Public Health Commons^™

Factors Associated With Emergency Hospitalization Of Kidney Disease Patients In A National Hospital Kenya., Dorcus Miyombe

MSc in Advanced Practice Nursing

Introduction: Emergency hospitalizations among End Stage Kidney Disease (ESKD) is a major global health burden, with low- and middle-income countries in sub-Saharan Africa (SSA), experiencing the highest rates of morbidity and mortality. Limited resource, economic burden, and insufficient health infrastructure were the main challenges. Emergency hospitalizations at Kenyatta National Hospital remains high due to systemic gaps and poor continuity of care. Prerenal, intrarenal, post-renal injuries, as well as any combination of these, are the primary causes of ESKD. There are stipulated guidelines for ESKD patients’ management however, realization of these goals has not been achieved leading to hospitalization KDIGO …

Community Health Promoters’ Experiences In Mitigation Of Cardiovascular Diseases In Lari Sub-County - Kiambu County, Kenya, Emily Njeri Muchina

MSc in Advanced Practice Nursing

Background: Cardiovascular diseases (CVDs) are a rising public health issue in low- and middle-income countries, including Kenya, where there is an escalation of their deaths and preventable risk factors. Community health promoters (CHPs) have a crucial role in the prevention of CVDs. Yet, low knowledge of CVD prevention and low detection of CVD risk factors characterise most underserved communities in Kenya. Little has been documented about CHPs' experiences in mitigating CVDs despite the presence of multilevel barriers and facilitators that can shape their experiences.

Aim: To gain an in-depth insight into the experiences of CHPs in mitigating CVD …

Predictors Of Complications Among Adult Patients Diagnosed With Type 2 Diabetis Mellitus At Thika Level Five Hospital, Kenya, Bernard Wambua Mbithi

MSc in Advanced Practice Nursing

Introduction: Despite advances in the management of Type 2 diabetes mellitus (T2DM), anecdotal reports from Thika Level Five Hospital indicate that patients still present with diabetes mellitus-associated complications. Therefore, this research aimed to determine the predictors of complications among adult patients diagnosed with T2DM in the hospital.

Methodology: Analytical cross-sectional design was utilized in this research. To select the respondents, purposive sampling was used to recruit six nurse managers and their deputies (making a total of 12 nurses), while 294 patients in the clinic were recruited using systematic sampling. Purposive sampling was also used to recruit 15 patients …

Optimal Anthropometric Discharge Criteria From Treatment Of Wasting: Meta-Analysis Of Individual Patient Data From 34 Studies, Lilia Bliznashka, Sandhya Chaudhary, Susan Rattigan, Sheila Isanaka, Ruth Adah, Tahmeed Ahmed, Nur Alam, Rodrigue Alitanou, Paluku Bahwere, Helen Nabwera

Paediatrics and Child Health, East Africa

Background: Community-based treatment of acute malnutrition saves lives, but recovered children remain at risk of relapse post-discharge. Strategies to reduce this risk may include modification of anthropometric discharge criteria.

Objectives: This study aims to compare the diagnostic accuracy of anthropometric indices to reduce post-discharge relapse risk.

Methods: We searched PubMed from inception to June 2022. We included studies that enrolled children aged 0–59 mo successfully treated for severe or moderate acute malnutrition (SAM or MAM), assessed anthropometry at discharge, and had ≥1 follow-up assessment ≤6 mo post-discharge. Pooled sensitivity and specificity for anthropometric indices at discharge over multiple cutoffs were …

Food Access And Food Insecurity Among Early Childhood Educators And Staff Prior To And During The Covid-19 Pandemic: A Mixed Methods Pilot Study, Rahel Mathews, Leah Pylate, Will Davis, Elizabeth Thorne, Jamila Taylor, Shecoya White, Bennett Pope, Emma Bryant

Journal of Human Sciences and Extension

Emerging research indicates that 40% of early childhood education (ECE) workers experience food insecurity. The purpose of this study was to describe the food insecurity and food access of Head Start teachers and staff in Mississippi before the COVID-19 pandemic and to understand how COVID-19 affected food access. A mixed-methods design was employed using cross-sectional surveys, at two different time points, and three focus groups. Three Head Start centers from the Mississippi Coast participated. Approximately 52% of teacher and staff respondents experienced food insecurity before COVID-19; during the pandemic, their level of food insecurity worsened from low to very low …

