The recognition of a case of childhood tuberculosis (TB) is a sentinel public event. It reflects a poor adult TB control programme, a marker of other diseases, e.g. HIV, provides a reservoir for future cases of TB, an opportunity to undertake contact tracing and a need for action in child health. Childhood TB accounts for 11% (884 000 cases) of the global burden of TB, with Africa accounting for 27% of the global cases despite having just 11% of the world’s population. South Africa has the seventh highest global burden of TB with an incidence of 600/100 000. Of the 2.8 million cases of childhood HIV disease, 2.2 million ( 80%) live in sub-Saharan Africa (SSA). There are 665 000 new childhood infections and 450 000 deaths (3%) globally from HIV each year despite effective strategies for the prevention of mother-to-child transmission. In SSA, only 6% of children deserving antiretroviral drugs receive therapy; consequently HIV disease accounts for 6% of all deaths in children younger than 5 years of age. In South Africa, of the 240 000 HIV-infected children only 10-15% receive treatment.