{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T04:57:05Z","timestamp":1784782625322,"version":"3.55.0"},"reference-count":18,"publisher":"Public Library of Science (PLoS)","issue":"3","license":[{"start":{"date-parts":[[2026,3,6]],"date-time":"2026-03-06T00:00:00Z","timestamp":1772755200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:p>Tuberculosis (TB) is a top global health challenge, with 1.2 million children aged 0\u201314 years becoming ill with TB every year. Yet, a significant proportion remain undiagnosed or missed due to diagnostic barriers. This cross-sectional study employing an embedded mixed method approach investigated factors contributing to low tuberculosis diagnosis among children in Gem Sub County, Siaya County Kenya, a high burden region. Data was collected from 71 healthcare workers (HCWs) and 16 respondents across six wards using semi-structured questionnaires and TB register abstraction. Qualitative data underwent deductive thematic analysis while quantitative data was analyzed using descriptive statistics and logistic regression in SPSS version 27. About a third (31.3%) of TB cases in children required three or more facility visits before diagnosis, with some needing up to 12 visits. Costly and inaccessible chest X-rays and GeneXpert underutilization due to difficulties in sputum and alternative sample (gastric lavage, nasopharyngeal aspirates) collection were key diagnostic constraints. Delayed care-seeking due to stigma, misconceptions (56.3% linked childhood TB to HIV) and low TB symptom awareness (37.5% of children presented with \u22642 symptoms) were patient related factors associated with low TB diagnosis. About 56.3% of caregivers sought routine TB screening, but 62.5% sought care only after persistent symptoms. Clinical officers showed substantially higher odds of reporting confidence in sample collection (OR=34, 95% CI 3.81\u2013303.21, p\u2009=\u20090.002) and GeneXpert interpretation (OR=15, 95% CI 3.20\u201370.39, p\u2009&lt;\u20090.001) than nurses. Trained HCWs were 7.16 times more likely to interpret X-rays accurately (95% CI 2.16\u201323.67, p\u2009&lt;\u20090.001). Enhanced HCW training, improved diagnostic access, targeted community education on stigma and misconceptions are critical for early TB detection in children.<\/jats:p>","DOI":"10.1371\/journal.pone.0335326","type":"journal-article","created":{"date-parts":[[2026,3,6]],"date-time":"2026-03-06T18:22:27Z","timestamp":1772821347000},"page":"e0335326","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":2,"title":["Factors contributing to low tuberculosis diagnosis among children aged 0\u201314 years in Gem Sub County in Siaya County, Kenya"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-8602-5124","authenticated-orcid":true,"given":"Lilian Atieno","family":"Okumu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel 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