Determinants And Consequences Of Patient And Health System Delays In Tuberculosis Diagnostics And Treatment Among Individuals Aged 15 Years And Above At Kenyatta National Hospital, Nairobi County, Kenya

BackgroundDelays in tuberculosis (TB) diagnosis and treatment continue to compromise control efforts, particularly in high-burden settings such as Kenya. These delays increase transmission, worsen clinical outcomes, and elevate mortality. The post-COVID-19 period has further strained health-care systems, influencing patient health-seeking behaviour and diagnostic efficiency. Objective: To quantify patient-related and health-system-related delays in TB diagnosis and treatment and to identify key determinants of these delays among adults receiving care at Kenyatta National Hospital (KNH). MethodsA descriptive cross-sectional study involving 128 smear-positive pulmonary TB patients was conducted in 2022. Participants aged [&ge;]15 years were selected through systematic sampling. Data on socio-demographic factors, care-seeking pathways, and diagnostic intervals were collected through structured interviews. Delay durations were categorized using the median as the cut-off point. Descriptive statistics, chisquare tests, and logistic regression were used to determine predictors of patient and system delays. Statistical significance was set at p < 0.05. ResultsWomen constituted 51.2% of participants, with the largest age group being 40-49 years (32.3%). A substantial proportion (29.9%) sought medical care only after 2-3 months of symptoms. Distance to health facilities, socio-economic constraints, and health-worker-related factors were significantly associated with prolonged delay (p < 0.05). Many patients (66.9%) reported fear upon receiving a diagnosis, while 96.1% believed they should access treatment free of charge. Perceived community stigma was high (96.9%), and both patient behaviour and health-system processes were considered contributors to delayed care. ConclusionSignificant patient-level and system-level delays persist at KNH, highlighting critical gaps in early TB detection and timely initiation of treatment. Strengthening diagnostic capacity, decentralizing services, enhancing patient awareness, and improving health-worker responsiveness are essential to accelerate TB case detection and align with national and global TB-control targets.