Referral Strategies For Recruitment And Engagement Of Community Adults Into Online Extension Health Programs, Cheryl L. Eschbach, Dawn A. Contreras, Holly B. Tiret

Journal of Human Sciences and Extension

This article shares details behind building organizational capacity to establish program referrals for statewide recruitment of community adults into Cooperative Extension’s online health programs. This study explores the role of intentional recruitment strategies (active and passive) to increase participant program enrollment into health education and shares examples from one state that has created a trained workforce that offers ongoing research- and evidence-based programs. After many years of trying paper, phone, and electronic medical record methods to increase program reach, Michigan State University Extension tried an electronic referral process via a QR code and web link, accompanied by program marketing, to …

An Implementation Science Analysis Of An Ethanol Cooking Fuel Promotion Project In Dar Es Salaam, Tanzania, Megan Benka-Coker, Maggie Clark, Marc Jeuland, Wubshet Tadele, Fiona Rick, Remidius Ruhinduka, Heather Miller, Harry Stokes, Ashlinn Quinn

Health Sciences Faculty Publications

In 2019, the United Nations Industrial Development Organization (UNIDO) launched the “Promotion of Bio-Ethanol as Alternative Clean Fuel for Cooking in the United Republic of Tanzania” project with an aim to promote and distribute 500,000 bioethanol stoves in Dar es Salaam by 2024. The “Proof of Concept” Phase I of the project aimed to sell 110,000 stoves and establish a strong retail market for ethanol fuel. In this study, we conduct an implementation science analysis of Phase I of the project, describing the roll-out of this market-based bioethanol stove program. Leveraging program administrative data, individual interviews and focus-group discussions, we …

Power, Interests, And Maternal Health Care: A Political Economy Analysis Of Service Delivery Redesign In Kenya, Jacinta Nzinga, Easter Olwanda, Kennedy Opondo, Hillary Kimutai, Jan Cooper, Brian Arwah, Benjamin Tsofa, Edwine Barasa, Kevin Croke

Institute for Human Development, East Africa

The maternal and newborn health (MNH) service delivery redesign (SDR) in Kakamega County, Kenya, represents the country's first system-level reorganization of MNH services. The reform aimed to improve care quality and reduce mortality by centralizing delivery services at designated hubs. Using a political economy lens, we examined how ideology, political dynamics, and institutional structures shaped the agenda-setting, adoption, implementation, and sustainability of SDR. We drew on data from document reviews, stakeholder analysis, semi-structured interviews, and non-participant observation to assess the structural, contextual, and institutional factors influencing the reform. Ambiguity around SDR's purpose contributed to the community's uncertain engagement characterized by …

John Henryism And The African American Experience: An Exploration Of Risk And Protective Factors And Health Outcomes, Joseph L. Twitdy

All-Inclusive List of Electronic Theses and Dissertations

Racial discrimination has been tied to adverse mental and physical health outcomes among African Americans. In the face of this adversity, African Americans have developed strategies for coping with everyday experiences of discrimination. One such coping method is based on the concept of John Henryism. The folktale of John Henry tells the story of an African American steel-driver racing against a steam-powered drill to clear a path for trains through a mountain. Although John Henry wins the race, he later dies due to exhaustion, ultimately passing with his hammer in his hand. The psychological concept of John Henryism (JH) refers …

Quality Of Life And Mental Health: A Qualitative Exploration Of Perceived Factors That Impact Older Adults, Chasiti Herring

All-Inclusive List of Electronic Theses and Dissertations

Enhancing quality of life and well-being is a universal phenomenon across the lifespan. As the population ages, older adults are in great need of supportive services to enhance quality of life and their ability to manage their mental health. The purpose of this study is to examine the quality of life (QoL) of older adults. This study aimed to provide valuable research in the area of QoL through the exploration of perceived factors that impact the older adult population. This exploratory qualitative research study consisted of 10 older adult participants between the ages of 65 and 95. Research recruitment prioritized …

Assessing U.S. Fatal & Nonfatal Injury Trends By Worker Age, Alexander Mcdaniel

All-Inclusive List of Electronic Theses and Dissertations

Occupational injuries and fatalities in the United States have declined over time; however, meaningful differences by worker age remain a concern for employers and safety professionals. Younger workers often experience higher non-fatal injury rates due to limited experience and developing hazard-recognition skills, while older workers face increased risk of severe and fatal outcomes related to age-associated physical changes. The purpose of this study was to analyze long-term injury and fatality trends by age group and determine whether differences exist over time. National injury data from the Census of Fatal Occupational Injuries (1992–2023) and the Survey of Occupational Injuries and Illnesses …

