India has the most number of child deaths due to tuberculosis, according to a Lancet study which found that over 55,000 children died from the disease in the country in 2015. Tuberculosis (TB) is thought to have affected more than one million children under 15 worldwide in 2015. Diagnosis of TB in children can be challenging, partly due to insensitive tests and non-specific symptoms. Although younger children are vulnerable to more severe forms of the disease, there are currently no estimates of the mortality rate for under-fives. “We estimate 239,000 children aged 14 years and under died from TB in 217 countries in 2015. 80 per cent of these were children under five years of age. This makes TB one of the top 10 causes of death in the age group,” said Pete Dodd from the University of Sheffield in the UK. Over 96 per cent of these deaths were in children not receiving treatment for the disease. Given excellent treatment outcomes, this highlights the scope to reduce this toll by improving treatment coverage. Most deaths were in the Africa and Southeast Asia regions, both for chilren under 5 and 15. The highest mortality was found in India, Nigeria, China, Indonesia, and the Democratic Republic of the Congo. All these countries are on the current WHO list of 30 high tuberculosis burden countries; all are populous, with tuberculosis incidence rates under 400 per 100,000 per year, researchers said. “Historically, TB in children has not received the attention that it might have done. The World Health Organization has been encouraging countries to report the number of TB cases they find in children by age group,” Dodd said. “This should be a call to action: TB is preventable and treatable and we must do more to stop these unnecessary deaths in children,” said Helen Jenkins, Assistant Professor at Boston University. Under-five mortality was a key indicator in the Millennium Development Goals and the subsequent Sustainable Development Goals, and is tracked by the UN Inter-agency Group on Child Mortality Estimation (IGME). These estimates have been important in assessing progress towards targets, directing public health funding and spending, and for advocacy.