Public Health Commons^™

Benefits, Challenges, And The Way Forward: Medical Specialists' Perception On Family Physician Integration In Healthcare System In Tanzania, Juvenalius Anselm, Roselyter Riang’A, Neelam Ismail, Davis Rubagumya, Jesca Munishi, Sumayyah Saudin, Lynn Moshi, Willbroad Kyejo, Nancy Matillya

Family Medicine, East Africa

Background Family medicine provides comprehensive care by integrating biomedical, behavioral, and social sciences. While established in some sub-Saharan countries, it remains new and unintegrated in Tanzania’s public health system. Its integration is vital for healthcare reform to enhance patient care and system quality.This study aimed to understand the perceptions of medical specialists regarding the integration of family physicians into the Tanzanian healthcare system.

Methods A descriptive qualitative study was conducted through in-depth interviews with ten medical specialists from Aga Khan Hospital and Muhimbili National Hospital in Dar es Salaam. Thematic analysis was employed in this study.

Results Integration of family …

Early Insights From A Multi-Centre National Stroke Surveillance Initiative In Tanzania, Sarah Shali Matuja, Azan Nyundo, Emmanuel Assey, Joel Bwelemo, Marieke Dekker, Sarah Urasa, Emanuel Makarius, Peter Kishimbo, Philip Adebayo, Paschal Ruggajo

Internal Medicine, East Africa

Background: Stroke is a leading cause of death and disability globally, with sub-Saharan Africa, bearing the greatest burden. Tanzania has only one active stroke registry, limiting evidence-based care and policy development. We aimed to expand the registry into a multi-centre study across eight major tertiary hospitals to generate baseline data for a national stroke registry.

Methods: From January to August 2024, we analysed de-identified data from adults (≥18 years) admitted with a World Health Organisation defined stroke. Data collected included demographics, risk factors, imaging, and in-hospital mortality. Logistic regression identified predictors of mortality.

Results: A total of 1000 patients were …

Evaluation Of Pulse Oximetry Alarm Fatigue And The Impact Of Spo2 Thresholds On Clinical Workflow: A Prospective Observational Study In A Kenyan Neonatal Unit, Bazil Masabo, Augustine Waswa, Jesse Coleman, Morris Ogero, Grace Irimu, Dorothy Chomba, Millicent Parsimei, Cynthia Shitote, Ferdinand Okwaro, William Macharia

Paediatrics and Child Health, East Africa

Introduction: Effective pulse oximetry monitoring in a newborn unit requires clinician action. However, if thresholds are not adapted to each neonate, frequent alarms cause alarm fatigue, which impacts the quality of patient monitoring, staff workload and clinical workflow.

Methods: We conducted an observational study from October 2021 to December 2022 in a Kenyan newborn unit which enrolled neonates through convenience sampling. Data were analysed in R using default thresholds of 85% to 96% for SpO2 and 90 to 200 bpm for PR.

Results: Among the 49 neonates enrolled, median hourly alarms per patient were 12 visual and …

Individual And Household Factors Associated With Tungiasis In A Marginalized Population In Karamoja, Northeastern Uganda, Lynne Elson, Abneel Matharu, Berrick Otieno, Hermann Feldmeier, Charles Waiswa, Amina Abubakar, Jürgen Krücken, Ulrike Fillinger, Francis Mutebi

Institute for Human Development, East Africa

Background Tungiasis is a neglected tropical skin disease caused by adult female fleas which burrow into the skin of people and animals, causing considerable pain and itching. The distribution of the disease is heterogeneous, with Napak district, Karamoja sub-region of northeastern Uganda having the highest disease burden recorded globally. We aimed to determine the factors associated with this high prevalence to inform future intervention strategies.

Methods We conducted a cross-sectional study to identify factors associated with infection of individual children and adults, and a nested case–control study to identify factors for whole households (families). Infected children were identified through mass-screening …

Caregiver Assessment Of Executive Function Deficits Among Hiv-Infected And Hiv-Exposed Uninfected Preschool Children In Kenya, Antipa Sigilai, Moses Nyongesa, Amin Hassan, Janet Thoya, Rachel Odhiambo, K. Katana, Beatrice Kabunda, Grace Bomu, Charles Newton, Amina Abubakar

Institute for Human Development, East Africa

Background: This study examined caregiver assessment of executive functioning (EF) in perinatally HIV-infected (PHIV) and perinatally HIV-exposed but uninfected (PHEU) Kenyan children, and explored the extent to which various biopsychosocial factors influence EF outcomes.