Diabetes And Hypertension Frequencies And Trends In The Health Districts Of Sololá, Alejandro Cerón, Sophie Perfetto, Ana Textor, Sidona Alemayehu, Emilia Alvear Escobar, Adele Beard, Sarah Berson, Rachel Bryant, Jennifer Calzontzi, Rylee Castro, Eva Cress Palencia, Jake Czarnecki, Jordyn Epstein, Nikki Harris, Patience Hinojos, Max Hippisley, Erin House, Jackson Hullett, Nathan Johnson, Amelie King, Saule Lankelyte, Juan Loya, Ashley Mackenzie, Ilana Mighdoll, Molly Morrill, Maria De Jesus Ramos Jimenez, Lilly Teklemedhin, Joseph Trujillo, Lauren Verachtert, Nathan Verachtert, Violet Vreeland, Alex Welch, Jada Wright

Anthropology: Undergraduate Student Scholarship

This report was prepared by the students, Graduate Teaching Assistants, and instructor of “The Social Determination of Health” class taught in the fall of 2025 at the University of Denver. The report was prepared for Dr. Luis Pablo Méndez, of the Vice Ministry of Health Regulation, Surveillance and Control, of the Ministry of Public Health and Social Assistance of Guatemala. The work used the following guiding question: How can available data about service production can be used to inform the planning process for the implementation of the Global Hearts Initiative’s HEARTS technical package in the Distrito de Redes Integradas de …

Across The Pond, Across The Waistline: A Comparative Look At The Childhood Obesity Crisis In The United States And United Kingdom, Samantha N. Eales

Honors College Theses

Childhood obesity is no longer just a local concern; it’s a global epidemic shaping the health of future generations. This paper compares how two similar nations with drastically different healthcare systems, the United States and the United Kingdom, tackle this growing crisis. Although both countries struggle with fast food culture, sedentary lifestyles, and targeted marketing, their health policy strategies differ dramatically. The U.S. leans on community programs and education, while the U.K. enforces stronger national regulations and advertising restrictions. By examining nutrition, physical activity, and policy, this thesis explores what each country does well and where they fall short. It …

Assessing Neurocognitive Functioning Among Adults Ageing With And Without Hiv At The Kenyan Coast: Measurement Issues And Correlates, Patrick Nzivo Mwangala, Carophine Nasambu, Ryan Wagner, Mihaela Duta, Gaia Scerif, Charles Newton, Amina Abubakar

Institute for Human Development, East Africa

Background: Cognitive impairment is one of the most prevalent complications of HIV infection, with significant medical and functional impacts. However, valid, and reliable assessment tools are lacking for the newly emergent ageing population of people living with HIV (PLWH) in many parts of sub-Saharan Africa (SSA), including Kenya. Without these tools, critical intervention opportunities, e.g., psychoeducation, treatment and additional support, are missed. To bridge this gap in Kenya, we adapted the Oxford Cognitive Screen Plus (OCSPlus), a tablet-based cognitive assessment tool designed for low-literacy settings, with adults ageing with HIV ≥ 50 years and their uninfected peers. This study examines …

Well-Being And Quality Of Life Of Kenyan Nurses, Midwives And Community Health Volunteers: Measurement Properties And Correlates Of The Bbq And Who-5, Paul Mwangi, Sabina Odero, Rachel Odhiambo, Brenda Nzioka, Constance Shumba, Eunice Ndirangu, Amina Abubakar

Institute for Human Development, East Africa

Healthcare workers’ quality of life (QoL) and well-being is directly linked to the quality of services they deliver. However, there is a shortage of validated measures to assess QoL, well-being and their predictors among healthcare workers in Kenya, as in other LMICs. This study aimed to assess the reliability and validity of the Brunnsviken Brief Quality of Life Scale (BBQ) and WHO-5 well-being index (WHO-5) among nurses, midwives and community health volunteers (CHVs) in Kenya. The BBQ and WHO-5 were selected due to their established psychometric strengths, brevity, and prior use in healthcare settings. Additionally, the sociodemographic, psychological, and health …

