Substantial progress has been made in the fight against tuberculosis (TB); however, new approaches are needed to achieve the current target set by the World Health Organization (WHO) to reduce TB incidence to 90% of 2016 levels by 2035 (1). A key element of WHO’s End TB Strategy is the prioritization of preventive treatment (2). However, the preventable burden of childhood TB has not been quantified in prospective epidemiologic studies, and globally, only an estimated 7% of eligible children received isoniazid chemoprophylaxis in 2015 (1).

Diagnosis of TB is more challenging in children than in adults (3). In low-resource settings, where TB burden is highest, diagnosis often relies on poorly validated clinical algorithms (4). As a result, adequate surveillance data are lacking, and published estimates of the global childhood TB burden vary widely (1,5–11). High-quality prospective data on the TB burden and case detection rate (CDR) in children are recognized priorities (8,11,12), and population-level data showing the preventable burden of childhood TB might reinforce the public health case for chemoprophylaxis in children. We designed the Kilifi Improving Diagnosis and Surveillance of Childhood TB (KIDS TB) Study to estimate the incidence, CDR, risk factors, and preventable burden of childhood TB in Kenya.