Gendered Pathways in TB Diagnosis: Insights from a School-Based Screening Initiative in Kakamega County, Kenya

References

[1] Abubakar, I., Zignol, M., Falzon, D., Raviglione, M., Ditiu, L., Masham, S., ... & Zumla, A. (2016). Drug-resistant tuberculosis: Time for visionary political leadership. The Lancet Infectious Diseases, 16(6), 639-640. https://doi.org/10.1016/S1473-3099(16)00030-9

[2] Barasa, F., & Kibebe, P. (2025). Schools as surveillance hubs: Uncovering adult TB burden through child-led screening in Kakamega County, Kenya. Kenya Innovation Challenge TB Project. https://gaspublishers.com/wp-content/uploads/2025/08/Schools-as-Surveillance-Hubs-Uncovering-Adult-TB-Burden-through-Child-Led-Screening-in-Kakamega-County-Kenya.pdf

[3] Chanda-Kapata, P., Kapata, N., Masiye, F., Maboshe, M., Klinkenberg, E., & Grobusch, M. P. (2017). Health-seeking behavior among adults with prolonged cough in Zambia: A population-based survey. BMC Public Health, 17(1), 1-9. https://doi.org/10.1186/s12889-017-4846-7

[4] GBD Tuberculosis Collaborators. (2018). Global, regional, and national burden of tuberculosis, 1990–2016: Results from the Global Burden of Diseases, Injuries, and Risk Factors 2016 Study. The Lancet Infectious Diseases, 18(12), 1329-1349. https://doi.org/10.1016/S1473-3099(18)30625-X

[5] Hargreaves, J. R., Boccia, D., Evans, C. A., Adato, M., Petticrew, M., & Porter, J. D. (2011). The social determinants of tuberculosis: From evidence to action. American Journal of Public Health, 101(4), 654-662. https://doi.org/10.2105/AJPH.2010.199505

[6] Horton, K. C., MacPherson, P., Houben, R. M. G. J., White, R. G., & Corbett, E. L. (2016). Sex differences in tuberculosis burden and notifications in low- and middle-income countries: A systematic review and meta-analysis. PLoS Medicine, 13(9), e1002119. https://doi.org/10.1371/journal.pmed.1002119

[7] Kaona, F. A. D., Tuba, M., Siziya, S., & Sikaona, L. (2004). An assessment of factors contributing to treatment adherence and knowledge of TB transmission among patients on TB treatment. BMC Public Health, 4, 68. https://doi.org/10.1186/1471-2458-4-68

[8] Khan, A. J., Khowaja, S., Khan, F. S., Qazi, F., Lotia, I., Habib, A., ... & Creswell, J. (2019). Engaging the private sector to increase tuberculosis case detection: An impact evaluation study. The Lancet Infectious Diseases, 19(8), e284-e290. https://doi.org/10.1016/S1473-3099(12)70116-0

[9] Long, Q., Qu, Y., & Lucas, H. (2019). What are the barriers to seeking treatment for tuberculosis? A systematic review of qualitative studies. Global Public Health, 14(10), 1473-1486. https://doi.org/10.1080/17441692.2019.1586798

[10] Mbuthia, G. W., Olungah, C. O., & Ondicho, T. G. (2018). Health-seeking pathway of patients with pulmonary tuberculosis at a public health facility in Kenya. Journal of Health Care for the Poor and Underserved, 29(3), 1062-1077. https://doi.org/10.1353/hpu.2018.0079

[11] Ministry of Health. (2023). Tuberculosis policy brief. https://www.health.go.ke/sites/default/files/2023-06/Tuberculosis.pdf [Crossref]

[12] Ministry of Health. (2025). Kenya showcases breakthroughs in TB diagnosis and treatment at TICAD9. https://www.health.go.ke/kenya-showcases-breakthroughs-tb-diagnosis-and-treatment-ticad9-side-event [Crossref]

