Public Health Commons^™

Dementia Risk Reduction In The African Context: Multi-National Implementation Of Multimodal Strategies To Promote Healthy Brain Aging In Africa (The Africa-Fingers Project), Chinedu Momoh, Rachel Maina, Lukoye Atwoli, Karen Blackmon, Edna Bosire, Gloria Chemutai, Linda Khakali, Sylvia Mbugua, Zul Merali, Olivera Nesic Taylor,, Anthony Ngugi, Cyprian Mostert, Eunice Muthoni, Roselyter Riang’A, Mansoor Saleh, Shahin Sayed, Jasmit Shah

Brain and Mind Institute

Dementia prevention in Africa is critically underexplored, despite the continent's high prevalence of modifiable risk factors. With a predominantly young and middle-aged population, Africa presents a prime opportunity to implement evidence-based strategies that could significantly reduce future dementia cases and mitigate its economic impact. The multinational Africa-FINGERS program offers an innovative solution, pioneering culturally sensitive, multidomain interventions tailored to the unique challenges of the region. Leveraging insights from landmark global studies such as Worldwide-FINGERS and Alzheimer's Disease Neuroimaging Initiative, the program employs a multideterminant precision prevention framework, grounded in community based systems dynamics. Africa-FINGERS further integrates cutting-edge state-of-the-art multimodal biomarker …

Metastatic Recurrence In Women Diagnosed With Non-Metastatic Breast Cancer: A Systematic Review And Meta-Analysis, Eileen Morgan, Colette O’Neill, Richa Shah, Oliver Langselius, Yaqi Su, Clara Frick, Hanna Fink, Aude Bardot, Miriam Mutebi, Paul Walsh

General Surgery, East Africa

Background: To assess proportions of metastatic recurrence in women initially diagnosed with non-metastatic breast cancer by stage at diagnosis, breast cancer subtype, calendar period and age.

Methods: A systematic search of MEDLINE and Web of Science databases (January 2010–12 May 2022) was conducted. Studies reporting the proportion of distant metastatic recurrence in women with non-metastatic breast cancer were identified and outcomes and characteristics were extracted. Risk of bias was assessed independently by two reviewers. Random-effects meta-analyses of proportions were used to calculate pooled estimates and 95% confidence intervals (CIs).

Results: 193 studies covering over 280,000 patients were included in the …

Addressing Barriers To Post-Graduate Research Training In Low Resource Settings: An Innovative Approach In An Institution Of Higher Learning In Kenya, Eunice Muthoni, Rosebella Iseme, Roselyter Riang’A, James Orwa, Ken Njenga, Anthony Ngugi

Population Health, East Africa

Background: Numerous barriers hinder health research training in Post-Graduate Medical Education Programs, especially in developing countries. Research training is pivotal for medical residency, providing essential knowledge and skills for dissertation completion, fostering evidence-based medical practice, and nurturing future independent clinical researchers. A holistic approach to research education is imperative to surmount these barriers. We describe here a dissertation-centric research curriculum, delivered longitudinally, an innovative strategy undertaken by Aga Khan University's Medical College in East Africa (AKU-MCEA) to deliver postgraduate research.

Methods: A review of AKU-MCEA post-graduate research methods curriculum was conducted based on implementing Departments' experience, institutional policies, and residency …

Sexual Behavior Among Emerging Adults In Africa: A Systematic Review And Meta-Analysis, Stevenson Chea, Vincent A. Kagonya, Osman Abdullahi, Amina Abubakar, Souheila Abbeddou, Kristien Michielsen, Amin Hassan

Institute for Human Development, East Africa

Background: Estimates on sexual behavior (SB) among emerging adults (EmA) is varied in literature, which presents a challenge when designing targeted interventions. We aimed to summarize literature on prevalence and risk factors of SB among EmA in Africa.

Methods: A search for studies published in PubMed, Embase, and Psych Info by March 2023 was done. Studies involving EmA (18–25 years), conducted in Africa, and reporting 1 or more of 7 SBs were reviewed. Pooled prevalence estimates were summarized using forest plots. Heterogeneity in SB was explored. Risk factors were synthesized using a modified socioecological model.

