Medicine and Health Sciences Commons^™

Influence Of Institutional Support And Organisational Culture On Hiv And Ncd Integration, David Njuguna, Caroline Kyalo, Eunice Muthoni, Daniel Mwai, Elvis Kirui, Wesley Rotich, Joy Mugambi, James Waweru, Nelson Muriu, Easter Olwanda

Population Health, East Africa

Background: The integration of services for human immunodeficiency virus (HIV) and noncommunicable diseases (NCDs) has gained increasing attention in recent years because of the overlapping prevalence and shared risk factors between these health conditions. However, successful integration requires more than just the alignment of clinical practices. The role of institutional support and organisational culture in promoting effective integration remains an underexplored area.

Aim: This study aims to fill this gap by examining how institutional structures and organisational values influence the integration of HIV and NCD care.

Setting: The study setting was Nakuru County in Kenya.

Methods: …

Recommended Best Practices For Construct-Centered Adaptation Of The Harmonized Cognitive Assessment Protocol, Emily Briceño, Darina Bassil, Pranali Khobragade, Anthony Ngugi, Martine Bejjani, Eric Ochieng, Silvia Mejia-Arango, Salima Douhou, Kazione Kulisewa, Miguel Rentería

Population Health, East Africa

Objectives The Harmonized Cognitive Assessment Protocol (HCAP) neuropsychological assessment approach aims to support the collection of harmonizable data on cognitive function for cross-national cognitive aging and dementia research. As the measurement of cognition is sensitive to differences in contextual, cultural, educational, linguistic, social, and other factors that may influence cognitive test performance, HCAP requires adaptation to be appropriate for the contexts in which it is administered. We aim to provide methodological recommendations for the adaptation and implementation of the HCAP and other cognitive data collection tools in novel settings.

Methods We drew from existing guidelines on cross-cultural psychological test adaptation …

The Colchicine-Sodium-Glucose Cotransporter Two Inhibitors Conundrum: Promise, Pitfalls, And Next Steps, Ali Bin Jabbar, Asma Ahmed, Salim S. Virani

Population Health, East Africa

No abstract provided.

Fifth Edition Who Classification: Mature B-Cell Neoplasms, Kikkeri Naresh, Kennosuke Karube, Anita Borges, Wah Cheuk, Sumeet Gujral, Shahin Sayed, Aliyah Sohani, Stefano Lazzi, German Ott, Ming-Qing Du

Pathology, East Africa

We present a review of mature B-cell neoplasms as described in the fifth edition of the WHO classification of haematolymphoid tumours (WHO-HAEM5). Entities have expanded, and definitions are increasingly reliant on genomic and other technologies. However, the WHO-HAEM5 employs a hierarchical structure with family (class)-level definitions that group several specific entities. This approach enables the assignment of a family-level diagnosis when criteria for specific entities cannot be met due to resource constraints. To facilitate application in resource-limited settings, WHO-HAEM5 divides diagnostic criteria into ‘essential’ and desirable criteria for most entities. This review focuses on changes and updates in B-cell lymphoma …

Improving The Reporting On Health Equity In Observational Research (Strobe-Equity): Extension Checklist And Elaboration, Omar Dewidar, Larissa Shamseer, G J. Melendez-Torres, Elie A. Akl, Jacqueline Ramke, Xiaoqin Wang, Oyekola Oloyede, Taryn Young, Stuart G. Nicholls, Zulfiqar Ahmed Bhutta

Institute for Global Health and Development

Data on health equity to inform societally relevant evidence based decisions and policy making are lacking in the research literature. Observational studies have the potential to provide data on health equity. Yet, guidance on how to report health equity data and considerations in observational research is inadequate. The STROBE-Equity extension addresses this gap by providing a structured set of criteria to enhance the reporting of health equity data and considerations.