Sustaining Community Health Through Impactful Snap-Ed Initiatives In Utah, Lacee Jimenez, Kristi Strongo, Lea Palmer, Lendel K. Narine, Heidi Leblanc

Outcomes and Impact Quarterly

Create Better Health (CBH), Utah’s SNAP-Ed program, addresses food insecurity and chronic disease prevention through nutrition education, policy, systems, and environmental (PSE) initiatives, and social media marketing. From 2024 to 2025, CBH reached over 13,500 Utahns through direct education and 81,000 through community interventions. Evaluation results showed significant improvements in nutrition behaviors, including increased fruit and vegetable intake, food resource management, and label use. Follow-up surveys showed sustained behavior change. CBH’s comprehensive approach demonstrates measurable public health impact and points to the importance of continued investment in nutrition education and food access programs to build healthier, food-secure communities.

Feasibility Of Home-Based Urine Collection In Children Under 5 Years In The Origins Birth Cohort Study: Mixed Method Protocol And Sample Completion Results, Courtney D.A. Kidd, Najma A. Moumin, Andrea Macrae, Tim J. Green, Desiree T. Silva, Susan L. Prescott, Nina D’Vaz

Research outputs 2022 to 2026

Background: Urine is an attractive biospecimen for nutritional status and population health surveys. It is an excellent non-invasive alternative to blood for appropriate biomarkers in young children and is suitable for home-based collection, enabling representative collections across a population. However, the bulk of literature in this population is restricted to collection in primary care settings. Feasibility of home-based collection at scale has not been tested. Here, we describe a mixed method approach to collect urine samples in a large cohort study with children under 5 years. Methods: The ORIGINS Project is an ongoing birth cohort investigating early life influences on …

Culturally Responsive Recommendations For Eating Disorder Prevention And Management For First Nations Peoples In Australia: A Policy Scoping Review, Zyana Gall, Hilary Smith, Gabrielle Grant, Kanita Kunaratnam, Carissa Lee, Felicity Kerslake, Alana Gall

Research outputs 2022 to 2026

Background: Evidence suggests First Nations people in Australia may experience a higher burden of eating disorders (EDs) than the broader Australian population. EDs are among the most debilitating and lethal mental health conditions; however, little is known about the unique considerations for First Nations people experiencing EDs, especially around best practices. This policy scoping review aims to map the current recommendations for managing EDs specific to First Nations peoples and to identify further research opportunities. Methods: We conducted targeted searches of electronic databases and health websites (n = 53) for policies, reports, toolkits/guidelines, and fact sheets that contained any information …

Prevalence And Trends Of Coexisting Forms Of Malnutrition And Its Associated Factors Among Children Aged 6–59 Months In South And Southeast Asia, 1996–2022: A Cross-Sectional Time Series Study, Wenjie Guo, Maggie Zgambo, Sanmei Chen, Yoko Shimpuku

Research outputs 2022 to 2026

Background: South and Southeast Asia face severe malnutrition in children under five, with coexisting forms of malnutrition (CFM) exacerbating mortality risks and posing greater challenges than isolated forms of malnutrition. We aimed to assess the prevalence, trends, and factors of CFM among children aged 6–59 months in South and Southeast Asian countries and the entire region. Methods: We used anthropometric and hemoglobin data from 515,170 children aged 6–59 months in seven low- and middle-income South and Southeast Asian countries, based on Demographic and Health Surveys conducted between 1996 and 2022. Weighted multivariable logistic regression was performed to identify the sociodemographic …

Trends And Determinants Of Early Neonatal Mortality In Ethiopia: Evidence From The Ethiopian Demographic And Health Survey Data, Tsion Mulat Tebeje, Beminate Lemma Seifu, Yordanos Sisay Asgedom, Kusse Urmale Mare, Zufan Alamrie Asmare, Hiwot Altaye Asebe, Abdu Hailu Shibeshi, Afework Alemu Lombebo, Kebede Gemeda Sabo, Bezawit Melak Fente, Bizunesh Fantahun Kase

Research outputs 2022 to 2026

Background: Early neonatal mortality (ENM) accounts for three-fourths of all neonatal deaths and one-third of overall child mortality. While previous studies have primarily focused on neonatal and under-five mortality, ENM has received comparatively less attention. This study aims to address this gap by analyzing trends and identifying factors associated with ENM in Ethiopia. Methods: Data from the Ethiopian Demographic and Health Survey (EDHS) conducted between 2005 and 2016 were analyzed, comprising a total weighted sample of 22,310 participants. To account for the hierarchical structure of the EDHS data, a mixed-effects binary logistic regression model was applied to identify associated factors. …