Results: Overall, …

Postnatal Growth Of Etiologically Characterized Preterm Newborns According To Gestational Age At Birth, Paola Roggero, Irina Ryumina, Robert Gunier, Adele Winsey, Stephen Rauch, Irma Alejandra Coronado Zarco, Shabina Ariff, Maria Albertina Rego, Constanza Soto Conti, R. Ochieng

Obstetrics and Gynaecology, East Africa

Objective: To examine the relationship between etiologically-based preterm birth sub-groups and early postnatal growth according to gestational age at birth.

Methods: Prospective, multinational, cohort study involving 15 hospitals that monitored preterm newborns to hospital discharge. Measures/exposures: maternal demographics; etiologically-based preterm birth sub-groups; very, moderate and late preterm categories, and feeding. Primary outcomes: serial anthropometric measures expressed as z-scores of the INTERGROWTH-21st preterm postnatal growth standards.

Results: We included 2320 singletons and 1180 twins: very=24.4% (n = 856, including 178 < 28 weeks’ gestation); moderate=16.9% (n = 592) and late preterm=58.6% (n = 2052). The median (interquartile range) postmenstrual age at the last measure was 37 (36–38) weeks. The ‘no main condition’ sub-group percentage increased from early to late preterm; the ‘perinatal sepsis’ sub-group percentage decreased. ‘Perinatal sepsis’, ‘suspected IUGR’ and ‘fetal distress’ very and late preterm infants had lower postnatal growth patterns than the ‘no main condition’ reference sub-group. This pattern persisted in late but not very preterm infants when postnatal growth was corrected for weight z-score at birth.

Conclusion: The proportional contribution of etiologically-based preterm sub-groups and their postnatal growth trajectories vary by preterm category. Postnatal growth is partially …

Removing Lead From The Global Economy, Stephen P. Luby, Jenna E. Forsyth, Zafar Fatmi, Mahbubur Rahman, Jesmin Sultana, Erica L. Plambeck, N Grant Miller, Eran Bendavid, Peter J. Winch, Howard Hu

Community Health Sciences

No abstract provided.

Burden Of Disease Attributable To High Body Mass Index: An Analysis Of Data From The Global Burden Of Disease Study 2021, Xiao-Dong Zhou, Qin-Fen Chen, Wah Yang, Mauricio Zuluaga, Giovanni Targher, Christopher Byrne, Luca Valentu, Fei Luo, Christos Katsouras, Christopher Opio

Internal Medicine, East Africa

Background: Obesity represents a major global health challenge with important clinical implications. Despite its recognized importance, the global disease burden attributable to high body mass index (BMI) remains less well understood.

Methods: We systematically analyzed global deaths and disability-adjusted life years (DALYs) attributable to high BMI using the methodology and analytical approaches of the Global Burden of Disease Study (GBD) 2021. High BMI was defined as a BMI over 25 kg/m2 for individuals aged ≥20 years. The Socio-Demographic Index (SDI) was used as a composite measure to assess the level of socio-economic development across different regions. Subgroup analyses considered age, …

Peer Counseling For Perinatal Depression In Low- And Middle-Income Countries: A Scoping Review, Alexander Cuncannon, Kailyn Seitz, Aneel Signh, Aliyah Dosani

Brain and Mind Institute

Perinatal depression is associated with adverse maternal, newborn and child health outcomes. Treatment gaps and sociocultural factors contribute to its disproportionate burden in low- and middle-income countries (LMICs). Task-sharing approaches, such as peer counseling, have been developed to improve access to mental health services. We conducted a scoping review to map the current literature on peer counseling for perinatal women experiencing depression in LMICs. We searched CINAHL, MEDLINE, APA PsycINFO, Global Health and EMBASE for literature with no date limits. We included 73 records in our analysis, with most being systematic reviews and meta-analyses, randomized controlled trials and qualitative studies. …

Healthcare Worker Practices For Hpv Vaccine Recommendation: A Systematic Review And Meta-Analysis, Damola Bakare, Elisa Gobbo, Kofoworola Akinsola, Ayobami Bakare, Julius Salako, Claudia Hanson, Sibylle Herzig Van Wees, Adegoke Falade, Carina King