Methods: Children aged 3–5 years that were PHIV (n = 43), PHEU (n = 52), or HIV-unexposed uninfected (HUU, n = 58) and their caregivers were enrolled in this study. EF was measured using the Childhood Executive Functioning Inventory. Caregivers’ common mental disorders (CMDs) and parenting behaviour were evaluated using the Shona Symptoms Questionnaire (SSQ) and a parenting behaviour scale, respectively. We used analyses …

Key Predictors Of Postpartum Depression And Anxiety Symptoms Among Mothers In Kilifi, Kenya: A Machine Learning Approach, Faith Benson, Rachel Odhiambo, Willie Brink, Anthony Ngugi, Akbar Waljee, Eileen Weinheimer-Haus, Cheryl Moyer, Ji Zhu, Amina Abubakar

Institute for Human Development, East Africa

Background:

The burden of maternal postpartum depression and anxiety is disproportionately high in sub-Saharan Africa (SSA), yet the use of advanced analytical methods to capture the complex interplay of variables influencing these conditions remains underexplored.

Objective:

To apply machine learning (ML) methods to predict depressive and anxiety symptoms in postpartum mothers and to identify key and actionable predictors.

Methods:

This cross-sectional study included 1,995 biological mothers of singleton infants aged 0–6 months, using survey data collected between March 2023 and March 2024 in Kaloleni and Rabai sub-counties, Kilifi County, Kenya, within the Kaloleni–Rabai Health and Demographic Surveillance …

Age-Specific Concentrations And Seroprevalence Of Antibodies Against Salmonella Enteritidis (O:9) And Salmonella Typhimurium (O:4,5) Across Three Sites In Kenya., Esther Muthumbi, Sean Elias, Alfred Mwanzu, Agnes Mutiso, Perpetual Wanjiku, Cecilia Mbae, Godfrey Bigogo, Jennifer Verani, Stefan Flasche, Samuel Kariuki

Population Health, East Africa

Background Seroprevalence studies can indicate the age distribution of first infection with nontyphoidal Salmonella and estimate the rate of infection by age.

Method We collected 1254 paired samples of serum and stool from healthy children and adults in Kilifi, Nairobi, and Siaya counties in Kenya, areas of low, medium, and high incidence of invasive nontyphoidal Salmonella disease, respectively. We quantified the age- and site-specific geometric mean concentrations (GMCs) of IgG and IgA antibodies against S Enteritidis O-antigen (O:9, serogroup D) and S Typhimurium O-antigen (O:4,5, serogroup B) using an in-house standardized enzyme-linked immunosorbent assay. Serum concentrations were estimated against a …

Implementation And Acceptability Of A Community Based Intervention For Cervical Cancer Screening Amongst Women Of Reproductive Age In Kiambu County, Kenya, Redempta Mutisya, Eliphas Gitonga, Molly Maundu, Rosebella Iseme

Population Health, East Africa

Objective In Kenya, cervical cancer is the top cause of cancer deaths and second most prevalent cancer among women aged 15–44. Despite the existence of screening programs, only 13.8% of women participate, with nearly 50% diagnosed late. Lack of knowledge and embarrassment is linked to low uptake. Post-intervention, uptake of screening and acceptability of SMS prompts and self-sampling were evaluated.

Methods Women (18+ years), who had never screened, were randomly chosen from a pre-existing database. They received either usual care (notification of availability of screening services at public health facility), text education, or interactive in-person sessions with self-sample training.

Results …

Serotype-Specific Pneumococcal Invasiveness: A Global Meta-Analysis Of Paired Estimates Of Disease Incidence And Carriage Prevalence, Katherine Gallagher, Fredrick Odiwour, Christian Bottomley, John Ojal, Aisha Adamu, Esther Muthumbi, Eunice Kagucia, Laura Hammitt, Sergio Massora, Betuel Sigaúque

Population Health, East Africa

Background Serotype-specific estimates of pneumococcal invasiveness used in pneumococcal carriage transmission models to predict changes in disease incidence post-vaccination are largely derived from high-income settings. We conducted a systematic review of carriage prevalence and invasive pneumococcal disease (IPD) incidence to calculate case–carrier ratios (CCRs) in different income settings.

