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The RECOVERY trial was established in March as a randomised clinical trial to test a range of potential treatments for COVID-19, including lopinavir-ritonavir, an antiviral treatment commonly used to treat HIV. There was no significant difference in the primary endpoint of 28-day mortality, and the results were consistent in different subgroups of patients. There was also no evidence of beneficial effects on the risk of progression to mechanical ventilation or length of hospital stay. The trial Steering Committee concluded that there is no beneficial effect of lopinavir-ritonavir in patients hospitalised with COVID-19 and closed that treatment arm.
Characterising support and care assistants in formal hospital settings: a scoping review
KWTRP NDM-CGHR
Posted 05/12/2023. The adoption of ‘Care Assistants’ in formal hospital settings as a HRH strategy is gaining more traction in the Global North than the Global South. Vincent Kagonya and colleagues highlight their effect on care as well as gaps in the labelling, role assignment, training, clinical governance, and regulation in the clinical environment.
National prevalence and risk factors for tungiasis in Kenya
KWTRP
Posted 29/11/2023. Tungiasis is a highly neglected tropical skin disease for which the global disease burden is unknown. Lynne Elson and colleagues report here on the first ever national prevalence survey which found a 1.3% prevalence in Kenya with 40% of primary schools having at least one case and extreme heterogeneity in distribution.
The influence of internship training experience on Kenyan and Ugandan doctors’ career intentions and decisions: a qualitative study
KWTRP NDM-CGHR
Posted 28/11/23. Medical internship is a key period for doctors’ individual career planning and also a transition period for the broader labour market. Daniel Mbuthia and colleagues highlighted how experience during internship shaped medical doctors’ career intentions in Kenya and Uganda, and emphasized the importance of job availability and context in influencing doctors’ career choices.
Development and validation of a new measurement instrument to assess internship experience of medical doctors in low-income and middle-income countries
KWTRP NDM-CGHR
Posted 22/11/2023. Routine surveys are used to understand the training quality and experiences of junior doctors but there are lack of tools designed to evaluate the training experiences of interns in LMICs where working conditions and resource constraints are challenging. Yingxi Zhao and colleagues described their process developing and validating a “medical internship experience scale”.
‘We were treated like we are nobody’: a mixed-methods study of medical doctors’ internship experiences in Kenya and Uganda
KWTRP NDM-CGHR
Posted 15/11/2023. Medical interns are an important workforce providing first-line healthcare services in hospitals. Yingxi Zhao and colleagues provided an overview of doctors’ internship experience in Kenya and Uganda, and highlighted challenges experienced by interns spanning from burnout, stress, challenging working environment, inadequate support and poor quality of supervision.
Hospital care for critical illness in low-resource settings: lessons learned during the COVID-19 pandemic
KWTRP NDM-CGHR
Posted 07/11/2023. As COVID spread globally support for LMIC focused on skilled, technologically enabled ICU care. This ignored fundamental weaknesses in health systems and the need for basic, effective care to save lives in all clinical settings. Whole of system vigilance and response requires reorientation of priorities and effective change management, by Mike English.
Malaria vaccine coverage estimation using age-eligible populations and service user denominators in Kenya
KWTRP
Posted 10/10/2023. Angela Moturi and colleagues evaluate RTS,S/AS01 malaria vaccine coverage in Kenya's pilot phase, showing high EPI (Extended Programme for Immunisation) user coverage (78%) for dose 3, but lower community coverage (57%). The 4th dose at 24 months had low coverage (<39%). Universal coverage of 3 doses of malaria vaccine needs improving. 24-month dosing remains a challenge.
Pharmacokinetics of single low dose primaquine in Ugandan and Congolese children with falciparum malaria
KIMORU KWTRP MORU
Posted 29/09/2023. This large study on the pharmacokinetics of single low dose primaquine in young Ugandan and Congolese children will help the MORU team develop an optimal dose for children with falciparum malaria to block malaria transmission and contribute to malaria elimination, especially of resistant falciparum parasites. By Bob Taylor
A rapid review of community engagement and informed consent processes for adaptive platform trials and alternative design trials for public health emergencies
KWTRP MORU NDM-CGHR
Posted 30/08/2023. Alternative Design Trials (ADTs) and Adaptive Platform Trials (APTs) have enabled efficient large-scale testing of biomedical interventions during recent Public Health Emergencies (PHEs). Alun Davies and colleagues aimed to rapidly review evidence on engagement and informed consent for ADTs and APTs during PHE to consider what (if any) recommendations can inform practice.
Policies and resources for strengthening of emergency and critical care services in the context of the global COVID-19 pandemic in Kenya
KWTRP NDM-CGHR
Posted 26/07/2023. Critical illnesses cause several million deaths annually, many occurring in low-resource settings. Despite great efforts and investments, lower income countries faced constraints in upscaling critical care during the COVID-19 pandemic. Rosanna Mazhar, Jacquie Oliwa and colleagues explore how Kenya’s efforts to do so were operationalised, offering insights into some of the challenges faced.
