Time from onset of symptoms to diagnosis of tuberculosis and associated factors among children below 18 years of age at selected healthcare facilities in Dar es Salaam, Tanzania
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Date
2025
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Kairuki University
Abstract
Background: Despite being a preventable and curable disease, tuberculosis is a global public health problem and the second leading cause of mortality among infectious diseases globally. To stop the spread of tuberculosis, it is critical to detect the infection early on, limit the reservoir of infection, and ensure high treatment completion rates. However, the clinical presentation of tuberculosis in children is non-specific, leading to delayed diagnosis and increased risk of mortality.
Objective: The broad objective was to determine the median time from onset of symptoms to diagnosis of tuberculosis and the factors associated with late diagnosis of tuberculosis among children below 18 years of age at selected healthcare facilities in Dar es Salaam, Tanzania.
Methodology: This was health facility-based descriptive cross-sectional study that was carried out from December 2024- February 2025. A total of 268 children attending Tuberculosis clinics aged 0-17 years were recruited consecutively upon obtaining informed consent plus assent where appropriate. Data on socio-demographic characteristics, clinical features, behavioural aspects of caregivers and healthcare-related factors were collected using a structured questionnaire. Binary logistic regression analysis
was done to assess the factors associated with the late diagnosis of Tuberculosis among study participants.
Results: A total of 268 study participants were enrolled into the study. Most study participants (58%) were aged 0–4 years, and 50% were females). The median time to diagnosis was 31 days (IQR 21–45). In multivariate analysis, five factors were significantly associated with delayed diagnosis of tuberculosis among study participants. Unexplained weight loss (aOR 5.2, 95% CI: 1.77–15.00), belief that symptoms would resolve without treatment (aOR 4.7, 95% CI: 1.55–14.27), multiple health facility visits before
diagnosis of tuberculosis (aOR 10.2, 95% CI: 2.08–50.11), and financial constraints (aOR 4.7, 95% CI: 1.64–13.71) increased odds of delay. Conversely, night sweats were associated with reduced odds of delay (aOR 0.2, 95% CI: 0.07–0.78).
Conclusion: The study found prolonged median diagnostic delays for tuberculosis among study participants in 80% of cases having delays of more than two weeks. The main factors leading to delays in diagnosis of tuberculosis include personal beliefs about symptoms resolution, financial constraints that delay timely access to health care and multiple health facility visits before the diagnosis was made. These findings underscore the complex interaction of individual-level factors, socio-economic barriers and health system-related factors contributing to delayed diagnosis of tuberculosis among the study participants. Recommendations: To reduce delays in establishing the diagnosis of tuberculosis among children, the key identified factors must be addressed:
i. Sustained health education on tuberculosis among children at household and community level to raise awareness and promote early treatment seeking behaviour especially when a child presents with persistent cough lasting 2 weeks or more associated with growth failure.
ii. Improvement of knowledge and skills of health care providers at all levels through continuous medical education sessions regarding tuberculosis in children and the need for timely referral for diagnostic work-up.
iii. Further studies are needed that should focus on adolescent experiences and to evaluate integrated screening models to enhance
timely diagnosis of tuberculosis in children.
Description
A dissertation report submitted in partial fulfillment of the requirements for the degree of Master of Medicine in Paediatrics and Child Health
Keywords
tuberculosis, INTERDISCIPLINARY RESEARCH AREAS::Children
Citation
Biubwa, Suleiman S. 2025. Time from onset of symptoms to diagnosis of tuberculosis and associated factors among children below 18 years of age at selected healthcare facilities in Dar es Salaam, Tanzania. Dissertation. Kairuki University