Imbalances In Circulating Monocyte And High-Density Lipoprotein Cholesterol Exacerbates The Residual Risk Of Incident Myocardial Infarction Beyond Ldl-C: A Real-Life, Prospective Cohort Study, Dan Wu, Yulong Lan, Xiong Ding, Lois Balmer, Xingang Li, Wei Wang, Shouling Wu, Youren Chen

Research outputs 2022 to 2026

Background: A sustained oversupply of monocytes and markedly decreased levels of high-density lipoprotein cholesterol (HDL-C) are notable in high-risk groups with residual cardiovascular risk, despite aggressive low-density lipoprotein cholesterol (LDL-C) lowering. This study aimed to explore whether an imbalance in circulating monocyte and HDL-C levels accounts for the residual risk of incident myocardial infarction (MI) within optimal LDL-C levels. Methods: A total of 48,522 participants free of cardiovascular diseases from a real-life, prospective cohort (Kailuan study) were included. The monocyte count, HDL-C level and monocyte-to-HDL-C ratio (MHR), calculated as time-averaged cumulative and baseline values, were used as the exposures. Time-to-event …

Cutting Through The Fog: Recognising Brain Fog As A Significant Public Health Concern, Darren Haywood, Susan L. Rossell, Nicolas H. Hart

Research outputs 2022 to 2026

Brain fog is a highly common condition that can have significant impacts on quality of life and functioning. Most people will experience a condition, illness, or infection that might result in the development of brain fog. We provide a call to action to minimise the impacts of brain fog.

Health Workforce Issues And Recommended Practices In The Implementation Of Universal Health Coverage In The Philippines: A Qualitative Study, Veincent Christian Pepito, Arianna Maever Loreche, Ruth Shane Legaspi, Ryan Camado Guinaran, Theo Prudencio Juhani Z. Capeding, Madeline Mae A. Ong, Manuel M. Dayrit

Ateneo School of Medicine and Public Health Publications

Background

The transition towards Universal Health Coverage (UHC) in a devolved healthcare system such as the Philippines is beset by health workforce issues considering that it is among the world’s leading source countries for health workers. This study aims to document health workforce issues and recommended practices in the implementation of UHC in the Philippines.

Methods

We conducted focus group discussions and key informant interviews with health policymakers and UHC implementers in the national, regional, and local levels. Participants included local chief executives, healthcare facility administrators, and healthcare providers at tertiary, secondary, and primary levels, as well as patients. We …

Human Alveolar Macrophage Function Is Impaired In Tuberculosis Contacts With Diabetes, Léanie Kleynhans, Carine Kunsevi-Kilola, Happy Tshivhula, Tariq Webber, Alana Keyser, Nicole Prins, Candice I. Snyders, Ayanda Shabangu, Virginie Rozot, Blanca I. Restrepo

School of Medicine Publications

Background: Tuberculosis (TB) remains a leading cause of morbidity and mortality worldwide. Individuals with type 2 diabetes (T2D) are at increased risk of developing active TB, tend to present with more severe disease and experience adverse treatment outcomes compared to individuals without T2D co-morbidity. However, the underlying mechanisms responsible for increased susceptibility of patients with T2D to TB remain poorly understood.

Methods: We performed bronchoscopies and collected bronchoalveolar lavage fluid (BAL) from TB contacts with and without T2D in South Africa and obtained paired human alveolar macrophages (HAMs) and monocyte-derived macrophages (MDMs) for transcriptomic, epigenetic and functional assays.

