Diagnosis and outcome of childhood tuberculosis: implementing public health policy in three districts of Pakistan. 
All nine public sector hospitals in three districts of Pakistan.  To estimate case notifications of children with tuberculosis (TB) and their outcomes.  A retrospective cohort following all children aged <15 years placed on TB treatment under the National TB Control Programme (NTP) in public hospitals.  The study period was 2 years before and 2 years after the implementation of new NTP policy guidelines for childhood TB.  Data were collected from hospital TB registers, patient treatment cards and quarterly reports.  With the introduction of the new NTP policy, case notification of childhood TB increased from 189 (2004-2005) to 731 for the 2 years 2006-2007.  The annual notification rate of childhood TB cases increased from 1.4 (2004-2005) to 5.2 per 100 000 population (2006-2007).  Of the total 920 childhood TB cases registered, 610 were pulmonary, 202 extra-pulmonary and the remaining 108 unclassified.  The three-fold increase in case notification was accompanied by a lack of follow-up, resulting in an increase in unknown treatment outcomes from 21.7% to 73.3%.  Managing children with TB in routine NTP practice is possible, but without adequate operational guidelines, expanding services and follow-up, it can lead to suboptimal results.