Post-tuberculosis lung disease in children and adolescents: Myth or reality – A narrative review

Childhood tuberculosis (TB) remains a major cause of morbidity and mortality in high-burden settings, with Africa carrying a disproportionate share of incident and undiagnosed disease. A longstanding cure-centered paradigm has reinforced the notion that post-TB lung disease (PTLD) in children is rare or clinically unimportant. In this narrative review, drawing on literature identified through PubMed and prioritizing evidence from high-burden African settings, we show that a meaningful subset of children and adolescents has persistent symptoms, impaired lung function, and/or radiographic sequelae after completing treatment. These sequelae may affect overall well-being, including growth, exercise tolerance, school participation, and health-related quality of life. Prospective cohort data, including a birth cohort with pre-TB measurements, strengthen causal inference by linking early-life TB to later respiratory impairment and age-dependent trajectories during critical windows of lung development. We describe current practice in Africa, highlighting gaps between guidance and implementation: Limited access to child-appropriate spirometry, variable quality and interpretation of chest radiography, constrained availability of computed tomography scans, and weak referral and rehabilitation pathways. Finally, we outline priorities to move from recognition to action: integrate structured post-treatment follow-up into pediatric TB care, strengthen diagnostic and rehabilitation capacity, embed PTLD indicators within national program monitoring, and advance African-led research to harmonize definitions, establish longitudinal cohorts, and evaluate scalable service delivery models aligned with universal health coverage goals.