Gendered Pathways in TB Diagnosis: Insights from a School-Based Screening Initiative in Kakamega County, Kenya

Background: Tuberculosis (TB) remains a major public health challenge in Kenya, with persistent gender disparities in diagnosis and treatment access. This study examines gendered pathways in TB detection through a school-based, child-led screening initiative in Kakamega County, highlighting how social norms, barriers, and health-seeking behaviors influence outcomes. This study is informed by feminist theory, with a focus on intersectional feminism, and guided by the Social Determinants of Health framework. It examines how overlapping social identities and structural conditions influence unequal access to tuberculosis diagnosis. Methods: A retrospective cross-sectional analysis was conducted on data from the Kenya Innovation Challenge TB project (2019–2024), involving 56,664 screened adults (28,394 males, 28,270 females). Descriptive statistics, Chi-square tests, and odds ratios were used to assess gender differences in TB diagnosis and treatment initiation. Results: Men accounted for 61.6% of 700 confirmed TB cases, with a significantly higher yield (1.52%) than women (0.95%; ?² = 36.21, p < 0.001; OR = 1.62, 95% CI: 1.38–1.90). Treatment initiation was equitable (>99% for both sexes). Conclusion: Despite balanced screening, women appear underdiagnosed, likely due to stigma, caregiving roles, and diagnostic biases. Gender-responsive strategies are essential for equitable TB control. This study underscores the value of integrating gender analysis into community-based interventions to address hidden inequalities.