Gaps in Pediatric Tuberculosis Detection, Diagnosis and Association with Timely Treatment at Kerugoya County Referral Hospital, In Kirinyaga County, Kenya

Abstract

Delayed detection and case diagnosis of pediatric tuberculosis (TB) is a significant factor in TB transmission, morbidity, and mortality especially in resource-limited settings, such as the sub-Saharan Africa, including Kenya. This study aimed to identify gaps in pediatric TB case detection and diagnosis, as well as their association with prompt treatment in such settings by focusing on a level 5 hospital in the Kenyan healthcare system; that is Kerugoya County Referral Hospital (KCRH), in Kirinyaga County, in Kenya. A facility-based cross- sectional survey that adopted a mixed methods approach by collecting quantitative and qualitative data using structured questionnaires and interviews guides was conducted at KCRH. To characterize the cases, secondary data for the paediatric TB cases diagnosed and treated at KCRH during the period between 1st January, 2024 to 31st December, 2024, was also collected. The study participants included randomly selected healthcare workers (HCWs) and section heads at the same facility. Quantitative data was analyzed using descriptive statistics for the medians, range, frequencies and relative frequencies, and inferential statistics for significant associations and relationships (Odds ratios, p < 0.05), and the results presented in the form of summary tables and a bar graph.Qualitative data was analyzed thematically and results presented as narratives and illustrative direct quotes of the respondents. Notably, although there were only minimal delays from the case diagnosis to treatment initiation, the study found substantial delays in the whole spectrum of paediatric TB health-seeking pathway. With an overall median duration from the “first visit to hospital” to the “TB treatment initiation” of 30 (2 - 205) days, it means that nearly half or 48% (59/123) of all the paediatric TB cases seen at the KCRH during the specified period experienced HCW and Healthcare system- related delays in treatment initiation, ranging from 8 to 198 days. Additionally, the median duration from signs and symptom onset to the first visit to hospital was 35 (2 – 215) days, meaning that 43.1% (53/123) of the same paediatric TB cases experienced caregiver- related delays in detection. Furthermore, although there were delays from the onset of symptoms to paediatric TB case diagnosis (median duration of 69 (3 – 273) days and with 82.9% (102/123) of the cases experiencing delays in TB diagnosis ranging from 8 to 266 days, on a positive note there was minimal delays in treatment initiation once the TB was diagnosed. The median time for this interval was only 2 days, with only 4.1% (5/123) of the cases experiencing some delays in treatment initiation. Some of the targeted community education on paediatric TB, as stigma reduction initiatives at the community/household level, is recommended. Finally, more health financing support, and further research into caregiver behaviors and educational interventions are critical to accelerating diagnosis and improving pediatric TB outcomes.