Published in PLOS One on 2026-03-06, this study is presented as an attributed evidence briefing. The excerpts below are the original researchers’ words, reproduced under their Creative Commons Attribution licence. Health Signal has selected the abstract and, where needed, opening background paragraphs; the complete methods, results, limitations and references remain in the linked paper.
Original authors: Lilian Atieno Okumu, Daniel Ogungu Onguru, David Otieno Odongo, James Onyuro Oketch
Source: PLOS One • DOI 10.1371/journal.pone.0335326
Read the complete primary study ↗ · Creative Commons Attribution licence
From the researchers
Abstract
Tuberculosis (TB) is a top global health challenge, with 1.2 million children aged 0–14 years becoming ill with TB every year. Yet, a significant proportion remain undiagnosed or missed due to diagnostic barriers. This cross-sectional study employing an embedded mixed method approach investigated factors contributing to low tuberculosis diagnosis among children in Gem Sub County, Siaya County Kenya, a high burden region. Data was collected from 71 healthcare workers (HCWs) and 16 respondents across six wards using semi-structured questionnaires and TB register abstraction. Qualitative data underwent deductive thematic analysis while quantitative data was analyzed using descriptive statistics and logistic regression in SPSS version 27. About a third (31.3%) of TB cases in children required three or more facility visits before diagnosis, with some needing up to 12 visits. Costly and inaccessible chest X-rays and GeneXpert underutilization due to difficulties in sputum and alternative sample (gastric lavage, nasopharyngeal aspirates) collection were key diagnostic constraints. Delayed care-seeking due to stigma, misconceptions (56.3% linked childhood TB to HIV) and low TB symptom awareness (37.5% of children presented with ≤2 symptoms) were patient related factors associated with low TB diagnosis. About 56.3% of caregivers sought routine TB screening, but 62.5% sought care only after persistent symptoms. Clinical officers showed substantially higher odds of reporting confidence in sample collection (OR=34, 95% CI 3.81–303.21, p = 0.002) and GeneXpert interpretation (OR=15, 95% CI 3.20–70.39, p < 0.001) than nurses. Trained HCWs were 7.16 times more likely to interpret X-rays accurately (95% CI 2.16–23.67, p < 0.001). Enhanced HCW training, improved diagnostic access, targeted community education on stigma and misconceptions are critical for early TB detection in children.
Introduction
Tuberculosis (TB), caused by Mycobacterium Tuberculosis, transmitted through respiratory droplets from infected individuals, is a formidable global health challenge. In 2023, an estimated 10.8 million new cases occurred worldwide, including 1.3 million among children aged 0–14 years, equivalent to 12% of the total TB burden [1]. Of these, 8.2 million people were reported as newly diagnosed, up from 7.5 million in 2022 and 7.1 million in 2019 [1]. Furthermore, despite being preventable and treatable [2], TB causes deaths, claiming approximately 1.3 million lives annually [1]. Yet, many cases remain undiagnosed or underreported, in particular, pediatric population [3]. Previous research has shown that this is mainly attributed to nonspecific symptoms, low bacillary loads, and challenges in sputum sample collection in children, and limited access to diagnostic tools in high-burden settings [4,5].
Kenya, ranking fourth in Africa for TB burden after Ethiopia, Nigeria, and South Africa, is among the top 10 high-burden countries globally. The Kenya National TB prevalence survey of 2015/2016, reported a TB prevalence of 558 per 100,000 population with nearly half of the cases missed annually [6]. Notably, 21% of the patients with TB symptoms sought prior care at private clinics and chemists [6]. TB is often under-reported, with children representing only 8% of the 2,903 TB cases reported in Siaya County in 2021 according to Kenya TB surveillance data 2021, below the national target of 12%. In Gem Sub-County, only 4% of the 619 TB cases reported in 2021 were pediatric, well below the expected 10–15% range, highlighting significant diagnostic gaps.
Reading this evidence
Use the full paper to check the study design, participant selection, comparator and outcome definitions before drawing a practical conclusion. An association does not by itself show cause and effect. A reported performance measure needs its denominator and uncertainty. A finding from a particular facility, sample or time period should retain that scope when it is discussed elsewhere.
This briefing makes the source accessible within the wider technology & industry desk. It does not assess an individual patient or certify a product. When considering relevance to another health system, examine the original authors’ account of context and limitations, then seek local implementation evidence. The related reporting below provides other studies to read alongside this one; it is a topic connection, rather than a claim that their results are directly comparable.
© 2026 Lilian Atieno Okumu, Daniel Ogungu Onguru, David Otieno Odongo, James Onyuro Oketch. Excerpts reproduced under CC BY. Selection, formatting and contextual notes by Health Signal. The researchers are the authors of the source study, not members of Health Signal’s staff.
Explore connected evidence
- Evidence brief: Contribution of xpert MTB/RIF assay and Urine LF-LAM for the diagnosis of tuberculosis in children aged 5 – 14 years, at selected health facilities in Ethiopia, 2016 – 2019
- Evidence brief: Implementation bottlenecks of near point of care HIV viral load monitoring for children and young people in Tanzania: A Qualitative Study
- Evidence brief: Diagnostic accuracy of the TrueNat™ MTB plus assay for detecting pulmonary tuberculosis in adults
