Schools as Surveillance Hubs: Uncovering Adult TB Burden through Child-Led Screening in Kakamega County, Kenya

Tuberculosis (TB) continues to pose a public health challenge in Kenya. Many adult cases remain undiagnosed due to stigma, poor health-seeking behavior, and limited diagnostic access. To respond to this gap, the Kenya Innovation Challenge TB (KIC-TB) project piloted a school-based, child-led screening initiative in Kakamega County. The approach used schoolchildren as health messengers to identify symptomatic adults within households and schools. This study applied a retrospective, descriptive cross-sectional design using data from 312,660 individuals screened across 205 schools between 2019 and 2024. Children used simplified symptom checklists to assess household members, while staff underwent direct screening. Confirmed cases were diagnosed using GeneXpert, and treatment linkage was monitored. Statistical tests including chi-square, Fisher’s exact test, and odds ratios were used to compare TB yields between groups. Adults made up 15% of those screened but accounted for over half of confirmed TB cases. The TB yield among parents was 1.34%, significantly higher than among children at 0.08%. Chi-square testing confirmed a significant difference in detection across groups (χ² = 2412.81, p < 0.001). Parents had 16.65 times higher odds of TB diagnosis compared to children. Fisher’s exact test showed a significantly higher yield among non-teaching staff than teachers (p = 0.041). Treatment initiation exceeded 99% for confirmed cases. Schools can serve as effective TB surveillance hubs when supported by child-led screening. This model is cost-effective, community-based, and able to uncover undetected TB cases within household settings. Findings support the integration of school-based screening into Kenya’s national TB surveillance framework.