How Life-Cycle Real-World Evidence Can Bridge Evidentiary Gaps In Precision Oncology, Emanuel Krebs, Deirdre Weymann, Tania M. Bubela, Dean A. Regier

Office of the Provost

Precision oncology uses omics-based diagnostic technologies to inform histology-agnostic cancer treatment. To date, health system implementation remains limited owing to high uncertainty in regulatory and reimbursement evidence submissions. In this perspective, we describe a life-cycle approach to the evaluation of precision oncology technologies that addresses evidentiary uncertainty and is grounded in real-world evidence (RWE) derived using data routinely collected by healthcare systems. We consider the role for RWE in international regulatory and reimbursement decision-making, review common biases for observational precision oncology evaluations, make specific recommendations for RWE study design and analysis, and specify healthcare system requirements for data collection. We …

Association Of Covid-19 Status With Maternal And Neonatal Outcomes Among Pregnant Women At Mombasa County Referral Hospital, Kenya, Salome Mghoi Rajab

MSc in Advanced Practice Midwifery

Background: COVID-19 pandemic has raised global concern regarding maternal and neonatal health owing to physiological and immunological changes that may heighten disease severity. Despite the global evidence linking COVID-19 infection with unfavorable pregnancy outcomes, data from Sub-Saharan Africa remain limited. This leaves an essential vacuum in our understanding of how COVID-19 status affects maternal and neonatal outcomes in counties like Mombasa, where health-care system problems may alter risks. Vertical transmission remains a puzzle to be solved.

Aim: To assess the association of COVID-19 status on maternal and neonatal outcomes between March 2020 to March 2022.

Methodology: A …

Assessing The Impact Of Tungiasis On Children’S Quality Of Life In Kenya, Lynne Elson, Berrick Otieno, Abneel Matharu, Naomi Riithi, Esther Chongwo, Francis Mutebi, Hermann Feldmeier, Jürgen Krücken, Ulrike Fillinger, Amina Abubakar

Institute for Human Development, East Africa

Tungiasis is a neglected tropical skin disease caused by the sand flea, Tunga penetrans which penetrates the skin causing considerable pain and itching. In this cross-sectional study we aimed to assess its impact on the quality of life of school children in Kenya. School pupils (198) aged 8–14 years with tungiasis were randomly selected and interviewed using a tungiasis-specific quality of life instrument (TLQI). The caregivers of each infected pupil and 199 randomly selected caregivers of uninfected pupils were interviewed using the proxy KIDscreen52 to assess their child’s general health-related quality of life (HR-QoL). Generalized linear models were used to …

Assessing The Psychological Wellbeing And Resilience Of Frontline Health Workers In Uganda: A Cross-Sectional Study, Ahmed Sarki, Joseph Atukwatse, Gideon Mbithi, Sabina Odero, Mary Namuguzi, Bernard Mutwiri, Lestine Bitakwitse, Peninah Wachira, Kevinson Mwangi, Eunice Ndirangu, Amina Abubakar

Institute for Human Development, East Africa

Background: Health workers in the frontline are the major drivers of health systems in low- and middle-income countries. However, these health workers face both chronic and acute shocks and stressors that expose them to mental health problems which are often overlooked. We examined the prevalence of mental health problems, correlates of psychological functioning, and resilience of frontline health workers in Uganda.

Methods: We conducted a cross-sectional study comprising 1800 frontline health workers across all regions of Uganda from August through October 2023. We used tools such as the PC-PTSD-5, PHQ9, PSS, GAD-7, Oldenburg Burnout Inventory, and CD-RISC-10 to assess PTSD, …

International Accreditation For Acute Stroke Care: Lessons Learnt From A Kenyan Stroke Centre, Dilraj Sokhi

Internal Medicine, East Africa

Background: The prevalence of stroke is increasing in Africa, yet resources remain limited in managing the disease. Whilst there are international guidelines on how to set up and manage stroke services, even in resource-limited settings, the uptake remains low. We describe here the opportunities and challenges we faced whilst setting up a stroke care pathway of international standards in a regional referral hospital in East Africa.

Methods: We describe how we adapted international stroke care guidelines for acute primary stroke (including both ischemic and hemorrhagic stroke), and used these to inform our stroke care pathway. We highlight opportunities of leveraging …

Pharmacy Newsletter : September 2025, Pharmacy Department

Department of Pharmacy Archives

• Pharmacy Newsletter provides information regarding the decisions of P&TC, current concepts in drug therapy, warnings and cautions issued by various regulatory agencies, drug interactions, ADRs, and matters related to drug usage.
• AKUH Clinical Pharmacy Accolades
• Beyond Weight Loss: GLP-1 Receptor Agonists as a Cardiometabolic Paradigm Shift in Type 2 Diabetes
• Key Insights | Drug & Poison Information Center
• Carbamazepine Intoxication Management
• TOX TOK: General Treatment Approach To Unknown Poisoning - Coma Cocktail
• Pharmacy & Therapeutics Committee: Ensuring Safe & Effective Medication Use! Progress & Reports
• Dexamethasone Induced Psychosis: Exploring Steroid Impact on Mental Health
• ASHP Residency Program: Leading Pharmacy Training …

