article · Journal of Social Science and Human Research Studies
This retrospective study evaluated a school-based, child-led tuberculosis screening model implemented in Kakamega, Kenya, between July 2021 and June 2024. Screening reached 266,943 children and diagnosed 214 cases, with all diagnosed individuals successfully linked to treatment. Paediatric cases made up 23.2% of all tuberculosis diagnoses under the programme, surpassing the national benchmark of 10% to 15%. Furthermore, bacteriological confirmation reached 54.7%, exceeding typical global rates of 20% to 30%, although 1,247 children needed to be screened per case found. Crucially, the care cascade showed no significant disparities between girls and boys. The evidence indicates that school-based, child-led screening effectively finds missing paediatric cases without gender bias, justifying the expansion of the approach beyond a pilot phase.
Paediatric tuberculosis remains chronically underdiagnosed globally, preventing health systems from reaching critical case-finding targets. This research confirms that child-led screening within schools can bridge the missing cases gap effectively. The approach demonstrates that high diagnostic confirmation and complete treatment linkage can be achieved without introducing gender-based inequities, providing health authorities with an actionable strategy to improve child health outcomes.
This work represents an applied and tested public health delivery model ready for wider adoption rather than an unproven pilot. The primary users are national tuberculosis control programmes, health ministries, and non-governmental implementing partners. It provides a validated operational framework for deploying community-level screening in schools to improve case detection and treatment adherence within public health systems.
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Kenya's NTLD-P targets children as 10–15% of all notified tuberculosis (TB) cases, a target the country has struggled to meet. This study examines the paediatric TB care cascade generated by the Kenya Innovation Challenge Tuberculosis (KIC-TB) project's school-based, child-led screening model in Kakamega, asking whether it displays the sex-based inequity previously documented among adults reached by the same programme, and whether its paediatric contribution meets national case-finding benchmarks. This is a retrospective, descriptive and analytical study of programmatic screening data from the NFM3 funding phase (July 2021–June 2024), the period for which complete, sex-disaggregated paediatric records are available. The care cascade: screened, presumptive, investigated, diagnosed, and linked to treatment was analysed by sex using chi-square and Fisher's exact tests, with odds ratios and 95% confidence intervals, and benchmarked against national and global literature. Of 266,943 children screened, 214 were diagnosed with TB (117 bacteriologically confirmed) and all were linked to treatment (100%). No significant sex difference was found at any cascade stage (all p > 0.17). Children accounted for 23.2% of all TB cases diagnosed, exceeding national targets, with bacteriological confirmation (54.7%) above typical global figures (20–30%), though the number needed to screen (1,247) exceeded the pooled global school-setting estimate (464). School-based, child-led screening can close a meaningful share of Kenya's paediatric case-finding gap without introducing sex-based inequity, and current evidence supports expanding this channel rather than treating it as an unproven pilot.
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DOI: 10.65150/ep-jsshrs/v2e8/2026-27
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