Patient and Health System Factors Associated with Post Presentation Delay in Tuberculosis Diagnosis in Starehe Sub-County, Nairobi
DOI:
https://doi.org/10.47604/gjhs.3689Keywords:
Tuberculosis, Diagnostic Delay, Post-Presentation Delay, Missed DiagnosisAbstract
Purpose: Majority of TB patients seek care at an advanced stage of the disease. However, diagnosis is often not made at the first point of contact prolonging infectiousness and complicating treatment. Previous research has focused on delayed health care-seeking, while few studies have comprehensively assessed the full diagnostic pathway particularly in urban settings where health services are presumed better. This study aimed to assess the duration and factors contributing to TB diagnostic delay after initial contact with a healthcare provider in an urban subcounty in Nairobi, Kenya.
Methodology: A cross-sectional survey was conducted among TB patients on treatment in two health facilities within Starehe Sub County, Nairobi. Structured questionnaires were used to collect data on sociodemographic, health seeking behavior and accessibility. Descriptive analysis was done to understand the socio demographic characteristics. Bivariate and multivariate logistic regression were used to identify factors associated with the delay.
Findings: The median delay from initial contact to diagnosis was 14 days, with 52% of the respondents exceeding this period. In the analysis of post presentation diagnostic delay, lack of symptom improvement after initial medication remained statistically significant p= 0.03 (AOR = 3.73, 95% CI: 1.12–12.43). 92.5% of the study population were treated for alternative presumed conditions before receiving a TB diagnosis, indicating missed diagnostic opportunities. Both patient-level and health system factors contributed to prolonged TB diagnostic timelines in this setting, underscoring persistent gaps in timely case detection. Strengthening patient awareness alongside enhanced clinical suspicion, follow-up, and diagnostic pathways is essential to reduce delays in urban TB care.
Unique Contribution to Theory, Practice and Policy: The study findings highlight critical missed opportunities for timely TB diagnosis post initial care seeking. Tailored communication and targeted support for at risk groups may help address delays linked to underestimation of TB risk or overreliance on self-treatment. Strengthening provider capacity in TB suspicion and clinical follow up including routine reassessment of patients whose symptoms neither improve nor worsen is equally critical. Closing these gaps is essential to reduce missed opportunities within the health system.
Downloads
References
Buregyeya, E., Criel, B., Nuwaha, F., & Colebunders, R. (2014). Delays in diagnosis and treatment of pulmonary tuberculosis in Wakiso and Mukono districts, Uganda. BMC Public Health, 14, Article 586. https://doi.org/10.1186/1471-2458-14-586
Creswell, J., Sahu, S., Blok, L., Bakker, M. I., Stevens, R., & Ditiu, L. (2014). A multi-site evaluation of innovative approaches to increase tuberculosis case notification: Summary results. PLOS ONE, 9(4), e94465. https://doi.org/10.1371/journal.pone.0094465
Eltayeb, D., Pietersen, E., Engel, M., & Abdullahi, L. (2020). Factors associated with tuberculosis diagnosis and treatment delays in Middle East and North Africa: A systematic review. Eastern Mediterranean Health Journal, 26(4), 468–479. https://doi.org/10.26719/emhj.19.079
Enos, M., Sitienei, J., Ong’ang’o, J., Mungai, B., Kamene, M., Wambugu, J., et al. (2018). Kenya tuberculosis prevalence survey 2016: Challenges and opportunities of ending TB in Kenya. PLOS ONE, 13(12), e0209098. https://doi.org/10.1371/journal.pone.0209098
Finnie, R. K. C., Khoza, L. B., Van den Borne, B., Mabunda, T., Abotchie, P., & Mullen, P. D. (2011). Factors associated with patient and health care system delay in diagnosis and treatment for TB in sub-Saharan African countries with high burdens of TB and HIV. Tropical Medicine & International Health, 16(4), 394–411. https://doi.org/10.1111/j.1365-3156.2010.02718.x
Juma, B. M., Nzioki, J. M., Kibiti, C., & Shaikh, M. (2022). Socio-cultural factors associated with patient delay in commencement of anti-TB drugs among TB patients in Kwale County, Kenya. African Journal of Health Sciences, 35(4), 469–474. https://doi.org/10.4314/ajhs.v35i4
Kenya Institute for Public Policy Research and Analysis. (2021). An assessment of healthcare delivery in Kenya under the devolved system. https://kippra.or.ke/wp-content/uploads/2021/02/an-assessment-of-healthcare-delivery-in-kenya-under-the-devolved-system-sp19.pdf
Kunjok, D. M., Mwangi, J. G., Kairu-Wanyoike, S., Kinyua, J., & Mambo, S. (2024). Spatial epidemiology of tuberculosis diagnostic delays, healthcare access disparities, and socioeconomic inequities in Nairobi County, Kenya. PLOS Global Public Health, 4(1), e0003320.
