatment in Africa

Challenges of TB management in African children. Click on image to enlarge.

 

• Poor Awareness: Poor community awareness of the symptoms of TB coupled with cultural beliefs, cause delay in seeking help early

• Stigma: The fear of being discriminated may prevent infected individuals from seeking care, leading to delayed treatment 

• Weak health infrastructure: Weak healthcare system symbolised by staff shortages, inadequate health facilities, and  poor funding

• Limited access to healthcare: Socio economic factors, such as poverty, unemployment, and high cost of treatment could hinder infected individuals from getting treated

• Cost: In the absence of health insurance, the full cost of care (including transport, diagnostic tests, medications, supplies, etc.) may be too high for many infected people to bear out-of-pocket. This also contributes to delays in seeking care as well as poor compliance with treatment

• Misdiagnosis: This occurs in most cases as a result of inaccurate screening and testing process

• Drug resistant TB: When treatment is cut short, the infection can reoccur again and become harder to treat. 

 

How can I prevent tuberculosis in my child?

1. Vaccination: This is a vital way to protect and prevent your child from catching tuberculosis. The Bacillus Calmette Guerin (BCG) is a part of the routine immunization schedule given at or soon after birth especially to children in countries with high rates of TB like Nigeria 

2. Avoiding close contact with anyone known to have active TB:  If your child ever comes in contact with an infected person, consult a doctor immediately for evaluation, testing, contact tracing and management

3. Participation in health awareness raising and education: Helping to raise awareness and education in caregivers, schools, and communities about the cause, symptoms, mode of spread, prevention and importance of completion of treatment of tuberculosis is very vital to its control. 

4. Practicing good hygiene: This reduces the risk or spread of many infections including TB. Encourage your child to wash their hands regularly, cough into their elbow and cover their mouth when sneezing

5. Adopting healthy lifestyles: This helps to build a strong immune system in your children and improves their ability to fight off infections well.

• Feed them with balanced diet rich in fruits and vegetables
• Ensure they get adequate sleep and rest
• Encourage regular physical activity 

6. Encouraging your child to play in open spaces: As may be practical, make your children spend quality time daily in well ventilated rooms and open spaces.

7. Engaging with others in pressing political leaders and health managers for improved public health and social support: Evidence is available showing that improving affordable public housing, nutrition support, public open spaces, health infrastructure and availability of medicines  generally helps directly and indirectly in boosting the immunity of children against infections generally, including  response to TB bacteria.

 

Conclusion

Tuberculosis (TB) is a contagious infection caused by Mycobacterium tuberculosis. It mainly affects the lungs and can also affect other organs. It spreads through the air when an infected person coughs or sneezes. Children under five are especially vulnerable due to weak immune systems.

TB occurs in three stages: primary, latent, and active. Only active TB is contagious. In Nigeria, childhood TB remains a concern due to poverty, malnutrition, overcrowding, and HIV.

Symptoms in children include persistent cough, fever, night sweats, weight loss, and swollen lymph nodes. Diagnosis involves medical history, physical exam, blood/skin tests, chest X-ray, and lab tests like AFB smear and TB culture.

Treatment includes a 4 or 6-month antibiotic course and must be supervised by a healthcare provider. Completing treatment is crucial to prevent drug resistance.

Prevention involves BCG vaccination, avoiding contact with active TB cases, good hygiene, healthy nutrition, and ensuring well-ventilated living spaces.

 

References:

1. World Health Organization. Tuberculosis [Internet]. March 14, 2025. [Accessed July 28, 2025]. Available from here.

2. Center for Disease Control and Prevention (CDC). Clinical Overview of Tuberculosis Disease. [Internet]. 2025 April 17.  [Accessed July 28, 2025]. Available from here.

3. Center for Disease Control and Prevention. Tuberculosis in Children. [Internet]. 2025 April 17   [Accessed July 28, 2025]. Available from here.

4. Tristram D, Tobin EH. Tuberculosis in Children. [Updated 2024 Nov 22]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from here.

5. World Health Organization. Tuberculosis Profile-Nigeria. [Internet]. Last updated July 30, 2025.  [Accessed July 31, 2025]. Available from here. 

6. Stanford Medicine. Tuberculosis in children.  [Internet n.d]. [Accessed July 31, 2025]. Available from here.

7. Siddalingaiah N, Chawla K, Nagaraja SB, & Hazra D. Risk factors for the development of tuberculosis among the pediatric population: a systematic review and meta-analysis. European Journal of Pediatrics, 2023;182(7), 3007–3019. Available from here

8. Nyasulu P, Kambale S, Chirwa T, Umanah T, Singini I, Sikwese S, Banda HT, Banda RP, et al. Knowledge and perception about tuberculosis among children attending primary school in Ntcheu District, Malawi. Journal of Multidisciplinary Healthcare, 2016;9, 121–131. Available from here

9. Kloc M, Ghobrial RM, Kuchar E, Lewicki S, & Kubiak JZ. Development of child immunity in the context of COVID-19 pandemic. Clinical immunology. 2020;217, 108510. Available from here

10. Syeda Sahra. Tuberculosis (TB) treatment & management. [Internet]. Medscape. October 31, 2024. [Accessed July 28, 2025]. Available from here

11. Medanta. Tuberculosis (TB) in children: Types, symptoms, diagnosis & treatment. [Internet, n.d]. [Accessed July 29, 2025]  Available from here

12. NHS. UK.Tuberculosis(Tb)  [Internet]. Last reviewed April 20, 2023. [[Accessed July 30, 2025].  Available from here

13. Center for Disease Control and Prevention. About tuberculosis.January 17, 2025 [Accessed July 30, 2025]. Available from here

14. Shaban D. Understanding tuberculosis: causes, symptoms, and treatment options. WebMD. July 27, 2023.  [Accessed July 30, 2025]. Available from here

15. Center for Disease Control and Prevention. Clinical and laboratory diagnosis for tuberculosis. January 31, 2025. [Accessed July 30, 2025. Available from here.

 

Related: Chest Infection in African Children

 

 

Published: August 25, 2025

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