Prevalence And Factors Associated With Depression, Anxiety And Post-Traumatic Stress Disorder Among Healthcare Workers From Sub-Saharan Africa: Systematic Review, Ezra Too, Peninah Wachira, Solomon Njenga, Sabina Odero, Eunice Ndirangu, Amina Abubakar

Institute for Human Development, East Africa

Background: Depression, anxiety and post-traumatic stress disorder (PTSD) are prevalent among healthcare workers (HCWs), including those from sub-Saharan Africa (SSA). However, there are limited summary data on the burden and factors associated with these disorders in this region. We conducted this systematic review (registration no. CRD42022349136) to fill this gap.

Aims: The aim of this review was to systematically summarise the available evidence on the prevalence and factors associated with depression, anxiety and PTSD, or their symptoms, among HCWs from SSA.

Method: We searched African Index Medicus, African Journals Online, CINAHL, PsycINFO and PubMed for articles published, from database inception …

Fetal Myocardial Performance Index In The Late Third Trimester For The Prediction Of Intrapartum Cardiotocographic Abnormalities, Sikolia Wanyonyi, Ingrid Gichere

Obstetrics and Gynaecology, East Africa

Objective

We sought to determine whether fetal myocardial performance index (MPI) performed in the late third trimester could predict abnormal intrapartum cardiotocographic (CTG) patterns.

Methods

A prospective observational study including women presenting for fetal growth ultrasound from 32 weeks. Three consecutive measurements of the left ventricular MPI were obtained and averaged. The patients’ intrapartum CTG events were later observed.

Results

A total of 299 women were analyzed. The fetal MPI across the population were 0.41, 0.50 and 0.63, representing 10th, 50th and 90th centiles, respectively. A one-way analysis of variance (ANOVA) did not show a significant difference in MPI values …

Bridging Gaps In Breast Cancer Care: A Breast Cancer Care Quality Index To Improve Outcomes Worldwide, Eduardo Cazap, Benjamin Anderson, Giuseppe Curigliano, Sandeep Sehdev, Fatima Cardoso, Ana Gonzalez, Emad Shash, Cheng-Har Yip, André Mattar, Miriam Mutebi

General Surgery, East Africa

Background: Breast cancer (BC) care faces challenges in early detection, timely diagnosis and comprehensive management. Disparities persist, with underserved populations facing the greatest barriers. Addressing these requires policies that support consistent, evidence-based practices and enhance healthcare capacity and technology advancements. This document presents the development of the Breast Cancer Care Quality Index (BCCQI), supported by evidence to promote equitable care and improve BC outcomes globally, and discusses its adoption as a strategic tool within National Cancer Control Plans.

Methods: A two-part methodology identified challenges in BC care and defined dimensions, targets and indicators for the BCCQI, aligned with …

Low Prevalence Of Helminth Infection In Ugandan Children Hospitalized With Severe Malaria, Drew Capone, Nuzrath Jahan, Ruth Namazzi, Robert Opoka, Chandy John

Paediatrics and Child Health, East Africa

Co-infection by intestinal helminths and Plasmodium spp. may be common in endemic communities. In 2003, Uganda instituted a national deworming program, with anti-helminth medication provided twice annually to children 6 months to 5 years of age, but few follow-up studies have been conducted. Several studies have identified a relationship between helminth infection, Plasmodium spp. infection and malaria severity. However, the relationship is not well defined, and results are inconclusive. We analyzed 177 stool samples from a cohort of children with severe malaria enrolled in two hospitals in Uganda from 2014–2017. All children were 6 months to 48 months of age …

Use Of Perioperative Scores In Predicting Postoperative Event And Selection For Discharge After Elective Laparoscopic Cholecystectomy: A Retrospective Cohort Study, Brian Nyamweya Bundi