Lambert, M. L., & Van der Stuyft, P. (2005). Delays to tuberculosis treatment: Shall we continue to blame the victim? Tropical Medicine & International Health, 10(10), 945–946. https://doi.org/10.1111/j.1365-3156.2005.01485.x
Laohasiriwong, W., Mahato, R. K., Koju, R., & Vaeteewootacharn, K. (2016). Delay for first consultation and its associated factors among new pulmonary tuberculosis patients of Central Nepal. Tuberculosis Research and Treatment, 2016, Article 4583871. https://doi.org/10.1155/2016/4583871
Liefooghe, R., Baliddawa, J. B., Kipruto, E. M., Vermeire, C., & De Munynck, A. O. (1997). From their own perspective: A Kenyan community’s perception of tuberculosis. Tropical Medicine & International Health, 2(8), 809–821. https://doi.org/10.1046/j.1365-3156.1997.d01-380.x
Lönnroth, K., Corbett, E., Golub, J., Godfrey-Faussett, P., Uplekar, M., Weil, D., & Raviglione, M. (2013). Systematic screening for active tuberculosis: Rationale, definitions and key considerations. The International Journal of Tuberculosis and Lung Disease, 17(3), 289–298. https://doi.org/10.5588/ijtld.12.0797
Masini, E., Hanson, C., Ogoro, J., Brown, J., Ngari, F., Mingkwan, P., et al. (2017). Using patient-pathway analysis to inform a differentiated program response to tuberculosis: The case of Kenya. The Journal of Infectious Diseases, 216(Suppl. 7), S714–S723. https://doi.org/10.1093/infdis/jix376
Mbuthia, G. W., Olungah, C. O., & Ondicho, T. G. (2018). Health-seeking pathway and factors leading to delays in tuberculosis diagnosis in West Pokot County, Kenya: A grounded theory study. PLOS ONE, 13(11), e0207995. https://doi.org/10.1371/journal.pone.0207995
Muttamba, W., Ssengooba, W., Kirenga, B., Sekibira, R., Walusimbi, S., Katamba, A., et al. (2019). Health-seeking behavior among individuals presenting with chronic cough at referral hospitals in Uganda: Missed opportunity for early tuberculosis diagnosis. PLOS ONE, 14(6), e0217900. https://doi.org/10.1371/journal.pone.0217900
National Tuberculosis, Leprosy and Lung Disease Program. (2016). Annual report 2016. Ministry of Health, Kenya. https://nltp.co.ke/reports/annual-reports/
Petros de Guex, K., Augustino, D., Mejan, P., Gadiye, R, Massong, C., Lukumay, S., … Thomas, T. A. (2023). Roadblocks and resilience: A qualitative study of the impact of pediatric tuberculosis on Tanzanian households and solutions from caregivers. Global Public Health, 18(7), 1–15.
Shiferaw, W. S., & Zegeye, A. M. (2019). Delay in tuberculosis diagnosis and treatment in Ethiopia: A systematic review and meta-analysis. BMC Health Services Research, 19, Article 232. https://doi.org/10.1186/s12913-019-4056-7
Takarinda, K. C., Harries, A. D., Nyathi, B., Ngwenya, M., Mutasa-Apollo, T., & Sandy, C. (2015). Tuberculosis treatment delays and associated factors within the Zimbabwe national tuberculosis programme. BMC Public Health, 15, Article 29. https://doi.org/10.1186/s12889-015-1437-7
Tollefson, D., Ngari, F., Mwakala, M., Gethi, D., Kipruto, H., Cain, K., et al. (2016). Under-reporting of sputum smear-positive tuberculosis cases in Kenya. The International Journal of Tuberculosis and Lung Disease, 20(10), 1334–1341.
World Health Organization. (2007). Global tuberculosis control: Surveillance, planning, financing. WHO Press.
World Health Organization. (2015). Implementing the end TB strategy: The essentials. https://iris.who.int/handle/10665/206499
World Health Organization. (2019). Global tuberculosis report 2019. https://iris.who.int/handle/10665/329368
World Health Organization. (2023). Global tuberculosis report 2023. https://www.who.int/publications/i/item/9789240083851
World Vision International. (2015). Ethiopia’s community health workers. https://www.wvi.org/sites/default/files/CHW%20Profile%20Ethiopia.pdf
Yimer, S., Bjune, G., & Alene, G. (2005). Diagnostic and treatment delay among pulmonary tuberculosis patients in Ethiopia: A cross-sectional study. BMC Infectious Diseases, 5, Article 112. https://doi.org/10.1186/1471-2334-5-112
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Maureen A. Maloba, Evans Amukoye, Magu Dennis
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution (CC-BY) 4.0 License that allows others to share the work with an acknowledgment of the work's authorship and initial publication in this journal.