Findings: Following …

Identifying Alcohol Intervention-Relevant Constructs For Greek Life: Examining Across Greek Membership And Gender Among College Students, Emily Susan Renzoni

Psychology Theses & Dissertations

Among college populations, students who are members of social Greek life organizations (i.e., social fraternities and sororities) drink more and experience higher rates of negative alcohol-related consequences than their non-affiliated peers. Although there has been success of alcohol interventions in general college populations, research has shown that college drinking interventions that are delivered to students in Greek life are not efficacious in reducing alcohol consumption or related consequences. It is meaningful to investigate if the content commonly addressed in these interventions, although well-documented as being linked to drinking in the general college population, has the same associations for students who …

Telehealth And Virtual Supervision Practices For Health Professions Education In The Department Of Veterans Affairs, Nancy D. Harada, Kimberly Falco, Marjorie Bowman, John M. Byrne

Population and Public Health Sciences Faculty Publications

Background Telehealth and virtual supervision practices in health professions clinical education has grown rapidly, including in the Department of Veterans Affairs (VA) which oversees the largest interprofessional training effort in the United States. Telehealth is the provision of healthcare that is provided remotely through telecommunication technology, and virtual supervision is clinical supervision of health professions trainees (HPTs) that occurs through telecommunication technology. In this study we evaluate participation in telehealth and virtual supervision for physician, nursing, and associated health HPTs, and describe prevalent themes concerning HPT perceptions of telehealth and virtual supervision. Methods The survey study cohort included 10,865 HPTs …

The Frontal Assessment Battery In Older Multilingual Kenyan Adults, Anne Njoki Gitere, Anne Nyambura, Karen Blackmon, Levi Muyela, Rachel Maina, Olivera Nesic Taylor,, Jasmit Shah, Dilraj Sokhi, Sylvia Mbugua, Samuel Gitau, Sheila Waa, Juzar Hooker, Zul Merali, Chinedu Momoh, Karen Blackmon

Brain and Mind Institute

Background: The Frontal Assessment Battery (FAB) was developed as a short (6-item) bedside assessment of executive dysfunction in older adults with suspected neurodegeneration. This study describes psychometric features of the FAB in multilingual Kenyan adults with and without clinical diagnosis of dementia.

Method: The FAB consists of six items assessing verbal abstract reasoning, lexical fluency, motor learning, and inhibitory control. The score on each item ranges from 0-3, with higher scores indicating better performance. Bilingual English-Swahili study personnel translated, blind back-translated, and applied consensus-driven cultural adaptations. FAB was then administered to 95 participants [71 cognitively unimpaired (CU) controls; 24 people …

Burden Of Neurodevelopmental Disorders In Kenyan Children, Symon Kariuki, Patricia Kipkemoi, Martha Kombe, Mary Bitta, Jacqueline Phillips Owen, Amina Abubakar, Charles Newton

Institute for Human Development, East Africa

Importance: Neurodevelopmental disorders (NDDs) such as autism spectrum disorder (ASD), attention-deficit/hyperactivity disorder (ADHD), and intellectual disability contribute to one-tenth of the global burden of mental and neurologic disorders. The burden of NDDs is not well documented in Africa.

Objective:To assess the prevalence, risk factors, and comorbidities of NDDs in young Kenyan children.

Design, setting and participants: This cross-sectional study was conducted among children aged 6 to 9 years residing in the Kilifi Health and Demographic Surveillance System in Kenya. In stage I of the study, children were screened for NDDs from March 16, 2015, to September 14, 2016; those …

Care Starts Before Entering The Clinic – A Holistic Approach To Assessing Primary Care Access At Walter Reed National Military Medical Center, Cory E. Hauptman

All Theses

Walter Reed National Military Medical Center is the world’s largest military treatment facility and the primary provider of healthcare to the military, their families, and military retirees in the Washington DC area. The federal government is legally bound to provide access to primary healthcare services to Tricare enrollees within a 30-minute travel time of their residences. This time constraint has only been applied to the transit period from a patient’s residence to the base where the care is provided and has not accounted for the time it takes a patient to get to the clinic once they arrive at the …

Awareness And Usability Of Community And Facility-Based Health Sector Client Feedback Mechanism In Tanzania Public Health System. A Mixed Methods Study, James Kengia, Pius Kagoma, Ally Kinyaga, Helga Mutasingwa, Simon Debere, Robert Smith, Marcos Mzeru, Rashid Mbunda, Claud Kumalija, Paschal Ruggajo

Internal Medicine, East Africa

Background Client feedback systems are increasingly becoming important in person-centered health care. The systems provide opportunities to the public to interact with the health care providers and policymakers, present their concerns related to the performance of the health care system in order to improve the quality, equity, and responsiveness in the provision of services, hence increase social accountability. This study aimed to assess the situation of client feedback systems in Tanzania, focusing on the awareness and usability of existing facility- and community-based feedback platforms from the client’s perspective.

Methods The study employed a concurrent mixed-method design using both quantitative and …