Free TB Children: Contributing to the Eradication of Pediatric Tuberculosis in Sierra Leone

According to the World Health Organization (WHO), 1.3 million children and young adolescents contract tuberculosis each year worldwide, yet only half are diagnosed and treated. More than 200,000 children die from the disease annually, nearly half of them in Africa. Sierra Leone is among the most affected countries. In response to this crisis, Solthis, a health NGO, with the support of L’Initiative, launched the Free TB Children project, a 48-month initiative. This project builds on the success of TB Speed, which demonstrated the effectiveness of decentralizing pediatric tuberculosis screening. Free TB Children specifically targets children under five in Bo District, one of the hardest-hit regions, aiming to strengthen both diagnosis and access to treatment.

The diagnosis of children under five is a priority, as they account for 80% of pediatric tuberculosis-related deaths worldwide. In Sierra Leone, they are rarely screened or given preventive treatment, despite the high prevalence of the disease, which is further worsened by malnutrition—a major risk factor affecting one third of them. Lack of awareness among parents and healthcare providers, stigma, financial barriers, and limited access to healthcare further complicate treatment, which has already been weakened by the Ebola epidemics (2014–2016) and the COVID-19 outbreak (2020–2021).

First Operational Research on Pediatric Tuberculosis Screening

With the support of L’Initiative, the TB Speed project, launched in 2017 by the University of Bordeaux in partnership with Solthis and the National Leprosy and Tuberculosis Control Program (NLTCP), tested systematic screening on more than 8,000 children exposed to tuberculosis in the Bo and Port Loko regions. The project relied on GeneXpert technology, which detects the DNA of Mycobacterium tuberculosis, and on training healthcare workers to improve case detection. Additionally, decentralizing diagnosis to district hospitals and primary health centers significantly enhanced tuberculosis detection rates. Building on these results, L’Initiative and Solthis are continuing their long-standing partnership with the Free TB Children project, which aims to accelerate early screening and decentralize pediatric tuberculosis diagnosis in Bo Province.

A Comprehensive, Large-Scale Project

With a total budget of €2,675,000, 90% of which is funded by L’Initiative – Expertise France, the project is being implemented by Solthis in collaboration with several key partners:

• The National Leprosy and Tuberculosis Control Program (NLTCP), responsible for the national tuberculosis control strategy.
• The Civil Society Movement Against Tuberculosis Sierra Leone (CISMAT-SL), which strengthens community engagement to improve awareness and access to care.
• The Lincoln Institute for Rural and Coastal Health (LIRCH), which conducts operational research to support the national scale-up of systematic screening.

Training sessions will be provided to primary and maternal healthcare workers on pediatric tuberculosis, screening, and referral of suspected cases. A specialized training program will also help district hospital professionals enhance diagnosis and patient care, including in maternal health, HIV, and nutrition. This community-based approach ensures a continuum of care, from screening to the management of sick children, while also identifying contact cases. It guarantees equitable access to healthcare and strengthens families’ autonomy through awareness and education.

Research and Advocacy for National Scale-Up

To ensure local ownership of the project and prepare for its nationwide expansion, an operational research study is being conducted in collaboration with LIRCH. This study will assess the feasibility, effectiveness, and cost efficiency of the screening and treatment strategy.

The findings will be used to support advocacy efforts and integrate the most effective solutions into Sierra Leone’s national policies on pediatric tuberculosis control. Through this integrated and collaborative approach, Free TB Children aims to significantly reduce the impact of tuberculosis on young children and improve access to care for the most vulnerable populations.