Abstract: Delayed detection and case diagnosis of pediatric tuberculosis (TB) is a significant factor in TB transmission, morbidity, and mortality especially in resource-limited settings, such as the sub-Saharan Africa, including Kenya. This study aimed to identify gaps in pediatric TB case detection and diagnosis, as well as their association with prompt treatment in such settings by focusing on a level 5 hospital in the Kenyan healthcare system; that is Kerugoya County Referral Hospital (KCRH), in Kirinyaga County, in Kenya. A facility-based cross- sectional survey that adopted a mixed methods approach by collecting quantitative and qualitative data using structured questionnaires and interviews guides was conducted at KCRH.