Search

Accessibility to chest X-ray and TB testing in Kenya

Case study

Identifying gaps in population accessibility to chest X-ray and TB testing services to inform chest X-ray scale up

Objective

Analyze current population accessibility to chest X-ray (CXR) and TB testing services following the adoption of WHO recommendations for the integration of CXR into TB screening algorithms in high TB burden countries.

Analysis focus

  • Evaluating the current level of population accessibility to CXR and TB testing services at national and sub-national levels.
  • Identifying accessibility gaps for placement of newly procured CXR instruments.

Key data sources

  • Health facilities data: Geocodes from the country Master facility list.
  • Population data: 2020 census data from WorldPop.
  • County categorization: 47 counties categorized by the Ministry of Health as easy-, moderate- or hard-to-reach counties.

Key findings

  • Since the NTP guidelines look at mWRD or initial CXR followed by referral to mWRD, coverage in the network with the CXR sites only (26 sites) and the combined access to sites with CXR and/or mWRD (245 sites) were analysed.
  • Uneven distribution of sites across counties, with most of sites located in easy- and moderate-to-reach counties, results in low accessibility in hard-to-reach counties (23%) and high coverage in easy-to-reach counties (89%).
  • Although easy-to-reach counties contain almost half (48%) of the population in Kenya, highly populated hard-to-reach counties with low accessibility exist, such as Mandera county in the Northeast of Kenya.
  • Mandera county is the second most densely population county after Nairobi and has only two CXR sites and three CXR/mWRD sites, resulting in 18% coverage for 4,9% of the national population.
  • To improve national and sub-national accessibility, a group of sub-counties with population over 100K and accessibility below 30% was selected for placement of the new CXRs. 50 sub-counties in 19 counties were identified based on these criteria.

Implications

Performing a population accessibility analysis using DxGeoMap provided evidence to the NTP on where the gaps on accessibility to CXR screening and TB testing services in the country are and identified the areas with current coverage gaps where the newly CXR procured with partners funding should be prioritized for placement.