Pathways to diagnosis in children and adolescents with tuberculosis in Kenya

Abstract

Background: Tuberculosis in children signals active community transmission. About one million children develop TB annually, but most remain undiagnosed or face delayed treatment. Atypical presentations and limited diagnostic tools increase the risk of late or missed diagnoses, emphasizing the urgent need for enhanced screening, timely detection and effective management strategies to reduce morbidity and transmission.

Methods: This facility-based cross-sectional study was conducted from January to September 2025 at KNH, Mbagathi County Hospital and KEMRI, Nairobi. It included mothers of children aged ≤19 years with clinical or bacteriologically confirmed TB who provided consent/assent. A sample of 218 participants was selected using Yamane’s (1967) formula via consecutive sampling. Data were collected with structured questionnaires and analyzed using SPSS version 26.0.

Results: Among 117 children with TB, most were female (56.4%) and aged 0–5 years (66.7%). The majority visited two or more facilities (61.5%), primarily referral hospitals (43.6%). Extreme diagnostic delays (>8 weeks) occurred in 46.2%, with significant factors including the first health worker’s cadre (p=0.017) and parental age>35 years (p=0.021).

Conclusions: This study found significant delays in childhood tuberculosis diagnosis, with 46.2% experiencing delays over eight weeks and 56% delayed after facility presentation. Most children visited two or more facilities (61.5%), mainly referral hospitals (43.6%). Delays were significantly associated with the cadre of the first health worker consulted (p=0.017) and parental age above 35 years (p=0.021), emphasizing the need for improved health system efficiency, parent education and targeted training of healthcare workers to enhance timely TB detection and management.