Methods We conducted a systematic search of MEDLINE, Embase, and Global Health databases on March 14, 2022, to identify publications on pneumococcal carriage prevalence or IPD incidence; we requested individual-level data from authors of relevant texts. Serotype-specific CCRs, calculated as IPD incidence divided by carriage prevalence, were pooled across settings using random …

Breast Cancer Awareness And Preferences For Screening Messaging On Menstrual Hygiene Products In Ghana And Tanzania, Tingting Mo, Elisabeth Msoka, Clement Narh, Blandina Mmbaga, Modesta Mitao, Getrude Mshana, Janeth Kiwia, Huruma Sapheli, Frank Baiden, Miriam Mutebi

General Surgery, East Africa

Background Menstrual hygiene products (MHPs) may offer a high-reach, frequent, long-lasting yet underutilized channel for health education, particularly in low-resource settings. This study aimed to explore women’s breast health awareness (BHA) and their attitudes towards and preferences for BHA messages on MHPs.

Methods Women aged 18–49 years in Ghana and Tanzania (n = 438; 216 Ghana, 222 Tanzania), stratified by age and urban/rural setting, completed a questionnaire assessing socio-demographics, BHA, and preferences for BHA messages with MHP. BHA was assessed with an adapted 31-item Breast Cancer Awareness Measure Tool covering 4 domains: breast cancer signs and symptoms, confidence, skills, and …

Social, Environmental And Policy Contexts Affecting The Feasibility And Acceptability Of Improving Household Flooring For Better Health In Rural Kenya, Ulrike Fillinger, Victoria Ochwal, Hugo Legge, Sharon Muli, Karisa Kazungu, Carlos Mcharo, Jacinta Mwongeli, Charles Mwandawiro, Katherine Halliday, Doris Njomo

Institute for Human Development, East Africa

Background Homes with unimproved floors (earth, sand, or clay) are associated with increased risks of soil-transmitted parasites and enteric infections, leading to higher morbidity and reduced quality of life. This study explored the enablers and barriers to adopting improved flooring (sealed, washable, and durable) in three culturally diverse regions of Kenya - Narok, Bungoma, and Kwale - to mitigate disease burdens.

Methods Between August 2021 and July 2022, we conducted 24 focus group discussions with homeowners, stratified by age, gender, and floor type. Additionally, 28 key informant interviews with local government officials, microfinance representatives, and masonry trainers in Kwale and …

Feasibility, Acceptability And Initial Efficacy Of A Community-Based Mental Health Literacy Program Delivered By Civil Society Organizations Among Adults In Kenya: A Quasi-Experimental Study, Patrick Mwangala, Venoranda Rebecca Kuboka, Nimo Sharif, Ann Karendi, Gideon Mbithi, Amina Abubakar

Institute for Human Development, East Africa

Mental health literacy (MHL) strategies are crucial for mental health promotion and prevention. This study aimed to determine the acceptability, feasibility, appropriateness and initial efficacy of an adapted MHL program in a community sample of adults in Kenya. This was a quasi-experimental pre-post study conducted from July 2023 through July 2024. The MHL program contained nine modules delivered over 3 days. Participants were assessed at baseline and immediately after the program. The primary outcomes were mental health knowledge and participants’ attitudes on mental health/illness. Secondary outcomes included depressive symptoms, anxiety symptoms, self-perceived social support, self-perceived wellbeing, MHL program acceptability, feasibility …

Pregnancy Outcomes Among Women With And Without Hiv Infections Who Underwent Excisional Treatment For High-Grade Cervical Intraepithelial Neoplasia: A Retrospective Cohort Study In Low-Resource Settings, Poli Amubuomombe, Peter Itsura, Philiph Tonui, Elkanah Orang'o, Benjamin Odongo, Patrick Loehrer, Susan Cu-Uvin

Obstetrics and Gynaecology, East Africa

Objective The standard treatment for high-grade squamous intraepithelial lesions is excisional involving the uterine cervix, while surveillance is an acceptable approach for low-grade squamous intraepithelial lesions. There is controversy about excisional treatment on pregnancy outcomes. The objective of this study was to determine pregnancy outcomes in women living with and without HIV who underwent excisional treatment for high-grade cervical intraepithelial lesions.

