Closing the Missing Children Gap: Paediatric Tuberculosis Case-Finding Through School-Based, Child-Led Screening in Kakamega, Kenya

ABSTRACT : Kenya's NTLD-P targets children as 10–15% of all notified tuberculosis (TB) cases, a target the country has struggled to meet. This study examines the paediatric TB care cascade generated by the Kenya Innovation Challenge Tuberculosis (KIC-TB) project's school-based, child-led screening model in Kakamega, asking whether it displays the sex-based inequity previously documented among adults reached by the same programme, and whether its paediatric contribution meets national case-finding benchmarks. This is a retrospective, descriptive and analytical study of programmatic screening data from the NFM3 funding phase (July 2021–June 2024), the period for which complete, sex-disaggregated paediatric records are available. The care cascade: screened, presumptive, investigated, diagnosed, and linked to treatment was analysed by sex using chi-square and Fisher's exact tests, with odds ratios and 95% confidence intervals, and benchmarked against national and global literature. Of 266,943 children screened, 214 were diagnosed with TB (117 bacteriologically confirmed) and all were linked to treatment (100%). No significant sex difference was found at any cascade stage (all p > 0.17). Children accounted for 23.2% of all TB cases diagnosed, exceeding national targets, with bacteriological confirmation (54.7%) above typical global figures (20–30%), though the number needed to screen (1,247) exceeded the pooled global school-setting estimate (464). School-based, child-led screening can close a meaningful share of Kenya's paediatric case-finding gap without introducing sex-based inequity, and current evidence supports expanding this channel rather than treating it as an unproven pilot.