Master of Medicine in General Surgery

Background: While daycare laparoscopic cholecystectomy is gaining momentum in developed countries, a majority of patients in low and middle-income countries are admitted overnight. This safety precaution offers prompt access to emergency services should need arise. This precautional overnight stay has implications on cost, healthcare utilization and patient satisfaction. Daycare procedures routinely utilize scoring systems for assessing discharge readiness. We explored the utility of the modified Surgical APGAR Score (mSAS) and the White Fast Track Score (WFTS) as predictors for postoperative events and their role in identifying patients who can have a safe daycare discharge after laparoscopic cholecystectomy in this retrospective …

Identifying The Barriers And Facilitators To Guideline-Concordant Breast Cancer Surgical Care In Kenya: A Sequential Mixed Method Study, Emmanuel Marsuk Lomole

Master of Medicine in General Surgery

Introduction 

Breast cancer represents the most commonly diagnosed cancer in women. In Kenya, it constitutes 20% of all cancer diagnoses as well as the second most common cause of cancer related death in the country, with a 5-year survival between 40.1% and 64%. There exists heterogeneity in the delivery of breast cancer care despite the presence of guidelines that can standardize care and that have been contextualized for Sub-Saharan Africa. There is paucity of data on barriers and facilitators of guideline-concordant breast cancer surgical care.

Setting 

The Aga Khan University Hospital Nairobi.

Aim 

The purpose of this study was to …

First-Time Mothers' Experiences Of Breastfeeding During The Early Postpartum Period In Nairobi, Kenya: A Qualitative Study, Viola Siongei, Rose Maina, Eunice Pallangyo

School of Nursing & Midwifery, East Africa

Background/Aims The rate of exclusive breastfeeding in the first 6 months is still low, despite global active promotion of the practice. The exclusive breastfeeding rate among first-time mothers is much lower than among multiparous women, which has been attributed to difficulties assuming the new role and a lack of breastfeeding skills. This study aimed to gain an in-depth understanding of first-time mothers' breastfeeding experiences and the factors that influence these experiences during the early postpartum period in Nairobi, Kenya.

Methods This qualitative explorative, descriptive study involved 17 purposively sampled first-time mothers at 4–6 weeks postpartum. In-depth, face-to-face semi-structured interviews were …

Platelet Transfusion Practices In The Icu: A Prospective Multicenter Cohort Study, Van Stefan, Raasveld Jorinde, Andrew Flint, Jimmy Schenk, Claudia Van Den Oord, Merijn Reuland, Sanne De Bruin, Jan Bakker, Maurizio Cecconi,, Marcus Lance

Anaesthesiology, East Africa

Objective: There is a lack of comprehensive international data regarding platelet transfusion practices in the ICU. This study aimed to evaluate the current occurrence rate of platelet transfusion in the ICU and provide an overview of platelet transfusion practices including indications for a platelet transfusion, thresholds, (non-)adherence and geo-economic region variations.

Design: International prospective cohort study.

Setting: Two hundred thirty-three centers in 30 countries worldwide.

Patients: All patients 18 years old and older, admitted to the ICU during a single study week, selected by each site from one of the 16 predefined weeks (March 2019 to …

The Relationships Between Sporadic And Repetitive Non-Suicidal Self-Injury And Mental Disorders Among First-Year College Students: Results From The World Mental Health International College Student Initiative, Penelope Hasking, Glenn Kiekens, Maria Petukhova, Yesica Albor, Ahmad Al-Hadi, Jordi Alonso, Nouf Al-Saud, Yasmin Altwaijri, Claes Andersson, Lukoye Atwoli

Brain and Mind Institute

Background: Non-suicidal self-injury (NSSI) is associated with mental disorders, yet work regarding the direction of this association is inconsistent. We examined the prevalence, comorbidity, time–order associations with mental disorders, and sex differences in sporadic and repetitive NSSI among emerging adults.

Methods: We used survey data from n = 72,288 first-year college students as part of the World Mental Health-International College Student Survey Initiative (WMH-ICS) to explore time–order associations between onset of NSSI and mental disorders, based on retrospective age-of-onset reports using discrete-time survival models. We distinguished between sporadic (1–5 lifetime episodes) and repetitive (≥6 lifetime episodes) NSSI in …

Behavior Change Communication Strategies On Human Immunodeficiency Virus /Acquired Immunodeficiency Syndrome Risk Reduction For Long-Distance Truckers In Kenya, Cyrus Mutie, John Gachohi, Kawira Kithuci, Grace Mbuthia

School of Nursing & Midwifery, East Africa

Background Long-distance truckers (LDTs) not only experience heightened risk of human immunodeficiency virus (HIV) infections due to risky sexual networks, but are also hard to reach with consistent risk reduction messages due to their often disruptive work schedules. Besides, evidence of the existing behavior change communication (BCC) strategies to enhance HIV/ acquired immunodeficiency syndrome (AIDS) risk reduction is limited. Thus, the study sought to explore the most effective and preferred BCC strategies for adoption among LDTs in Kenya.

