Factors contributing to low tuberculosis diagnosis among children aged 0–14 years in Gem Sub County in Siaya County, Kenya

TL;DR

This study explores why many children in Kenya are not diagnosed with tuberculosis, finding issues like diagnostic barriers, stigma, and lack of healthcare worker training.

Contribution

The study identifies specific factors in a high TB burden region affecting child diagnosis, including healthcare worker confidence and diagnostic access.

Findings

About a third of TB cases in children required three or more facility visits before diagnosis.

Clinical officers showed higher odds of confidence in sample collection and GeneXpert interpretation than nurses.

Trained healthcare workers were significantly more likely to interpret X-rays accurately.

Abstract

Tuberculosis (TB) is a top global health challenge, with 1.2 million children aged 0–14 years becoming ill with TB every year. Yet, a significant proportion remain undiagnosed or missed due to diagnostic barriers. This cross-sectional study employing an embedded mixed method approach investigated factors contributing to low tuberculosis diagnosis among children in Gem Sub County, Siaya County Kenya, a high burden region. Data was collected from 71 healthcare workers (HCWs) and 16 respondents across six wards using semi-structured questionnaires and TB register abstraction. Qualitative data underwent deductive thematic analysis while quantitative data was analyzed using descriptive statistics and logistic regression in SPSS version 27. About a third (31.3%) of TB cases in children required three or more facility visits before diagnosis, with some needing up to 12 visits. Costly and inaccessible chest X-rays and GeneXpert underutilization due to difficulties in sputum and alternative sample (gastric lavage, nasopharyngeal aspirates) collection were key diagnostic constraints. Delayed care-seeking due to stigma, misconceptions (56.3% linked childhood TB to HIV) and low TB symptom awareness (37.5% of children presented with ≤2 symptoms) were patient related factors associated with low TB diagnosis. About 56.3% of caregivers sought routine TB screening, but 62.5% sought care only after persistent symptoms. Clinical officers showed substantially higher odds of reporting confidence in sample collection (OR=34, 95% CI 3.81–303.21, p = 0.002) and GeneXpert interpretation (OR=15, 95% CI 3.20–70.39, p < 0.001) than nurses. Trained HCWs were 7.16 times more likely to interpret X-rays accurately (95% CI 2.16–23.67, p < 0.001). Enhanced HCW training, improved diagnostic access, targeted community education on stigma and misconceptions are critical for early TB detection in children.

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