Patient Delay And Care-Seeking Pathways in Tuberculosis Diagnosis among Individuals Aged ≥15 Years at Kenyatta National Hospital, Nairobi, Kenya

Background: Tuberculosis (TB) diagnosis is often delayed when people postpone seeking care after symptom onset. This study assessed patient delay and care-seeking pathways among individuals aged ≥15 years receiving TB care at Kenyatta National Hospital (KNH), Nairobi, Kenya. Methods: A retrospective observational study was conducted among 127 people aged ≥15 years with pulmonary TB receiving care at KNH. Participants were recruited using systematic sampling from the TB treatment register. Data were collected using an interviewer-administered structured questionnaire and clinical-record review. Patient delay was defined as the interval from symptom onset to first consultation with a formal healthcare provider; prolonged patient delay was defined a priori as >14 days. Descriptive statistics, chi-square tests and multivariable logistic regression were performed. Adjusted odds ratios (AORs), 95% confidence intervals (CIs) and p-values are reported. Results: Of 128 patients approached/available during the study period, 127 contributed to the final analysis (99.2%). Females comprised 51.2% (65/127), and the largest age group was 40–49 years (32.3%, 41/127). Perceived TB stigma was reported by 96.9% (123/127), fear following diagnosis by 66.9% (85/127), and residence >10 km from a health facility by 31.5% (40/127). Age group (p=0.032), distance to a health facility (p=0.015) and education (p=0.041) were associated with delay in bivariate analyses; sex was not (p=0.210). After adjustment, none of the examined variables was statistically significant: female sex AOR 1.21 (95% CI 0.65–2.25; p=0.540), age 40–49 years AOR 1.48 (0.78–2.81; p=0.210), distance >5 km AOR 1.72 (0.89–3.31; p=0.103), and lower versus higher education AOR 1.36 (0.72–2.56; p=0.330). Conclusion: Patient delay and barriers to timely TB care were common in this tertiary-care population. The observed bivariate associations did not remain statistically significant after adjustment. Interventions should address TB awareness, stigma, geographical access and timely referral while recognizing that this single-facility study cannot establish causality or population-wide effects.