 Thank you. So, good morning everybody. To start talking, MSF has been working in Uzbekistan since 1998 in the semi-autonomous republic of Karakapakistan, in Uzbekistan Central Asia. And we have a program there about tuberculosis. We diagnose and treat patients with tuberculosis in cooperation with the Ministry of Health of the country. And since 2013, we have a specific guidelines for treatment of children there. Uzbekistan is one of the 27 countries of the world with high burden of MDR TB, multidrug-resistant TB, and this high burden is also expected within the pediatric population. Because most often they will get this disease within their own houses or with the adult which they are in close contact. To diagnose tuberculosis in children, we have unique challenges because usually children, they will get specific symptoms such as cough or fever, and those of younger age they have usually inability in producing sputum and also they have balsybacillary disease which means they have low concentrations of the bacillus in their lungs. Also to try to improve diagnosis of tuberculosis in children we must gather together the symptoms, radiological findings and also laboratory results which means microbiological results when it's possible. And also it's very important history to take a great history of the children. So in the history it's very important to try to find between the contacts of the children any person that is on treatment of tuberculosis trying to figure out if this patient has much drug resistant or much drug sensitive tuberculosis especially in those cases that we have negative laboratory results. And this is part of contact tracing, it's very important trying to diagnose the children in the right way. And also trying to increase the laboratory results we have two different procedures that we can do in children which are sputum induction already implemented in Karakapakstan and also gastric aspirated. So knowing about these difficulties in getting laboratory positive results in children and also knowing that Uzbekstan is a country with high burden of much drug resistant TB we decided to compare the treatment regimens prescribed for patients, pediatric patients with positive laboratory diagnosis of TB and those with negative laboratory diagnosis in Karakapakstan. For this aim we did a retrospective analysis of the routinely collected data from our program from 2013 to 2015 from our children and adolescents with age equal or less than 18 years old. As our results we had the total number of 655 pediatric patients that were started on tuberculosis treatment during this time 2013 to 2015 in Karakapakstan. The major age of them was 13 years old, 51% of them were male, 20% of them were less than 6 years old and 70% of the total number did not have a positive laboratory results, did not have a confirmation laboratory of tuberculosis. About the outcomes we have data from 2013 to 2014 because when we were doing this research many of our population that were started in 2015 did not complete the treatment regimen, those DS and DR. So our data is from the DS Drug Sensitive patients from 2013 to 2014, 355 patients. From then 69.5% had a good outcome which means treatment completed most of them and cured, cured it needs to be with positive laboratory results on the beginning. And we had one patient that died, one patient that was a failure, 3% of them were lost of follow-up and another 3% were transferred to MDR treatment regimens. And we had 24% of our patients with missing data. We don't know the outcomes in our database. So from our results we had 86% of our patients starting on treatment on drug sensitive treatment and only 14% of our patients starting on drug resistant treatment. And from the patients that were started on DS mainly they had negative lab results and for those that started DR mainly they had positive lab results. So from the 457 patients with negative lab results only 1% of them were started on DR treatment and from the 198 patients with positive lab results 41% of them had as diagnosis MDR tuberculosis. The odds rate between those two different groups is 3.63 and the p-value is less than 0.001. Just to compare the adult population in Karakapakstan in a survey from 2011 40% of them were started on DR treatment. Also we compare the treatment between the patients less than 6 years old and those from 6 to 18 years old and the odds rate between them is also relevant of the number 14 and our p-value is less than 0.001 meaning that children less than 6 years old only 4% of them had positive lab results and those children and adolescent from 6 to 18 36% of them had positive lab results. Also when we were collecting this data we realized that 44 patients they had more than one treatment cost regimen prescribed for them between 2013 and 2015 and from these patients on their first treatment cost that we have on our database 95% of them were started on DR treatment on their first regimen and these proportion drops to only 18% on their first treatment regimen. From those patients, 42 patients that were started on DR treatment on their first treatment regimen 16 of them had negative laboratory results did not have microbiological confirmation of tuberculosis and 26 of them had positive results and from those 81% were founded later that they had multi-drug resistant tuberculosis and not DS. The range time between the first treatment regimen and the second treatment regimen the corrected regimen vary from 24 days to 246 days. So in conclusion the RTB is being under-diagnosed in children especially those of younger age and contact tracing is critically important when there is a lack of lab diagnosis trying to identify the potential source of the infection of the children and try to have the likelihood of DS or the RTB in children. Also we figured out that we need to increase suspicion of the RTB in children in Uzbekistan also we need to increase our efforts to get lab diagnosis in children such as implementing gastric aspirate which is really good for those children less than six years old and it's of critical importance due to contact tracing especially in children without lab diagnosis. I would like to thank the Minister of Health of Karakapakstan and also the Epidemiology Department of MSF in Nukuz especially Dr. Robert Tokena Thank you.