Delays in TB care at Kenyatta National Hospital hinder treatment

Tuberculosis remains a leading infectious disease threat in high-burden countries, and delays in diagnosing and starting treatment make the problem worse by allowing more people to become infected and by increasing the chance of poor outcomes. Researchers led by Magoba Ronald Arnold set out to measure how long those delays are and why they happen among adults being treated at Kenyatta National Hospital in Nairobi County, Kenya. The study focused on people aged 15 years and older with smear-positive pulmonary TB, a type of disease that is detectable by examining sputum under a microscope. Conducted in 2022, the research used a descriptive cross-sectional design to capture a snapshot of care-seeking and health-system processes. By interviewing patients directly about when symptoms began, when they first sought care, and how long diagnosis and treatment took, the team aimed to identify where time was being lost. The study took place in the post-COVID-19 period, when strained health systems and changing patient behaviour may have altered both when people seek help and how quickly they are diagnosed.

The study enrolled 128 people diagnosed with smear-positive pulmonary TB using systematic sampling and gathered information through structured interviews on socio-demographic factors, care-seeking pathways, and diagnostic intervals. Delay durations were classified using the median as the cutoff, and the investigators analyzed the data with descriptive statistics, chi-square tests, and logistic regression, treating p < 0.05 as statistically significant. Women made up 51.2% of participants and the largest age group was 40–49 years (32.3%). Almost a third of patients (29.9%) sought medical care only after two to three months of symptoms. The analysis identified distance to health facilities, socio-economic constraints, and health-worker-related factors as significantly associated with prolonged delay (p < 0.05). Many patients described emotional and social barriers: 66.9% reported fear upon receiving a diagnosis, 96.1% believed treatment should be free, and perceived community stigma was very high at 96.9%. Both patient behaviour and health-system processes were reported as contributors to delayed care.

These findings point to persistent gaps at both the patient level and within the health system at Kenyatta National Hospital. Long delays before people seek care, combined with barriers inside the system, mean that TB cases are not being detected and treated quickly enough, which can fuel ongoing transmission, worsen clinical outcomes, and increase mortality. The authors conclude that practical steps are needed: strengthen diagnostic capacity so cases can be identified faster, decentralize services so care is closer to where people live, boost patient awareness to encourage earlier care-seeking, and improve health-worker responsiveness to speed up diagnosis and treatment initiation. Addressing socio-economic barriers and stigma is also essential because fear and perceived community judgment were nearly universal among participants. Taken together, these actions aim to accelerate TB case detection and help Kenya meet national and global TB-control targets by reducing the time people live with untreated, contagious disease.