DETERMINANTS AND CONSEQUENCES OF PATIENT AND HEALTH SYSTEM DELAYS IN TUBERCULOSIS DIAGNOSIS AND TREATMENT AMONG INDIVIDUALS AGED ≥15 YEARS AT KENYATTA NATIONAL HOSPITAL, NAIROBI, KENYA

Abstract Background Tuberculosis (TB) remains a leading cause of morbidity and mortality globally, particularly in low- and middle-income countries. Delays in diagnosis and treatment initiation significantly contribute to ongoing transmission, increased disease severity, and poor treatment outcomes. This study assessed the determinants and consequences of patient and health system delays among individuals aged 15 years and above at Kenyatta National Hospital, Nairobi, Kenya. Methods A retrospective cohort study was conducted among 127 TB patients aged ≥15 years. Data were collected using structured questionnaires and clinical record reviews to reconstruct timelines from symptom onset to treatment initiation. Patient delay was defined as the time from symptom onset to first healthcare contact, while health system delay referred to the time from first contact to confirmed diagnosis. Descriptive statistics, chi-square tests, and multivariable logistic regression were used to identify factors associated with delay. Results were reported as adjusted odds ratios (AORs) with 95% confidence intervals. Results The majority of participants were aged 40–49 years (32.3%), indicating a high burden among economically productive populations. Over half of the participants (59.8%) experienced prolonged patient delay exceeding two months. Key barriers to timely care-seeking included stigma (96.9%), fear of diagnosis (66.9%), and long distances to health facilities (31.5% residing >10 km away). Many participants initially sought care from informal providers or engaged in self-medication, contributing to complex and delayed care pathways. Bivariate analysis showed significant associations between delay and age (p = 0.032), distance to health facility (p = 0.015), and education level (p = 0.041). However, no independent predictors remained statistically significant after multivariable adjustment. Conclusion Patient and health system delays remain substantial challenges in TB control, driven by a combination of behavioral, social, and structural factors. Interventions should prioritize community awareness, stigma reduction, improved access to healthcare services, and strengthening of referral systems. Addressing these delays is critical to reducing transmission and improving TB outcomes in high-burden settings.