Methods and Methodology Nine key informants and 18 in-depth interviews were used to gather qualitative data from purposively sampled participants at Kenya's …

Patients´ Characteristics And Six-Month Outcomes Of Patients With Atrial Fibrillation In Kenya: A Retrospective Observational Cohort Study From The National Cardiovascular Registry, Salim Abdallah, Jasmit Shah, Anders Barasa, Felix Barasa, Benard Gitura, Mzee Ngunga

Internal Medicine, East Africa

Introduction: atrial fibrillation is increasingly diagnosed in Kenya due to the persistence of rheumatic heart disease and the rising burden of cardiovascular risk factors. We aim to describe the baseline, clinical, treatment characteristics, and six-month outcomes of patients diagnosed with atrial fibrillation in Kenya.

Methods: a retrospective observational cohort study design was employed. Data were obtained from three Kenyan referral hospitals, including public and private institutions. Baseline and six-month data were collected. Depending on the type of variable, data were summarized descriptively.

Results: two hundred forty participants were enrolled, with a median age of 59.0 (IQR: 42.0-75.8). …

Left Bundle Area Pacing Outcomes Among Patients With Very Wide Qrs – Insights From An African Registry, Willy Mucyo, Mzee Ngunga, Miriam Msunza, Jeilan Mohamed, Marcus Ngantcha, Brian Vezi

Internal Medicine, East Africa

Background: Left Bundle Area Pacing (LBAP) is a promising alternative to conventional cardiac resynchronization therapy. There is a high prevalence of dilated cardiomyopathy in Africa, which is often associated with very wide QRS. However, data on LBAP outcomes in Africa are limited. Objective To evaluate the procedural and clinical outcomes of LBAP among African patients with very wide QRS durations.

Methods: The Multicenter African Cardiac Outcomes in Pacing (MACOP) registry enrolled 311 patients in Kenya and South Africa who underwent LBAP between 2021 and 2024. We evaluated procedural and clinical outcomes. Patients were stratified by baseline QRSd (normal …

Women's Unique Health Needs And The Sustainable Development Goals: A Meeting Report From The 79th United Nations General Assembly Science Summit, Irene Aninye, Sarah Chew, Nicole Althaus, Michele Barry, Ru-Fong Cheng, Carolyn Harris, Eleanor Nwadinobi, Beth Battaglino, Aisha Brooks, Marleen Temmerman

Centre of Excellence in Women and Child Health

Biological sex, hormones, and gender uniquely affect health and disease, often resulting in disparities for women across the lifespan and from different racial and ethnic groups, geographical locations, and socio economic backgrounds. Without intentional investment and infrastructure to support good health and wellbeing for women,half of the world’s population remains vulnerable to preventable morbidity and mortality. The Society for Women’s Health Research and ECHAlliance–The Global Health Connector convened a women’s health programas part of the 10th Annual Science Summit during the United Nations 79th General Assembly. This hybrid event was held in New York, NY, (USA) and virtually in September …

End User Experiences Of An Electronic Health Records Platform In A Tertiary Hospital System In Kenya, Anmol Shrestha, Jasmit Shah, Zamanali Khakhar, Armando Ruiz, Zohray Talib, Sayed Karar

Internal Medicine, East Africa

Background: Electronic Health Record (EHR) systems allow health care facilities to provide better care to patients and improve overall provider efficiency. They are vital for low-and middle-income countries in achieving the United Nations Sustainable Development Goal of ensuring healthy lives and promoting the well-being of all their citizens. This study aimed to evaluate perceptions and usage of a comprehensive EHR by end-users after its deployment into a tertiary hospital system and its outpatient centers in Kenya and also aimed to understand the effectiveness of various implementation strategies deployed by the institution during their implementation process.

