09 September 2025
Launch of the RISK4Kids operational research project in Bangladesh
A new observational study has been launched in Bangladesh to evaluate novel sputum free triage tools in parallel with routine care to better diagnose pneumonia in children.
The study is conducted by teams from the Mérieux Foundation and icddr,b
Pneumonia remains a leading cause of mortality among children under five, responsible for about 14% of global child deaths in 2019 (WHO, Pneumonia. Fact sheet, 2020). Although largely preventable and treatable through vaccination, adequate nutrition, and timely administration of antibiotics and oxygen (WHO, Pneumonia in children, 2022), pneumonia continues to claim hundreds of thousands of young lives annually.
In resource-limited settings, diagnosis relies primarily on WHO clinical criteria: cough or difficulty breathing in children under five, age-specific tachypnea, and signs of respiratory distress. Severe disease is indicated by danger signs such as inability to drink, lethargy, convulsions, cyanosis, or hypoxemia. However, this approach lacks specificity and does not distinguish bacterial from viral pneumonia. Differentiating pneumonia from pulmonary tuberculosis (TB) is particularly challenging in children with recurrent or non-resolving illness.
In Bangladesh, despite implementation of the Integrated Management of Childhood Illness (IMCI) algorithm, pneumonia remains a leading killer, accounting for ~19–24% of under-five deaths (~24,000 annually) (Rahman AE et al., doi:10.7189). This burden coexists with a high incidence of pediatric TB (WHO TB Report 2024), creating overlapping clinical presentations and significant diagnostic uncertainty.
To address these challenges, the Mérieux Foundation, in collaboration with the Bangladesh Institute of Tropical and Infectious Diseases (BITID) and icddr,b, launched the RISK4Kids operational research project in July 2025. This 18-month prospective observational study enrolls children under 10 years presenting with cough and/or respiratory distress. The project evaluates novel sputum free triage tools in parallel with routine care: C-reactive protein (CRP) as a biomarker, AI-assisted chest X-ray interpretation, and the RISK6 transcriptomic signature, individually or in combination.
If validated, these approaches could enable earlier and more accurate therapeutic decisions, reducing mortality and morbidity from both pneumonia and pediatric TB, while minimizing inappropriate antibiotic prescriptions.
Dr Mohammad Khaja Mafij Uddin (icddr,b), Dr Zakir Hossain (BITID), and Stéphane Pouzol (Mérieux Foundation)