Centre of Excellence in Women and Child Health

Healthcare workers (HCWs) are trusted sources of information for vaccination and their attitude toward vaccination is thus critical. We aimed to synthesize existing literature on healthcare workers’ HPV vaccine confidence and their practices of recommending this vaccine. We conducted a systematic literature review and meta-analysis, with the search conducted last in March 2024. For the inclusion criteria, the studies needed to include healthcare worker practices or behaviors on recommending the HPV vaccination. Seventy-three articles were included. The proportions of HCWs recommending varied considerably by region and gender of the recipient, but there was no statistically significant difference in income level …

A Scoping Review Of Substance Use Brief Interventions In Africa, Florence Jaguga, Sarah Kiburi, Eunice Temet, Matthew Aalsma, Mary Ott, Rachel Maina, Cyprian Mostert, Lukoye Atwoli, Juddy Wachira, Gilliane Kosgei

Internal Medicine, East Africa

Background: The burden of substance use in Africa is substantial. Brief interventions (BIs) are a recommended public health strategy for the prevention and early intervention for substance use problems. The objective of this scoping review was to map the literature on substance use BIs in Africa, identify gaps, and provide directions for future research.

Methods: The scoping review was guided by the Arksey O’Malley Framework and the PRISMA-Scoping review (PRISMA-ScR) guidelines. A search of five bibliographic databases (PubMed, PsychINFO, Web of Science, Cumulative Index of Nursing and Allied Professionals (CINAHL) and Cochrane Library) was conducted from inception until 1st November …

Accuracy Of Nine-Item Patient Health Questionnaire Against Psychiatric Diagnosis For Depression Among People With Hiv, Marcela Yotebieng, Natalia Zotova, Charlotte Bernard, Suzanne Goodrich, Ajeh Rogers Awoh, Dana Watnick, Dominique Mahambu Nsonde, Elodie Flore Tchiengang Moungang, Moussa Seydi, Lukoye Atwoli

Internal Medicine, East Africa

Objective: The aim of this study was to assess the performance of the nine-item Patient Health Questionnaire (PHQ-9) against psychiatrist diagnosis in people with HIV (PWH).

Design: Cross-sectional analysis of data collected between January 2018 and July 2022 across five sites in Cameroon, Cote d’Ivoire, Kenya, Senegal, and the Republic of Congo. Participants were ≥18 years and receiving HIV care at the participating site. PHQ-9 was administered by study staff followed by a psychiatrist's evaluation within 3 days.

Results: Overall, 778 participants with complete data were included: 297 (38.2%) in Cameroon, 132 (17.0%) in Congo, 148 (19.0%) in Cote d’Ivoire, …

The Dengue Vaccine Initiative: A Bibliometric Analysis Of Research Publications, Festus Mulakoli, Abednego Ongeso, Horatius Musembi

School of Nursing & Midwifery, East Africa

Dengue fever has become a significant public health problem in tropical and subtropical regions and affects millions of people annually. Approximately 390 million people worldwide are estimated to be infected with dengue every year, of which 96 million develop dengue fever. Recently, there has been a noticeable increase in dengue cases, primarily in areas with tropical and subtropical climates. Vaccines have been developed to prevent or reduce the severity of the disease. This study reviews the number of publications on dengue vaccines and related topics worldwide. We aimed to evaluate the research output and create a narrative on global vaccine …

A Time-Stratified, Case–Crossover Study Of Heat Exposure And Perinatal Mortality From 16 Hospitals In Sub-Saharan Africa, Claudia Hanson, Jeroen De Bont, Kristi Sidney Annerstedt, Maria Del Rosario Alsina, Federica Nobile, Nathalie Roos, Peter Waiswa, Andrea Pembe, Jean-Paul Dossou, Hussein Kidanto

Centre of Excellence in Women and Child Health

Growing evidence suggests that extreme heat events affect both pregnant women and their infants, but few studies are available from sub-Saharan Africa. Using data from 138,015 singleton births in 16 hospitals in Benin, Malawi, Tanzania and Uganda, we investigated the association between extreme heat and early perinatal deaths, including antepartum and intrapartum stillbirths, and deaths within 24 h after birth using a time-stratified case–crossover design. We observed an association between an increase from the 75th to the 99th percentile in mean temperature 1 week (lag 0–6 d) before childbirth and perinatal mortality (odds ratio (OR) = 1.34 (95% confidence interval …

