Background: Delays in tuberculosis (TB) diagnosis and treatment remain important public health challenges, particularly in low- and middle-income countries. Delays may arise from late healthcare-seeking, barriers to accessing health services and delays in reaching a confirmed diagnosis. Understanding these factors is essential for improving early detection and timely treatment. Objective: To assess patient and health-system delays in TB diagnosis and treatment and examine factors associated with delayed care-seeking among individuals aged 15 years and above at Kenyatta National Hospital (KNH), Nairobi, Kenya. Methods: A facility-based observational study was conducted among 127 individuals aged 15 years and above receiving TB care at KNH. Data were obtained through structured questionnaires and review of clinical records. Descriptive statistics were used to summarize participant characteristics and reported barriers to care. Associations between selected characteristics and delay were assessed using chi-square tests, followed by binary logistic regression. Statistical significance was set at p < 0.05. Results: Of the 127 participants, 65 (51.2%) were female and 62 (48.8%) were male. The largest age group was 40–49 years, comprising 41 participants (32.3%). Seventy-six participants (59.8%) reported seeking care more than two months after symptom onset, based on the delay categories supplied for this analysis. Perceived stigma was reported by 123 participants (96.9%), while 85 (66.9%) reported fear following diagnosis. Forty participants (31.5%) lived more than 10 km from a health facility. At bivariate analysis, age group (p = 0.032), distance to a health facility (p = 0.015), and education level (p = 0.041) were associated with delay; sex was not statistically associated with delay (p = 0.210). No factor was statistically significant in the reported multivariable model. Conclusion: Delayed care-seeking was common among participants. Stigma, fear and geographical access were prominent concerns. Strengthening TB awareness, reducing stigma, improving access to diagnostic services and promoting timely referral may help reduce delays. The findings should be interpreted in light of the single-facility setting and potential recall bias. Keywords: Tuberculosis; patient delay; health-system delay; diagnostic delay; care-seeking; Kenya.
DETERMINANTS AND CONSEQUENCES OF PATIENT AND HEALTH SYSTEM DELAYS IN TUBERCULOSIS DIAGNOSIS AND TREATMENT AMONG INDIVIDUALS AGED 15 YEARS AND ABOVE AT KENYATTA NATIONAL HOSPITAL, NAIROBI, KENYA Received: 09 October 2026 Revised: 23 October 2026 Accepted: 24 October 2026 1. INTRODUCTION Tuberculosis remains a major global public health problem, despite the availability of effective diagnostic tools and treatment. Delays in diagnosis and treatment can prolong the period during which an infectious individual remains undiagnosed, contribute to disease progression and increase the risk of continued transmission. These delays remain particularly important in settings where access to healthcare is constrained by social, economic and health-system barriers. Patient delay generally refers to the interval between the onset of symptoms and the first contact with a healthcare provider. Health-system delay refers to the interval between the first contact with a healthcare provider and confirmed diagnosis, although operational definitions vary across studies. Total delay may include both intervals and, depending on the study framework, the time between diagnosis and treatment initiation. Clearly defining each interval is therefore essential when comparing findings and identifying opportunities for intervention. Several factors may contribute to delayed care-seeking. Limited knowledge of TB symptoms, stigma, fear of diagnosis, financial constraints and competing responsibilities may discourage individuals from seeking care promptly. Some patients initially use self-medication, visit pharmacies or consult providers outside formal diagnostic services before reaching a facility capable of confirming TB. Each additional step may create an opportunity for delayed recognition, referral or diagnosis. Health-system factors may also contribute to delays. These include geographical barriers, referral processes, access to diagnostic services, delays in clinical assessment and the availability of appropriate testing. Understanding the relative contribution of patient-related and health-system factors is important for designing interventions that improve timely diagnosis and treatment. TB can also have substantial social and economic consequences, particularly among adults who contribute to household income and caregiving. Delayed diagnosis may extend illness, increase the financial burden on patients and households, and create additional demands on healthcare services. Although previous research has examined TB diagnostic delays in different settings, local evidence remains important because healthcare-seeking pathways and access barriers vary between populations and health systems. Examining these factors at a major referral hospital can help identify barriers experienced by patients who ultimately reach specialist services. This study assessed patient and health-system delays in TB diagnosis and treatment among individuals aged 15 years and above receiving care at Kenyatta National Hospital in Nairobi, Kenya. It also examined selected socio-demographic and access-related factors associated with delayed care-seeking. 2. METHODS 2.1 Study design A facility-based observational study was conducted using structured participant interviews and review of clinical records. The study reconstructed reported care-seeking pathways and relevant clinical events retrospectively. Patient delay was defined as the interval between the onset of TB-related symptoms and first contact with a healthcare provider. Health-system delay was defined as the interval between first healthcare contact and confirmed TB diagnosis. Where treatment-initiation dates were available, these were used to describe the subsequent interval between diagnosis and initiation of treatment. The final designation of the study design should be consistent with the approved protocol and the actual sampling and data-collection procedures. 2.2 Study setting The study was conducted at Kenyatta National Hospital, Nairobi, Kenya. KNH is a national referral and teaching hospital that provides specialized diagnostic and treatment services and receives patients referred from different parts of the country. Its TB services provide a setting in which patient care-seeking pathways and barriers encountered before diagnosis can be examined. The study relates to the approved data-collection period in 2022. The findings describe participants and circumstances during that study period and should not be interpreted as a direct assessment of TB delays in 2026. 2.3 Study population The study population comprised individuals aged 15 years and above with a confirmed diagnosis of pulmonary TB who were receiving treatment at KNH during the study period. The eligibility criteria reported for the study included age 15 years and above, confirmed pulmonary TB, current receipt of treatment at the study site and provision of informed consent. Indiv
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