Patient and Health System Factors Associated with Post Presentation Delay in Tuberculosis Diagnosis in Starehe Sub-County, Nairobi

Abstract

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.