The Precise-Dyad Neurodevelopmental Substudy Protocol: Neurodevelopmental Risk In Children Of Mothers With Pregnancy Complications, Dorcas Magai, Jaya Chandna, Marie-Laure Volvert, Rachel Craik, Hawanatu Jah, Agnes Msoka, Amina Abubakar, Angela Koech, Grace Mwashigadi, Marleen Temmerman

Centre of Excellence in Women and Child Health

Background: Over 250 million children are not reaching their developmental potential globally. The impact of prenatal factors and their interplay with postnatal environmental factors on child neurodevelopment, is still unclear—particularly in low- and middle-income settings. This study aims to understand the impact of pregnancy complications as well as environmental, psychosocial, and biological predictors on neurodevelopmental trajectories. Open Peer Review Approval Status 1 2 version 2 (revision) 05 Aug 2024 view view version 1 09 Nov 2023 view view Kimford Meador, Stanford University School of Medicine, Palo Alto, CA,, USA 1. Page 1 of 21 Wellcome Open Research 2024, 8:508 Last …

Scaling Up, Sustaining, And Enhancing School-Based Sexuality Education Programs In Resource-Constrained And Conservative Contexts: Replicable Lessons From Positive-Deviant Countries, Chandra Mouli, Michielsen Kristien, Gogoi Aparajita, Nair M, Ziauddin Mohammed, Hadi S, Ijaz A, Rubio Auriolesh, Marleen Temmerman

Centre of Excellence in Women and Child Health

Despite considerable efforts, progress in the implementationof sexuality education (SE) has been uneven. This study identi-fied six “positive-deviant” low- and middle-income countries,i.e., countries that had scaled up, sustained and enhancedtheir SE programs when many others—in similar social, cul-tural and economic circumstances—were not able to do so. Inother words, they were significantly and consistently moresuccessful than the norm. Countries were shortlisted using avalidated framework and were analyzed using three other vali-dated frameworks on political priority setting, scaling up, andstakeholder engagement. The study found that India, Pakistan,Nigeria, Senegal, Mexico, and Uruguay had scaled up (eithernationwide or in some states/provinces), sustained andenhanced their …

Factors Associated With Non-Uptake Of Implantable Cardioverter-Defibrillator (Icd) Among Eligible Patients At A Tertiary Hospital In Kenya, Emmanuel Oluoch, Jasmit Shah, Jeilan Mohamed, Mohamed Varwani, Mzee Ngunga

Internal Medicine, East Africa

Background: Efficacy of Implantable Cardioverter-Defibrillator (ICD) implantation in both primary and secondary prevention of Sudden Cardiac Death (SCD) in at-risk population is well established. ICD implantation rates remain low particularly in Africa with a paucity of data regarding factors associated with non-uptake.

Objectives:The primary study objective was to determine the factors associated with non-uptake of ICD among heart failure (HF) patients with reduced ejection fraction (EF

Methods: This was a retrospective study among HF patients eligible for ICD implantation evaluated between 2018 to 2020. Comparison between ICD recipient and non-recipient categories was made to establish determinants of non-uptake.

Results: …

Access To Medicines For Parkinson's Disease In Kenya: A Qualitative Exploration, Natasha Fothergill-Misbah, Juzar Hooker, Judith Kwasa, Richard Walker

Internal Medicine, East Africa

Background: The accessibility of Parkinson’s disease medicines is limited across sub-Saharan Africa,which can have negative health, social and financial consequences for people with Parkinson’s disease andtheir families. However, there is a stark gap in the literature regarding the impact of poor access to medicineson individuals.