Methods: We conducted …

Healthcare Informatics September 2025, Aga Khan University

Department of Chief Medical Information Officer (CMIO) Archives

This issue of the Healthcare Informatics Newsletter provides key updates on the ongoing AKU OneHealth Electronic Health Record (EHR) build and usability phase. It highlights clinical engagement across nursing, anesthesia, pediatrics, OBGYN, oncology, and emergency medicine, as well as progress in analytics, KPIs, and departmental integration. The newsletter also shares insights from leadership messages, usability milestones, academic contributions, and upcoming events.

Cardiogenic Shock With Acute Myocardial Infarction Among Older Adults In The United States, Taha Mansoor, Ali Bin Jabbar, Mahmoud Ismayl, Dylan Yu, Kartik Gupta, Sachin Parikh, Austin Brubaker, Abdul Minhas, Dmitry Abramov, Salim S. Virani

Population Health, East Africa

Background: Characteristics and outcomes associated with cardiogenic shock (CS) with acute myocardial infarction (AMI) in older patients have not been well characterized.

Objectives: The purpose of this study was to investigate characteristics and outcomes of older patients admitted with CS with AMI.

Methods: We used the National Inpatient Sample database to evaluate clinical characteristics of hospitalizations, clinical outcomes, and health care utilization of hospitalizations of older patients ≥80 years with CS and AMI from 2003 to 2021. We also compared data from older patients with a reference relatively younger patient population (18-79 years).

Results: During the study period, …

Induction Of An Early Ifn-Γ Cellular Response And High Plasma Levels Of Sdf-1Α Are Inversely Associated With Covid-19 Severity And Residence In Rural Areas In Kenyan Patients, Perpetual Wanjiku, Benedict Orindi, John Kimotho, Shahin Sayed, Reena Shah, Mansoor Saleh, Viviane Olouch, Ann Karanu, Jasmit Shah, Zaitun Nneka

Pathology, East Africa

Introduction COVID-19 was less severe in Sub-Saharan Africa (SSA) compared with Europe and North America. It is unclear whether these differences could be explained immunologically. Here we determined levels of ex vivo SARS-CoV-2 peptide-specific IFN-γ producing cells, and plasma cytokines and chemokines over the first month of COVID-19 diagnosis among Kenyan COVID-19 patients from urban and rural areas.

Methods Between June 2020 and August 2022, we recruited and longitudinally monitored 188 COVID-19 patients from two regions in Kenya, Nairobi (urban, n=152) and Kilifi (rural, n=36), with varying disease severity – severe, mild/moderate, and asymptomatic. IFN-γ secreting cells were enumerated at …

The Psychosocial Impact Of Covid-19 Mitigation Measures On Frontline Staff Providing Sexual Health And Family Planning Services In Kenya: A Mixed-Methods Study, Ferdinand Okwaro, Abdu Mohiddin, Marleen Temmerman

Centre of Excellence in Women and Child Health

Background The recognition of the unintended impact of COVID-19 mitigation measures to the availability of sexual and reproductive health (SRH) services led to the initiation of mitigation and health systems support mechanisms within public health facilities by the Ministry of Health (MoH) in Kenya to maintain pre-Covid-19 levels of SRH service provision. These recovery mechanisms however concentrated on policy and infrastructural elements of service provision with limited attention given to the psychosocial impacts of COVID-19 on health care workers (HCWs). This paper examines the psychosocial impact of COVID-19 on front line family planning (FP) and sexually transmitted infections (STI) management …

Routine Antenatal Ultrasound By Nurse-Midwives In Rural Kenya: A Pragmatic Trial Assessing Feasibility And Effects Of The Mimba Yangu (My Pregnancy) Project, Claudia Hanson, Lucy Nyaga, Nidhi Leekha, Michaela Mantel, Sarah Kedenge, Caroline Gitonga, Violet Naanyu, Jasmit Shah, Marleen Temmerman

Centre of Excellence in Women and Child Health

Introduction: Task-sharing of obstetric ultrasound between nurse-midwives and doctors has the potential to operationalize the World Health Organization’s recommendation of at least one ultrasound before 24 weeks of gestational age for every pregnant woman. Here, we report on the feasibility, acceptability, and effects of the Mimba Yangu (My Pregnancy) task-sharing approach in rural Kenya.

Methods: We conducted a pragmatic trial including 28 primary care facilities between April 2021 and March 2022, selected based on feasibility criteria. Fourteen facilities received the ultrasound intervention composed of (i) task-sharing with nurse-midwives, (ii) the use of portable ultrasound devices (Lumify™) connected to a tablet, …