Design This retrospective cohort study compared the pregnancy outcomes of women with and without HIV who were or were not treated for cervical intraepithelial lesions. A cohort of 488 women with and without HIV infection who did or did …

Prevalence And Risk Factors For Laparoscopic Managed Ectopic Pregnancies At A Tertiary Referral Hospital - A 10-Year Synopsis: A Cross Sectional Study, Steve Mutiso, Eric Mugambi

Obstetrics and Gynaecology, East Africa

Background Ectopic pregnancies (EP) are a common pregnancy associated complication. They are associated with significant morbidity, and rarely mortality, if not managed properly. EP have a myriad of predisposing factors that help identify patients at risk and facilitate early diagnosis and intervention. We set out to conduct an audit of EP managed surgically at our hospital for a 10-year period and discern the incidence, prevalence and risk factors of their occurrence.

Methods This study was designed as a Retrospective Clinical Audit based at the Aga Khan University Hospital (AKUH). Study population was all women admitted to AKUH with a diagnosis …

Prediction Of First And Multiple Antiretroviral Therapy Interruptions In People Living With Hiv: Comparative Survival Analysis Using Cox And Explainable Machine Learning Models, Donald Salami, Emily Koech, Janet Turan, Kristen Stafford, Lilly Nyagah, Stephen Ohakanu, Anthony Ngugi, Manhattan Charurat

Institute for Human Development, East Africa

Background: The Cox proportional hazards (CPH) model is a common choice for analyzing time-to-treatment interruptions in patients on antiretroviral therapy (ART), valued for its straightforward interpretability and flexibility in handling time-dependent covariates. Machine learning (ML) models have increasingly been adapted for handling temporal data, with added advantages of handling complex, nonlinear relationships and large datasets, and providing clear practical interpretations.

Objective: This study aims to compare the predictive performance of the traditional CPH model and ML models in predicting treatment interruptions among patients on ART, while also providing both global and individual-level explanations to support personalized, data-driven interventions …

Early Neonatal Admissions With Feeding Difficulties To Acute Paediatric Services At A Tertiary Paediatric Hospital In England: Sequential Audits Pre-Covid-19 And During The Covid-19 Pandemic, Kalvin Lee, Thomas Frederick Dunne, Mary Masoud, Hayley Gleig, Heidi Stott, Helen Nabwera, Halina Kamarova

Centre of Excellence in Women and Child Health

Introduction: Our objective was to describe the population of infants < 7 days of age admitted to the acute general paediatric services at Alder Hey Children’s Hospital and ascertain the proportion with feeding difficulties amenable to community-based support.

Methods: Sequential retrospective audits of all infants < 7 days of age admitted to acute paediatrics at Alder Hey Children’s Hospital, Liverpool, England, from March to September 2019 (pre-COVID-19) and March to September 2020 (during COVID-19). All the infants were born and discharged from maternity units in Merseyside, Northwest England. Anonymised data were extracted from the electronic clinical records by three members of the clinical team.

Results: Pre-COVID-19, 38.6% (93) of the 241 admissions to acute general paediatric services had feeding difficulties. 31.2% (29) presented solely with feeding difficulties and 31.2% (29) were exclusively breastfed. However, during COVID-19, although there were fewer admissions (104), more than half (51%, 54) had feeding difficulties and for 54% (29), this was the only reason for admission. Over half (53.7%, 29) were exclusively breastfed.

Conclusion: Our audits showed that at least a third of infants < 7 days of age admitted with feeding difficulties did not have any other features of severe illness. These admissions unnecessarily expose infants to hospital-acquired infections while disrupting the opportunity for families to build close and loving relationships that enhance the establishment of breastfeeding. Co-designing infant feeding strategies with the mothers and stakeholders will be a crucial next step to enhance infant feeding support, particularly in impoverished communities in the region.

International Normative Charts For Twin Weight, Length, And Head Circumference At Birth, By Gestational Age And Sex: The Twin Neonatal Cross-Sectional Study Of The Intergrowth-21st Project, Francesca Giuliani, Sonia Deantoni, Enrico Bertino, Yasmin A. Jaffer, Manorama Purwar, Fernando C. Barros, Leila Cheikh Ismail, Wu Qingqing, Ilaria Stura, Maria Carvalho