Objectives: The study objective was to understand the accessibility of Parkinson’s disease medicines in Kenyafrom the perspective of people with Parkinson’s disease, their caregivers and neurologists.MethodsMethods: In-depth qualitative interviews were conducted with 55 people with Parkinson’s disease, 23 caregiversand 8 neurologists to understand their experience regarding challenges with accessing Parkinson’s diseasemedicines and the health, social …

Effect Of Male Partners' Involvement And Support On Reproductive, Maternal And Child Health And Well-Being In East Africa: A Scoping Review, Richard Fletcher, Faye Forbes, Abel Fekadu Dadi, Getachew Mullu Kassa, Casey Regan, Anna Galle, Addisu Beyene, Rebecca Liackman, Marleen Temmerman

Centre of Excellence in Women and Child Health

Background and Aims: East African countries have high rates of maternal and childmortality and morbidity. Studies have shown that the involvement of male partners inreproductive health can benefit maternal and child health (MCH). This scoping reviewaims to provide an overview of the evidence across East Africa that describes malepartner involvement and its effect on maternal, reproductive, and child well‐being.

Methods: Ten databases were searched to identify quantitative data on male'sinvolvement in East Africa. Studies reporting qualitative data, “intention to use” dataor only reporting on male partner's education or economic status were excluded.Studies were organized into five a priori categories: antenatal …

Health Professional Regulation And Provision Of Quality Health Services; Cross Sectional Analysis Of Private Health Care Providers In Wajir County, Kenya, Ali Ahmed Mohamed Qadar, Wanja Mwaura-Tenambergen, Eunice Muthoni, Luke Wahome Kinyua

Population Health, East Africa

Background: Health professional regulatory bodies oversee and enforce standards in healthcare to safeguard patient safety and prevent harm. However, international consistency in these regulations remains limited. The Kenya health sector relies on various bodies to enforce standards among professionals and institutions, albeit constrained by financial and human resources that hinder effective oversight. This study aimed to assess how regulatory practicessuch as licensing, training oversight, inspection of practice, and quality assurance mechanisms- affect the quality of healthcare provided by private providers.

Methods: The study targeted 108 healthcare providers from 36 private health facilities, primarily nurses and clinical officers. A sample of …

Assessment Of Ferritin And Lead Levels In Children Living In An Informal Urban Settlement In Kenya, Geoffrey Omuse, Daniel Maina, Maureene Ondayo, Stanley Onyango, Syama Sinuff, Alex Mugo, Pauline Samia, William Macharia

Pathology, East Africa

Background: Childhood lead exposure from recycling used lead-acid batteries (ULAB) in unregulated areas is a significant cause of lead toxicity, particularly in low and middle-income countries. This study aimed to assess the proportion of children with increased blood lead levels (BLLs) in an informal settlement where ULAB recycling occurs.

Methodology: This was a descriptive study conducted in Nairobi county, Kenya. Children aged 6 months to 7 years were recruited after obtaining written informed consent, completion of a questionnaire and collection of samples for complete blood count, ferritin, and lead analysis.

Results: Out of 215 children, 17 (8.0%) had BLLs ≥ …

Outcomes Of Different Steroid Dosing Regimens In Critical Covid-19 Pneumonia At A Kenyan Hospital: A Retrospective Cohort Study, John Odhiambo, Jasmit Shah, Nancy Kunyiha, Felix Riunga, Charles Makasa

Internal Medicine, East Africa

Background: Among therapeutic options for severe and critical COVID- 19 infection, dexamethasone six milligrams once daily for ten days has demonstrated mortality benefit and is guideline recommended at this dose. In practice, variable doses of steroids have been used, especially in critical care settings. Our study aimed to determine the pattern of steroid dosing and outcomes in terms of critical care mortality, occurrence of dysglycaemias, and occurrence of superadded infections in patients with critical COVID-19.

Methods: A retrospective cohort study was carried out on all eligible patients admitted to the Aga Khan University Hospital, Nairobi, with critical COVID-19 between 1st …

Enhancing Vaginal Delivery In Greece Through Educational And Behavioral Interventions Among Maternity Care Providers Regarding Labor Management: The Engage Stepped-Wedge Randomized Prospective Trial Protocol, Nikolaos Vrachnis, Nikolaos Antonakopoulos, Peter Von Dadelszen, Marianne Vidler, Georgios Maroudias, Jeffrey Bone, Ash Sandhu, Nikolaos Loukas, Laura Magee, Marleen Temmerman

Centre of Excellence in Women and Child Health

Background: There is an emerging need to systematically investigate the causes for the increased cesarean section rates in Greece and undertake interventions so as to substantially reduce its rates. To this end, the ability of the participating Greek obstetricians to follow evidence-based guidelines and respond to other educational and behavioral interventions while managing labor will be explored, along with barriers and enablers. Herein discussed is the protocol of a stepped-wedge designed intervention trial in Greek maternity units with the aforementioned goals in mind, named ENGAGE (ENhancinG vAGinal dElivery in Greece).

