Barriers to effective tuberculosis patient management in Kitui Central Sub-County, Kitui County, Kenya: A cross-sectional analysis of treatment delay and default

Jeffrey Munuve Muluvi; Ondimu Thomas Orindi; Tarasisio Ndwiga; Paul Musango

doi:10.51867/scimundi.6.2.2

Autores

Jeffrey Munuve Muluvi South Eastern Kenya University, Kenya https://orcid.org/0009-0002-5518-3038
Ondimu Thomas Orindi Technical University of Mombasa, Kenya https://orcid.org/0000-0001-9908-0239
Tarasisio Ndwiga South Eastern Kenya University, Kenya
Paul Musango Kenya Medical Training College (KMTC), Kenya https://orcid.org/0000-0001-9844-4539

DOI:

https://doi.org/10.51867/scimundi.6.2.2

Palavras-chave:

Barriers to Care, Kenya, Kitui County, Logistic Regression, TB Care Continuum, Treatment Default, Treatment Delay, Tuberculosis

Resumo

Tuberculosis (TB) remains a major global public health challenge, particularly in low- and middle-income settings where multiple, interacting barriers continue to undermine effective disease control. This study assessed the determinants of barriers to effective TB management in Kitui Central Sub-County, Kenya, focusing on treatment initiation delay, treatment default, and TB prevention and control strategies. The study was guided by the Health Belief Model, complemented by the Andersen Behavioral Model of Health Services Use. An analytical cross-sectional design was adopted, drawing a sample of 399 TB patients aged 15 years and above from eight purposively selected high-burden health facilities, using stratified systematic random sampling. Data were collected through structured, interviewer-administered questionnaires and analyzed in the Statistical Package for the Social Sciences (SPSS) version 29 and R using descriptive statistics, chi-square tests, and binary logistic regression, with crude and adjusted odds ratios (COR/AOR) reported at the 95% confidence level. The results showed that 42.9% of respondents delayed initiating TB treatment after diagnosis. Being diagnosed at the first health facility visited was the strongest predictor of delay (AOR = 6.924, 95% confidence interval (CI): 1.812–36.782, p = 0.004), while male sex increased the odds of delay (AOR/OR = 1.87, p = 0.018) and employment was protective (OR = 0.40, p < 0.001). For treatment default, 39.2% of respondents discontinued treatment; income level was the strongest predictor, with a marked "income paradox" in which middle- and higher-income respondents were more likely to default (OR = 6.99, p < 0.001) than the lowest-income group, while employment again conferred protection (OR = 0.40, p < 0.001) and single marital status increased default risk. Model diagnostics confirmed good fit (Hosmer–Lemeshow p > 0.05 for both models) and no problematic multicollinearity (VIF < 5), with Nagelkerke R² of 0.177 for the delay model and 0.122 for the default model. TB prevention and control assessment revealed strong facility-based interventions (Directly Observed Treatment, Short-course [DOTS] availability 91.3%; free drugs 97.4%) alongside markedly weaker community-based interventions (household contact tracing 37.0%; community outreach 28.6%). The study concludes that barriers to TB management in Kitui Central Sub-County are stage-specific: treatment initiation is shaped primarily by behavioral and health-system factors, while treatment continuation is shaped primarily by socio-economic and social-support factors. The study recommends strengthening intramural diagnosis-to-treatment linkages, reducing indirect financial barriers to care, adopting flexible and gender-responsive service delivery models, and integrating social protection and community health system strengthening into TB control programming.

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