Immunogenicity and safety of fractional doses of 17D-213 yellow fever vaccine in HIV-infected people in Kenya (YEFE): a randomised, double-blind, non-inferiority substudy of a phase 4 trial
KWTRP
Posted 10/05/2023. Although yellow fever vaccine provides a lifelong protection to most people, little research was done on HIV population. Josephine Bendera and colleagues evaluate the immunogenicity of fractional and standard doses of yellow fever vaccine on the HIV population. They demonstrate that fractional doses of vaccine are safe, effective and immunologically non inferior to standard doses in HIV-infected individuals.
Examining the influence of health sector coordination on the efficiency of county health systems in Kenya
KWTRP
Posted 19/04/2023. Lizah Nyawira and colleagues examined how health sector coordination influences the efficiency of the Kenyan health system. The study found that duplication, fragmentation, and misalignment of functions compromised coordination. This compromised efficiency by increasing transaction costs, impairing the implementation of health programs with negative impacts on health system performance.
Investigating rapid diagnostic testing in Kenya’s health system, 2018–2020: validating non-reporting in routine data using a health facility service assessment survey
KWTRP
Posted 14/04/2023. Angela Moturi and colleagues investigate the accuracy of routine data in assessing rapid diagnostic test availability for enhancing healthcare accessibility in Kenya. They address concerns over non-reporting of data by triangulating information from routine systems and a health facility survey. Contrary to expectations, the study finds that non-reporting persists despite established capacity.
Characterization of tungiasis infection and morbidity using thermography in Kenya revealed higher disease burden during COVID-19 school closures
KWTRP
Posted 24/03/23. Lynne Elson of KEMRI-Wellcome Trust and colleagues used thermography to help define a new disease severity classification for tungiasis (sand flea disease). In the process they found when children spent many months at home during COVID-19 school closures, the prevalence and severity of tungiasis increased.
Plasmodium falciparum adapts its investment into replication versus transmission according to the host environment
KWTRP
Posted 21/03/23. A collaborative study between Abdirahman Abdi's lab at KEMRI-Wellcome Trust, Kenya, and Prof Marti’s Lab of Glasgow University, UK, has characterised the human environmental factors that drive malaria parasites, Plasmodium falciparum to invest into the transmission to the next host or continued replication within the current host to maximise survival.
A framework for managing health research capacity strengthening consortia: addressing tensions and enhancing capacity outcomes
KWTRP NDM-CGHR
Posted 03/03/2023. Nadia Tagoe, Sassy Molyneux and colleagues conducted a case study involving three health research capacity strengthening (HRCS) consortia to critically examine their decision-making processes, strategies for resolving management tensions and potential implications for consortia outcomes. The researchers propose an evidence-informed management framework for consortia leaders to use to support decision-making to optimise research capacity gains.
Vitamin D Deficiency and Its Association with Iron Deficiency in African Children
KWTRP
Posted 10/05/2022. In this study, Reagan Mogire and colleagues found that vitamin D deficiency was associated with a 98% increased risk of iron deficiency in African children and also influenced hepcidin and other markers of iron status. Both nutrients should be considered in strategies to manage their deficiencies in Africa.
A global core outcome measurement set for snakebite clinical trials
KWTRP
Posted 24/01/2023. Snakebite is a priority NTD that causes 94,000 deaths each year and many more cases of severe disability. In research led by PhD student Michael Abouyannis at KWTRP and LSTM, global academics, policy makers, and the Kilifi snakebite patient group developed a globally relevant set of core outcome measures to support future clinical trials.
How does power shape district health management team responsiveness to public feedback in low- and middle-income countries: an interpretive synthesis
KWTRP NDM-CGHR
Posted 13/01/2023. Nancy Kagwanja and colleagues highlight the influence of social norms, structures, and actor power practices on responsiveness. Power practices were rooted in actors’ lived experiences which included social and organizational power relationships, personal characteristics, and worldviews. Our findings emphasize the need to consider actors’ lived experiences when intervening to strengthen responsiveness.
Spatial variation and inequities in antenatal care coverage in Kenya, Uganda and mainland Tanzania using model-based geostatistics: a socioeconomic and geographical accessibility lens
KWTRP
Posted 13/12/2022. Pregnant women in sub-Saharan Africa experience the highest levels of maternal mortality and stillbirths due to predominantly avoidable causes. However, Antenatal care (ANC) can prevent, detect, alleviate, or manage these causes. To inform planning, Peter Macharia and colleagues modelled ANC4+ coverage stratified by household wealth, maternal education, and spatial access to healthcare in East Africa.