ORIGINAL RESEARCH article
Front. Tuberc.
Sec. Diagnosis of Tuberculosis
Acceptability and feasibility of oral swabs for tuberculosis diagnosis in young children: a qualitative study from Uganda and Peru
Provisionally accepted
Francesca Wanda Basile1*
Rodrigo Calderon2
Franziska Held3Luisa Pollmeier3Emmanuel Nasinghe4Godfrey Bagenda5
Lazaaro Mujumbusi5Rose Namaganda6Angel Kanyange4Prossy Mbekeeka7Abner Tagoola7
Jerrold J Ellner8
Susan E Dorman9Moses Joloba4Carlos Zamudio2Adeodata Kekitiinwa6
Rinn Song1Nora Engel10- 1University of Oxford Oxford Vaccine Group, Oxford, United Kingdom
- 2Universidad Peruana Cayetano Heredia Instituto de Medicina Tropical Alexander von Humboldt, Lima District, Peru
- 3Universiteit Maastricht Department of Health Ethics and Society, Maastricht, Netherlands
- 4Integrated Biorepository of the H3Africa Uganda, Kampala, Uganda
- 5Makerere University College of Health Sciences, Kampala, Uganda
- 6Baylor College of Medicine Children's Foundation-Uganda, Kampala, Uganda
- 7Jinja Regional Referral Hospital, Jinja, Uganda
- 8Rutgers New Jersey Medical School, Newark, United States
- 9Medical University of South Carolina, Charleston, United States
- 10Vrije Universiteit Amsterdam Athena Instituut, Amsterdam, Netherlands
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Abstract (208 words) Background: Tuberculosis (TB) remains a leading cause of morbidity and mortality in young children, parMcularly in seSngs with limited diagnosMc capacity. Oral swabs represent a promising alternaMve specimen type due to their ease of collecMon, but evidence on their acceptability and feasibility remains limited. Methods: This qualitaMve sub-study was nested within the NOD-pedFEND diagnosMc trial evaluaMng novel tests for pediatric TB. We conducted semi-structured interviews and focus group discussions with 81 parMcipants across Uganda (n=57) and Peru (n=24), including caregivers (Uganda n=30; Peru n=7), healthcare workers (Uganda n=23; Peru n=12), and NaMonal TB Program stakeholders (Uganda n=4; Peru n=5). ParMcipants were recruited purposively from among those involved in or linked to the parent NOD-pedFEND study. Data were analyzed using themaMc analysis. Results: Oral swabs were widely perceived as acceptable due to their non-invasive nature, minimal discomfort, and ease of collecMon. Caregivers and healthcare workers valued the reduced burden on children compared to more invasive sampling methods. Across both countries, parMcipants expressed concerns about perceived low diagnosMc sensiMvity in children, parMcularly when compared with reference standard specimens. Despite these reservaMons, oral swabs were welcomed as a complementary, rather than subsMtute, diagnosMc modality. Stakeholders highlighted their potenMal role within future point-of-care diagnosMc strategies in low-resource seSngs. Conclusions: Oral swabs are acceptable and feasible for pediatric TB diagnosis in diverse seSngs, though concerns about sensiMvity persist. Their integraMon as an add-on test could expand diagnosMc access, especially if incorporated into scalable, point-of-care approaches.
Keywords: Acceptability, Childhood TB, Diagnostic research, feasibility, implemenation, qualitative study, TB diagnosis delay, tongue swabs
Received: 16 Oct 2025; Accepted: 22 Jan 2026.
Copyright: © 2026 Basile, Calderon, Held, Pollmeier, Nasinghe, Bagenda, Mujumbusi, Namaganda, Kanyange, Mbekeeka, Tagoola, Ellner, Dorman, Joloba, Zamudio, Kekitiinwa, Song and Engel. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Francesca Wanda Basile
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