Relationships Between Healthcare-Seeking Behavior and Socioeconomic Disparities Among Kenyan Adults Presenting with Signs and Symptoms of Tuberculosis

Abstract

IntroductionKenya is a high-burden country for tuberculosis (TB), yet most symptomatic adults do not seek formal care. This study examined the association between formal healthcare-seeking and household socioeconomic status (SES) among Kenyan adults with TB symptoms, using data from the 2016 nationally representative TB prevalence survey. Methods We used data from the 2016 Kenya National TB Prevalence Survey (63,050 participants). Our analysis focused on 23,155 adults (≥15 years) reporting TB-related symptoms. The outcome was formal care-seeking (yes/no) for TB symptoms, defined as any visit to a health facility for TB evaluation. Household SES was derived by principal‐component analysis (PCA) of asset ownership and categorized into tertiles. Multivariable models adjusted for age, sex, schooling level, occupation, and marital status. To account for clustering at both the household and community levels, we employed multilevel logistic regression with random intercepts for household and survey cluster. Results Only 15.9% of symptomatic adults reported seeking formal care. Higher SES did not predict greater care-seeking with individuals in the top wealth tertile having marginally lower adjusted odds of seeking care than those in the bottom tertile (OR≈0.84). In contrast, demographic factors were strongly associated with care-seeking. Older age groups were much more likely to seek care (age 30–50: OR≈1.39; >50: OR≈1.97 versus <30), and men were substantially less likely than women to seek care (OR≈0.70). Marital status also mattered. Married (OR≈1.5) and divorced/separated/widowed (OR≈2.3) adults were more likely than never-married peers to seek care. Education showed only a modest association with care-seeking (middle vs. low: OR ≈ 0.86), and no significant difference was observed for high vs. low education. Conclusion Formal care-seeking was uniformly low with about 84% of symptomatic adults not seeking treatment. Contrary to expectations, higher household wealth did not improve care-seeking, whereas demographic and social factors predominated. The results highlight men, younger adults, and unmarried individuals as subgroups with lower odds of seeking TB care, suggesting they may face greater barriers or reduced access. TB control programs should target outreach to these groups; for example, via male-friendly case finding and engaging family/community networks to amplify care-seeking. Continued use of high-quality surveillance data and community engagement will be essential to ensure that all symptomatic Kenyans promptly access TB diagnosis and care.