A lack of diagnostic equipment in Cambodia is causing cases of tuberculosis to be both over- and under-reported in children, a new study finds.

The study, published in online peer-reviewed journal BioMed Central Public Health, found the “availability of advanced diagnostic tools was low”.

“Only 27.5% of clinicians had Xpert machines available at their facility, and 5% had equipment to perform gastric aspiration,” the study reads.

But even when equipment was available, it wasn’t always used effectively.

While more than 77 percent of 40 clinicians interviewed said they had a chest X-ray at their health care centre, less than 35 percent of 104 parents reported that an X-ray examination was conducted on their child.

The limited availability of these tools, and “suboptimal clinician performance”, highlighted that more resources should be allocated to improve diagnoses of tuberculosis cases “which are likely being missed”, the report concluded.

Dr Mao Tan Eang, director of the National Centre for Tuberculosis and Leprosy Control, said while lack of equipment was a persistent problem, training in screening – not necessarily diagnosis – was widespread.

“In terms of diagnosing children, it’s quite complicated. We have trained some, but they need to be further refreshed in terms of diagnosis as well as [screening] training,” he said, adding diagnosis can only be done at the hospital level, not at the health-centre level.

He doubted there was much “over-diagnosis”, saying they identify 6,000-7,000 cases of tuberculosis per year.

Ministry of Health spokesman Ly Sovann described the situation as “very difficult” and said the government was trying to “reduce the prevalence of tuberculosis”, but did not elaborate on funding questions.