Obstetrics and Gynaecology, East Africa

Assessing the size of twins at birth using charts developed for singletons may over diagnose small for gestational age in this sub-population. The study aimed to produce international, twin-specific, newborn size normative charts by gestational age and sex. This longitudinal observational study in eight geographically diverse settings prospectively collected data between May 2009 and August 2013 from healthy pregnant women and their newborn twins. The participants were enrolled as part of the INTERGROWTH-21st study, and recruited based on World Health Organization recommendations for evaluation of anthropometric measures. All the women met, in addition to the underlying population characteristics of low …

Mapping Social Determinants Of Health Data In Sub-Saharan Africa: A Scoping Review Protocol, Felix Anyiam, Jessica Gjonaj, Ngeresa Osango, Richard Mugo, Peace Aber, Jasmit Shah, Judith Mangeni, Rajesh Vedanthan, Joseph Hogan, Ann Mwangi

Internal Medicine, East Africa

Introduction Research has increasingly underscored the impact of factors such as socioeconomic status, education, healthcare access, housing and environmental conditions in shaping population health outcomes. These factors, collectively called social determinants of health (SDOH), provide crucial context for understanding drivers of health outcomes. In sub-Saharan Africa (SSA), the study of SDOH is critical due to the region’s unique sociocultural and economic conditions. Understanding how SDOH interacts with health systems and capturing SDOH in data is crucial for informing modelling efforts and policies improving population health more effectively. This scoping review aims to map the types of data used to capture …

Real-World Prevalence Of Pd-L1 Positivity In Early-Stage/Metastatic Triple-Negative Breast Cancer: Primary Results And Pathology Insights From The Global Retrospective Observational Vanessa Study, Corrado D'Arrigo, Sitki Tuzlali, Romualdo Barroso-Sousa, Nagi El Saghir, Rebecca Dent, Nataša Medić-Milijić, Gyungyub Gong, Shahin Sayed, Tu Anh, Alisan Zirtiloglu

Pathology, East Africa

Aim To understand whether the worldwide implementation of PD-L1 testing in triple-negative breast cancer (TNBC) can be achieved in routine clinical practice.

Methods and results The multicentre retrospective observational VANESSA study consecutively and uniformly enrolled patients treated with systemic therapy for early or metastatic (e/m)TNBC diagnosed between 2014 and 2017. PD-L1 status was retrospectively assessed locally and centrally using the VENTANA PD-L1 (SP142) Assay (PD-L1 expression on tumour-infiltrating immune cells covering ≥1% of the tumour area). The primary objective was to determine the prevalence of PD-L1 positivity assessed locally on primary and/or metastatic tumour tissue. Concordance between local and central …

“Now That The Baby Is Out, I Can Be Vaccinated”: A Qualitative Study On Covid-19 Vaccine Hesitancy In Pregnant Women In Kilifi, Kenya, Angela Koech, Onesmus Wanje, Grace Mwashigadi, Geoffrey Katana, Richmond Mdindi, Peter Mwangome, Rachel Craik, Marianne Vidler, Mai-Lei Kinshella, Marleen Temmerman

Centre of Excellence in Women and Child Health

COVID-19 vaccines are safe and effective in pregnancy, but vaccine hesitancy limits uptake and effectiveness. This study explored COVID-19 vaccine hesitancy in pregnancy in Kilifi, coastal Kenya, to elicit reasons for vaccine hesitancy and acceptance, and to compile misconceptions around vaccination in pregnancy. Twenty-three in-depth interviews were conducted with pregnant women, mothers who had given birth in the previous 2 years and health workers (community health promoters, nurses, and supervisors). Data were analyzed using thematic template analysis based on the Vaccine Hesitancy Determinants Matrix. Concern about vaccine safety for the unborn baby was a major driver of hesitancy. Many pregnant …

Qualitative Exploration Of Factors Associated With Covid-19 Vaccination Among Pregnant Women In Kenya, Violet Naanyu, Ferdinand Okwaro, Ingrid Gichere, Mandeep Sura, Prachi Singh, Berhaun Fesshaye, Marleen Temmerman

Centre of Excellence in Women and Child Health

The COVID-19 pandemic significantly disrupted societies worldwide, and COVID-19 vaccination has been identified as instrumental in the fight against the pandemic. While studies have examined uptake of COVID-19 vaccination, more research is needed to gain a better understanding of the factors influencing pregnant women’s decisions to get vaccinated. In this study, we used a cross-sectional descriptive qualitative study to explore the attitudes, beliefs, and behaviors related to COVID-19 vaccination during pregnancy in Kenya. A total of 50 in-depth interviews were conducted between October 2023 to March 2024 with a purposively drawn sample of 25 pregnant and 25 postpartum women during …