Methods: Twenty-two selected maternity units in Greece will participate in …

A Landscape Evaluation Of Caffeine Citrate Availability And Use In Newborn Care Across Five Low- And Middle-Income Countries, Osayame Ekhaguere, Olufunke Bolaji, Helen Nabwera, Andrew Storey, Nicholas Embleton, Stephen Allen, Zelalem Demeke, Olufunke Fasawe, Betty Wariari, Mansharan Seth

Centre of Excellence in Women and Child Health

Apnoea of prematurity (AOP) is a common complication among preterm infants (< 37 weeks gestation), globally. However, access to caffeine citrate (CC) that is a proven safe and effective treatment in high-income countries is largely unavailable in low- and-middle income countries, where most preterm infants are born. Therefore, the overall aim of this study was to describe the demand, policies, and supply factors affecting the availability and clinical use of CC in LMICs. A mixed methods approach was used to collect data from diverse settings in LMICs including Ethiopia, Kenya, Nigeria, South Africa, and India. Qualitative semi-structured interviews and focus group discussions were conducted with 107 different health care providers, and 21 policymakers and other stakeholders from industry. Additional data was collected using standard questionnaires. A thematic framework approach was used to analyze the qualitative data and descriptive statistics were used to summarize the quantitative data. The findings indicate that there is variation in in-country policies on the use of CC in the prevention and treatment of AOP and its availability across the LMICs. As a result, the knowledge and experience of using CC also varied with clinicians in Ethiopia having no experience of using it while those in India have greater knowledge and experience of using it. This, in turn, influenced the demand, and our findings show that only 29% of eligible preterm infants are receiving CC in these countries. There is an urgent need to address the multilevel barriers to accessing CC for managing AOP in Africa. These include cost, lack of national policies, and, therefore, lack of demand stemming from its clinical equivalency with aminophylline. Practical ways to reduce the cost of CC in LMICs could potentially increase its availability and use.

Burnout Among Medical Residents, Coping Mechanisms And The Perceived Impact On Patient Care In A Low/ Middle Income Country, Charles Muteshi, Elizabeth Ochola, Dorothy Kamya

Obstetrics and Gynaecology, East Africa

Background: Burnout is a syndrome that result from chronic workplace stress and it characterized by emotional exhaustion, depersonalization and low personal accomplishments. Studies report higher burnout levels in medical personnel compared to the general population. Workplace burnout has been directly linked to medical errors and negative coping strategies such as substance abuse. The aims of this study were to assess the level of burnout in medical residents, evaluate their impressions about coping mechanisms and assess perceived impact on patient care in a low/ middle income country setting.

Methods: This was a cross sectional, mixed methods survey carried out at Aga …

Baseline Assessment Of Cervical Cancer Screening And Treatment Capacity In 25 Counties In Kenya, 2022, Valerian Mwenda, David Murage, Catherine Kilonzo, Joan-Paula Bor, Patricia Njiri, Lance Osiro, Mary Nyangasi, Marc Arbyn, Philippe Tummers, Marleen Temmerman

Centre of Excellence in Women and Child Health

Background: Cervical cancer is the leading cause of cancer deaths among women in Kenya. In the context of the Global strategy to accelerate the elimination of cervical cancer as a public health problem, Kenya is currently implementing screening and treatment scale-up. For effectively tracking the scale-up, a baseline assessment of cervical cancer screening and treatment service availability and readiness was conducted in 25 priority counties. We describe the findings of this assessment in the context of elimination efforts in Kenya.

Methods: The survey was conducted from February 2021 to January 2022. All public hospitals in the target counties …

In Their Voices: Kenyan Women's Experiences With Cancer Treatment–Related Side Effects, Tayreez Mushani, Dinah Kassaman, Sharon Brownie, Peterson Kiraithe, Margaret Barton-Burke

School of Nursing & Midwifery, East Africa

Objective This article reports on a secondary analysis of a qualitative study conducted in Nairobi, Kenya that reported several initial themes. In this article, the authors explore the theme of treatment-related side effect management by women receiving treatment for breast or cervical cancer.

