“She has been sick for the last three months, with persistent fever and cough. I went to a medical store and bought injections for her. She improved for five days but then became as sick as before. When the driver guided me to this place, I was weeping. They did an X-ray and said she has tuberculosis (TB),” said Nooria, whose 8-month-old daughter Nomania is one of the patients admitted to the MSF Inpatient Therapeutic Feeding Centre (ITFC) in Kandahar, southern Afghanistan, and later diagnosed with TB.
Malnutrition is a major risk for TB infection and progression to active TB, especially among children, while active TB exacerbates malnutrition by causing weight loss and heightened energy demand to tackle the infections.
Afghanistan grapples with a high burden of TB as well as child malnutrition. Yet, detecting and diagnosing paediatric TB in malnourished children remains challenging, and the level of awareness of these compounded diseases among the community is quite limited and stigmatized, which often results in delays in seeking the needed care.
In 2025, at least 10% of malnourished children treated by MSF team in Kandahar were diagnosed with TB – more than double the 2024 figure. Rather than signaling a worsening health burden, this increase highlights the importance of the team’s systematic TB screening during admission into the nutrition programme. It is widely believed that TB in malnourished children is underestimated and underdiagnosed, and actual numbers are understated.
To address this, MSF team in Kandahar has adopted a multi-pronged approach that includes systematic screening and a robust referral pathway for specialised TB care. When patients arrive at MSF facilities in Kandahar for the nutrition programme, the team conducts medical screening, covering medical history, household contact tracing, and clinical assessment. Based on the results, an X-ray may be performed for confirmation. Patients then receive nutritional support and start TB treatment during admission. Once malnutrition treatment is complete, patients are then referred to the provincial TB centre for onward advanced TB care.
Since 2016, MSF has been providing care for drug-resistant TB (DR-TB) patients in Kandahar province. MSF runs a dedicated DR-TB hospital with a laboratory, an outpatient clinic, and a 24-bed inpatient department. This facility serves as the main referral centre for DR-TB cases across Kandahar and southern Afghanistan. Concurrently, MSF operates a 45-bed ITFC, and an ambulatory therapeutic feeding centre (ATFC) to combat malnutrition in children under five. This integrated setup enables proactive screening and treatment of malnourished children with TB. Additionally, the team is supporting the National TB Programme through existing drug-sensitive TB structures in the provinces with screening, detection and referral linkage for DRTB treatment in provincial treatment centres in Kandahar.