The 2025 Accra Declaration On Upskilling And Cost-Effective Cardiac Surgery In Africa, Charles Yankah, Jonathan Nwiloh, Carlos Mestres, Abdelmalek Bouzid, Tom Mwambu, Andrew Duncan, Mohamed Debieche, Samuel Omokhodion, Uvie Onakpoya, Matthias Angres

General Surgery, East Africa

The Pan-African Society for Cardiothoracic Surgery (PASCaTS) organized the 1st Pan-African Cardiothoracic Surgery Summit on 21 to 24 February 2025 in Accra, Ghana. The summit brought together leading specialists from across Africa, China, Europe, South America and the USA to address the growing burden of cardiovascular disease, to share their vision for the fight against cardiovascular disease, to raise standards in the diagnosis, treatment, and recovery of patients thereby improving procedural safety and clinical outcomes in Africa. The experts agreed on the need for cost effectiveness in cardiac surgery, simulation skills training, an African regional cardiothoracic surgery database, African heart …

Intimate Partner Violence Experience, Support Seeking And Coping Strategies Among Pregnant Women In Southwestern Uganda, Eve Katushabe, John Baptist Asiimwe, John Bosco Ndinawe, Editor Abeneitwe, Agnes Katusiime, Gladys Nakidde, Vincent Batwala

School of Nursing & Midwifery, East Africa

Intimate partner violence (IPV) during pregnancy remains a global health challenge. This study aimed to explore pregnant women’s experiences of IPV, support seeking, and coping strategies in Southwestern Uganda. Pregnant women who had experienced IPV during pregnancy were purposively selected and completed in-depth interviews, with data saturation reached after 25 participants. Guided by the feminist theory, data were analyzed deductively and inductively using thematic analysis. Participating pregnant women were exposed to physical violence (e.g., the gravid abdomen being stepped on), psychological violence (e.g., verbal abuse), sexual violence (e.g., being forced into uncomfortable sexual positions), and financial control and manipulation (e.g., …

Location Of Births By Health Facility Type: A Time Trend Analysis From 1995 To 2023 In 130 Low- And Middle-Income Countries, Anna Gage, Madeleine Conrad, Chiara Sumich, Wes Warriner, Aduragbemi Banke-Thomas, Corinne Bintz, Kelly Bienhoff, Jessica Bishai, Abdu Mohiddin, Marleen Temmerman

Centre of Excellence in Women and Child Health

Background: With major increases in facility births in low- and middle-income countries (LMICs) since 1995, a key question is what types of facilities met the increased demand. Understanding the evolving delivery landscape is crucial to informing debates about optimal models for balancing access, quality, and equity. We studied the distribution of delivery location by health facility level and sector (private versus public) in 130 LMICs from 1995 to 2023.

Methods: We used 745 data sources with delivery location information in our analysis. We first categorised births as in-facility or not, then further classified facility births by level (hospital …

Implementing A Change Process To Support Respectful Communication In Newborn Units In Kenya: A Qualitative Study, Mwanamvua Boga, Peris Musitia, Dorothy Oluoch, Dyuti Sen, Hiza Dayo, Ane Haaland, Lisa Hinton, Jacinta Nzinga, Mike English, Sassy Molyneux

Institute for Human Development, East Africa

Background: In contexts of high workloads, resource shortages, and environmental inadequacies, neonatal nurses in many low- and middle-income countries face high levels of stress and burnout, as well as significant communication challenges. Advancing care in these ‘on the edge’ emotionally fraught contexts requires a multi-layered systems approac:, including context-sensitive courses that support respectful communication.

Methods: We share our learning from the implementation of a communication and emotional competence training process in two public hospital newborn units in Kenya. We adapted an existing course in collaboration with newborn unit nurse managers, with the aim of enhancing relationships among staff and …

A Cost-Consequence Analysis Of The Children’S Administration Oxygenation Strategies Trial (Coast) In Severe Pneumonia, Orlagh U. Carroll, Richard Grieve, Sarah Kiguli, Peter Olupot-Olupot, Robert Opoka, Charles Engoru, Florence Alaroker, Abner Tagoola, Mainga Hamaluba, Eva Nabawanuka