Methods Women were interviewed at three points during their active treatment trajectory. Participants were purposefully selected and saturation was reached when interviews did not yield any new themes. The interviews were transcribed and analyzed for internal consistency, frequency, extensiveness, intensity and specificity. The Nvivo pro 12 software was used in organizing and managing the data to facilitate …

Interdisciplinary Perspectives On Multimorbidity In Africa: Developing An Expanded Conceptual Model, Justin Dixon, Ben Morton, Misheck Nkhata, Alan Silman, Ibrahim Simiyu, Stephen Spencer, Myrna Van Pinxteren, Edna Bosire, Christopher Bunn, Claire Calderwood

Brain and Mind Institute

Multimorbidity is an emerging challenge for health systems globally. It is commonly defined as the co-occurrence of two or more chronic conditions in one person, but its meaning remains a lively area of academic debate, and the utility of the concept beyond high-income settings is uncertain. This article presents the findings from an interdisciplinary research initiative that drew together 60 academic and applied partners working in 10 African countries to answer the questions: how useful is the concept of multimorbidity within Africa? Can the concept be adapted to context to optimise its transformative potentials? During a three-day concept-building workshop, we …

Community Health Volunteers’ Experiences Of Implementing Covid-19 Vaccine Education And Promotion In Kenya: A Qualitative Descriptive Study, Constance Shumba, Peterson Kiraithe, Isabel Kambo, Sheila Shaibu

School of Nursing & Midwifery, East Africa

Background: Vaccination was a key measure in the COVID-19 pandemic response, though much work was needed to promote vaccine uptake and acceptance. In Kenya, Community Health Volunteers (CHVs) played a key role in vaccine education and promotion. We conducted this study to explore CHVs’ experiences of implementing COVID-19 vaccine education and promotion during the pandemic to increase COVID-19 vaccine uptake in two areas of Kenya.

Methods: In a qualitative descriptive study, we conducted 30 structured in-depth interviews with 20 CHVs and 10 Community Health Assistants from rural Kilifi County and Kangemi, an urban informal settlement of Nairobi County in Kenya …

Clinical Presentation And Outcomes Of Care In Adults With Diabetic Ketoacidosis Pre-Covid-19 And During-Covid-19 At A Tertiary, Referral Hospital In Nairobi, Kenya, Sairabanu Sokwalla, Jasmit Shah, Sangeeta Chauhan, Reena Shah, Salim Surani, Eric Njenga, Nancy Kunyiha

Internal Medicine, East Africa

Background: Prognosis of DKA has improved over time with the availability of evidence-based protocols and resources. However, in Kenya, there are limited resources for the appropriate diagnosis and management of DKA, mostly limited to tertiary-level referral facilities. This study aimed to review the clinical presentation, management, and outcomes of adult patients admitted with DKA and assess differences in these parameters before and during the COVID-19 pandemic.

Methods: This was a retrospective study of DKA admissions from January 2017 to December 2021. Patient data were retrieved from the medical records department using ICD-10 codes, and individual details were abstracted on clinical …

Associations Between Disordered Eating Behaviour And Sexual Behaviour Amongst Emerging Adults Attending A Tertiary Education Institution In Coastal Kenya, Stevenson Chea, Adama Kazienga, Eunice Oyugi, Isaac Menza, Carophine Nasambu, Fauz Ibrahim, Osman Abdullahi, Amin Hassan, Amina Abubakar, Kristien Michielsen

Institute for Human Development, East Africa

Background Sexual behavior (SB) is a well-documented pathway to HIV acquisition in emerging adults and remains common amongst African emerging adults. Previous research in high-income countries indicates a correlation between disordered eating behavior (DEB) and engaging in sexual behaviors. We aimed to describe the relationship between DEB and SB amongst emerging adults attending a tertiary educational institution at the Kenyan Coast.

Methods We applied a cross-sectional design nested in a young adults’ cohort study. Eligibility included sexually active emerging adults aged 18–24 years. Three DEBs (emotional, restrained and external eating) were assessed using the Dutch Eating Behavior Questionnaire and analysed …