Beyond Symptoms: How Access to Diagnostic Services Shapes Inflammatory Bowel Disease Detection at Kenya’s Tertiary Hospital

Résumé

Context: Inflammatory Bowel Disease (IBD) is increasingly recognized in Sub-Saharan Africa, yet its detection in low-resource settings remains constrained by limited access to specialized diagnostic procedures. In Kenya, empirical evidence linking diagnostic access to IBD detection in tertiary hospitals is scarce.

Aim: This study assessed whether access to selected diagnostic procedures influences the diagnosis of IBD at Kenyatta National Referral Hospital (KNH), Nairobi, Kenya.

Methods: A cross-sectional analytical study was conducted among patients attending the gastroenterology unit at KNH. Of the 184 patients approached, 151 completed the study (response rate: 82%). Data were collected using a researcher-administered questionnaire and a checklist verifying hospital records. Access to ten diagnostic procedures (bone chemistry, stool tests, blood tests, endoscopy, ultrasound, physical examination, X-ray, CT scan, liver function tests, and MRI) was assessed as a binary exposure. The outcome was confirmed IBD diagnosis (yes/no). Descriptive statistics summarized participant characteristics and diagnostic access.

Results: The mean age of participants was 38.6±2.41 years; 52.3% were females, 44.4% were married, and 41.7% had secondary education. Overall, 45 participants (29.8%) had IBD, while 106 (70.2%) were diagnosed with irritable bowel syndrome (IBS). Among IBS cases, gastroesophageal and gastric disorders were most common (43.7%). Clinical symptoms frequently reported included abdominal pain (55.5%), diarrhea (50.3%), and dehydration (42.4%). Access to diagnostic procedures was generally low: 86.8% did not have access to MRI, 78.8% lacked access to bone chemistry testing, 78.8% could not access CT scans, 72.2% did not have access to blood tests, and 66.9% did not have access to endoscopy. Chi-square analysis showed no significant association between IBD diagnosis and access to all routine diagnostics procedures assessed by the study, including endoscopy (χ²=1.373, p=0.241), stool tests (χ²=0.183, p=0.669), blood tests (χ²=0.999, p=0.318), CT scan (χ²=0.055, p=0.815), MRI (χ²=0.254, p=0.614), or liver function tests (χ²=0.521, p=0.470).

Conclusion: IBD accounted for nearly one-third of gastrointestinal diagnoses at KNH. Access to routine diagnostic investigations was limited and not independently associated with IBD detection. These findings highlight persistent gaps in diagnostic access and underscore the need for earlier, equitable access to definitive diagnostic services to improve timely IBD detection in Kenyan tertiary settings.