Paediatrics and Child Health, East Africa

Oxygen supplementation is a recommended treatment for children with severe pneumonia or hypoxaemia. The open, fractional-factorial Children’s Oxygen Administration Strategies Trial (COAST) recruited Kenyan and Ugandan children with severe pneumonia and hypoxaemia. Participants in the severe hypoxaemia stratum (SpO₂ <  80%) were randomised to high-flow nasal therapy (HFNT) or low-flow oxygen (LFO), and in the hypoxaemia stratum (SpO₂ 80–91%) to HFNT, LFO or permissive hypoxaemia (ratio 1:1:2). The trial stopped early and there is ongoing uncertainty about the clinical benefits of the alternative strategies. There is a lack of evidence about the relative costs, of alternative oxygen delivery for critically-ill children in low- and middle- income countries. We used data from COAST to conduct a cost-consequence analysis …

“Kuchoka”: Investigation Of Research Fatigue In Mosoriot, Kenya, Felishana Cherop, Violet Naanyu, Juddy Wachira, Lukoye Atwoli

Internal Medicine, East Africa

Background: Health research is key to the promotion of population and community health, however, conducting many research studies in a community can cause research fatigue.

Purpose: We determined the prevalence of research fatigue and associated factors in Mosoriot, Kenya.

Methods: We conducted a cross-sectional study in the Mosoriot community from Wednesday 28, May 2014, to Thursday 30, April 2015, involving (n = 327) community members who were randomly sampled to respond to self-administered and/or guided questionnaires. We analyzed descriptive statistics to summarise the data and used the Pearson Chi-Square test to assess the bivariate associations between the …

Longitudinal Implementation Of A Neurodevelopmental Screening Program For Children Born To Mothers Living With Hiv In Maternal–Child Clinics In Kenya: A Mixed Methods Study, Megan S. Mchenry, Eren Oyungu, Amina Abubakar, Ananda Roselyne Ombitsa, Micaela Gaviola, Cleophas Cherop, Beatrice Kaniaru, Carolyne Jerop, Alan Mcguire, Rachel C. Vreeman

Institute for Human Development, East Africa

Background: Children with perinatal HIV exposure are at increased risk for neurodevelopmental (ND) delays, yet little is known about ND screening implementation for this population.

Methods: This longitudinal study evaluated ND screening implementation at a health clinic in Kenya, from 9/2021 to 8/2023. Children aged 18-36 months with perinatal HIV exposure were screened using a 12-item general ND tool. Implementation outcomes—acceptability, feasibility, fidelity, and sustainability—were assessed through time-motion observations, clinic records, and semi-structured interviews with caregivers and staff.

Results: Of 507 eligible children, 405 (80%) were screened. Screening rates were consistent over 24 months, with average time …

Sexual Dysfunction In Women With Endometriosis In A Low-Middle-Income Country, Edna Chacha, Charles Muteshi, Felix Oindi, Elsie Wandera

Obstetrics and Gynaecology, East Africa

Background Endometriosis affects up to 10% of reproductive-age women and significantly impairs quality of life including sexual function, intimate relationships, fertility, and psychological wellbeing. While its impact has been extensively studied in Western populations, there is limited Sub-Saharan African data exploring how the disease affects female sexual health and distress. This study aimed to assess sexual function and sexual distress among women with endometriosis at a tertiary hospital in Kenya.

Methods A cross-sectional study was conducted involving 108 women aged 18 to 49 with confirmed endometriosis from January to June 2022. The study used validated self-administered questionnaires: Female Sexual Function …

Predicting Off-Track Development In Infants Aged 0–6 Months In Low-Resource Settings Using Machine Learning, Faith Benson, Rachel Odhiambo, Anthony Ngugi, Willie Brink, Akbar Waljee, Cheryl Moyer, Ji Zhu, Felix Agoi, Amina Abubakar

Institute for Human Development, East Africa

Background This study aimed to address the critical gap in the limited application of machine learning (ML) for identifying developmental delays in low-resource settings by developing models to predict off-track development in infants aged 0 to 6 months and identify key predictors.

Methods A cross-sectional study involving 1,995 singleton infants aged 0 to 6 months was conducted in Kaloleni and Rabai sub-counties, Kilifi, Kenya, between March 2023 and March 2024. Development was assessed using the World Health Organization’s Indicators of Infant and Young Child Development tool, with Development-for-Age Z-scores used to classify infants as on- or off-track. Ridge logistic regression …