article · Journal of Social Science and Human Research Studies
A retrospective study evaluated a school-based, child-led tuberculosis screening programme implemented in Kakamega, Kenya, between July 2021 and June 2024. The initiative aimed to address national shortfalls in paediatric tuberculosis notifications and determine whether sex disparities emerged across the care cascade. Across 266,943 screened children, 214 were diagnosed with tuberculosis, representing 23.2% of all cases diagnosed under the programme and surpassing national targets. Bacteriological confirmation was achieved in 54.7% of paediatric cases, which exceeds typical global benchmarks. Every diagnosed child was linked to treatment, achieving a 100% linkage rate, and no significant differences based on sex were found at any step of the care pathway. Although the number needed to screen was higher than global school-based averages, the findings demonstrate that this model reliably finds paediatric cases without introducing sex-based inequities.
Tuberculosis in children is frequently underdiagnosed, making national notification targets difficult to meet. By utilising a school-based, child-led screening method, health systems can systematically identify missing paediatric cases and achieve complete linkage to clinical care. The findings show that this approach performs equitably for both boys and girls, offering a proven strategy to address critical coverage gaps in high-burden environments.
This research provides an applied, field-tested public health delivery model ready for programmatic scale-up. Potential users include national tuberculosis control programmes, health ministries, and non-governmental health organisations seeking structured case-finding protocols. Because the approach has been demonstrated at scale across more than 260,000 pupils, it is near-market for public health commissioning, though implementers must account for the operational resources needed to maintain screening volumes in schools.
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ABSTRACT : Kenya's NTLD-P targets children as 10–15% of all notified tuberculosis (TB) cases, a target the country has struggled to meet. This study examines the paediatric TB care cascade generated by the Kenya Innovation Challenge Tuberculosis (KIC-TB) project's school-based, child-led screening model in Kakamega, asking whether it displays the sex-based inequity previously documented among adults reached by the same programme, and whether its paediatric contribution meets national case-finding benchmarks. This is a retrospective, descriptive and analytical study of programmatic screening data from the NFM3 funding phase (July 2021–June 2024), the period for which complete, sex-disaggregated paediatric records are available. The care cascade: screened, presumptive, investigated, diagnosed, and linked to treatment was analysed by sex using chi-square and Fisher's exact tests, with odds ratios and 95% confidence intervals, and benchmarked against national and global literature. Of 266,943 children screened, 214 were diagnosed with TB (117 bacteriologically confirmed) and all were linked to treatment (100%). No significant sex difference was found at any cascade stage (all p > 0.17). Children accounted for 23.2% of all TB cases diagnosed, exceeding national targets, with bacteriological confirmation (54.7%) above typical global figures (20–30%), though the number needed to screen (1,247) exceeded the pooled global school-setting estimate (464). School-based, child-led screening can close a meaningful share of Kenya's paediatric case-finding gap without introducing sex-based inequity, and current evidence supports expanding this channel rather than treating it as an unproven pilot.
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DOI: 10.5281/zenodo.22139366
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