[13] Sekandi, J. N., Zalwango, S., Martinez, L., Handel, A., Kakaire, R., Nankabirwa, J. I., ... & Whalen, C. C. (2020). Four degrees of separation: Social contacts and health providers influence the steps to final diagnosis of active tuberculosis. American Journal of Epidemiology, 189(11), 1363-1371. https://doi.org/10.1093/aje/kwaa094

[14] Squire, S. B., & Theobald, S. (2018). Gender and tuberculosis: A review of the evidence and programmatic considerations. The International Journal of Tuberculosis and Lung Disease, 22(5), S3-S10. https://doi.org/10.5588/ijtld.17.0879

[15] Tadesse, T., Demissie, M., Berhane, Y., Kebede, Y., & Abebe, M. (2019). Community-based tuberculosis screening interventions: A systematic review. The International Journal of Tuberculosis and Lung Disease, 23(4), 432-440. https://doi.org/10.5588/ijtld.18.0456

[16] USAID TB ARC II. (2023). Tuberculosis Active Case Finding and Gender Analysis Report. USAID Kenya. https://www.usaid.gov/kenya/documents/tuberculosis-active-case-finding-and-gender-analysis-report

[17] Wang, Y., Chen, S., Zhang, H., Li, X., & Wang, L. (2020). Gender differences in tuberculosis diagnosis and treatment delays in China. Public Health, 185, 48-54. https://doi.org/10.1016/j.puhe.2020.05.032

[18] World Health Organization. (2022). Global tuberculosis report 2022. https://www.who.int/publications/i/item/9789240061729 [Crossref]

[19] World Health Organization. (2023). Global tuberculosis report 2023. https://www.who.int/teams/global-tuberculosis-programme/tb-reports/global-tuberculosis-report-2023 [Crossref]

[20] Yang, W. T., Gounder, C. R., Akande, T., De Neve, J. W., McIntire, K. N., & Chandrasekaran, P. (2021). Intersectional inequalities in tuberculosis: A call for a gender-responsive approach. The Lancet Global Health, 9(6), e744-e745. https://doi.org/10.1016/S2214-109X(21)00123-7 [Crossref]

@article{1711412,
      author = {Francis O. Barasa, PhD},
      title = {Gendered Pathways in TB Diagnosis: Insights from a School-Based Screening Initiative in Kakamega County, Kenya},
      journal = {Iconic Research And Engineering Journals},
      year = {2025},
      volume = {9},
      number = {4},
      pages = {911-921},
      issn = {2456-8880},
      url = {https://www.irejournals.com/formatedpaper/1711412.pdf},
      abstract = {Background: Tuberculosis (TB) remains a major public health challenge in Kenya, with persistent gender disparities in diagnosis and treatment access. This study examines gendered pathways in TB detection through a school-based, child-led screening initiative in Kakamega County, highlighting how social norms, barriers, and health-seeking behaviors influence outcomes. This study is informed by feminist theory, with a focus on intersectional feminism, and guided by the Social Determinants of Health framework. It examines how overlapping social identities and structural conditions influence unequal access to tuberculosis diagnosis.

Methods: A retrospective cross-sectional analysis was conducted on data from the Kenya Innovation Challenge TB project (2019?2024), involving 56,664 screened adults (28,394 males, 28,270 females). Descriptive statistics, Chi-square tests, and odds ratios were used to assess gender differences in TB diagnosis and treatment initiation.

Results: Men accounted for 61.6% of 700 confirmed TB cases, with a significantly higher yield (1.52%) than women (0.95%; ?? = 36.21, p < 0.001; OR = 1.62, 95% CI: 1.38?1.90). Treatment initiation was equitable (>99% for both sexes).

Conclusion: Despite balanced screening, women appear underdiagnosed, likely due to stigma, caregiving roles, and diagnostic biases. Gender-responsive strategies are essential for equitable TB control. This study underscores the value of integrating gender analysis into community-based interventions to address hidden inequalities.},
      keywords = {Tuberculosis, Gender disparities, School-based screening, Child-led intervention, Diagnostic yield, Treatment initiation},
      month = {October},
      doi = {https://doi.org/10.64388/IREV9I4-1711412-6021}
  }