Search results (142)
« Back to Research HighlightsCreating different global health futures: mapping the health research ecosystem and taking decolonial action
Posted 29/04/2025. Decolonisation in global health emphasises the need to challenge and change entrenched power asymmetries and unfair health research practices. Nadia Tagoe, Sassy Molyneux, Caesar Atuire and colleagues have proposed practical decolonial action using a four-step framework and a reflexive tool that can help transform key domains of the global health knowledge ecosystem.
Putting health facilities on the map: a renewed call to create geolocated, comprehensive, updated, openly licensed dataset of health facilities in sub-Saharan African countries
Posted 15/04/2025. Healthcare service provision and planning depend on the availability of a comprehensive health facility database (HFDB) to adequately meet the healthcare needs of a population. However, the availability of HFDBs has remained a big challenge in sub-Saharan Africa (SSA). Peter Macharia and colleagues elaborate historical developments and the current status of HFDBS while describing the steps required and challenges to overcome for harmonized SSA-wide HFDBs.
Situational analysis of antibiotic prescriptions in Kenyan neonatal units for antimicrobial stewardship: a retrospective longitudinal study
Posted 08/04/2025. High antibiotic use in Kenyan neonatal units may contribute to antimicrobial resistance. A study of 88,000 neonatal admissions in 22 hospitals found 62.6% received antibiotics at admission, mostly first-line drugs. However, non-first-line use was higher in outborn neonates. Monitoring antibiotic patterns at scale feasible and crucial for assessing antimicrobial stewardship and reducing resistance. With Jalemba Aluvaala and Mike English
Strengthening the paediatric clinical trial ecosystem to better inform policy and programmes
Posted 04/04/2025. The first WHO Global Clinical Trials Forum was convened in November 2023 to develop a shared vision of an effective global clinical trial infrastructure. In this paper, the Paediatric Clinical Trials Working Group shares perspectives, identify challenges, and proposes solutions to strengthen the global paediatric clinical trials ecosystem. By James Berkley
Effects of health system limitations on the use of blood culture and sensitivity testing in Kenyan county hospitals: an interview-based qualitative study using causal loop diagrams
Posted 02/04/2025. Antibiotic resistance is rising in Africa, but blood culture and sensitivity (BCS) testing faces challenges in Kenyan hospitals. A study using a complex systems approach across eight hospitals found that interconnected issues in both demand and supply, including cost, turnaround time, and logistical barriers undermine the use and sustainability of BCS testing at scale; targeted antimicrobial stewardship may offer a viable alternative. By Jacob McKnight & Mike English with KWTRP colleagues.
Reducing global inequities in medical oxygen access: the Lancet Global Health Commission on medical oxygen security
Posted 01/04/2025. Medical oxygen is a critical treatment in severe illness, yet global access remains inequitable, especially in low-income countries. The COVID-19 pandemic highlighted these disparities. The Lancet Global Health Commission emphasizes systemic improvements, investments in infrastructure, workforce training, and affordability. Addressing these gaps can save millions of lives and strengthen global health resilience. With Jacquie Oliwa and Mike English as members of this Lancet Commission.
Through the eyes of the participant: using photovoice to understand the experiences and effects of ivermectin MDA in the context of the BOHEMIA clinical trial in Kwale, Kenya
Posted 27/03/2025. The photovoice sub-study in the BOHEMIA clinical trial let participants document their experiences and perceptions of the intervention. Their photos captured trial experiences, MDA effects and overlooked community concerns. This provided insights from participants' perspectives, highlighting issues beyond the study's scope that local health authorities and researchers might have missed. By Truphena Onyango
Multiple insecticide resistance in Anopheles funestus from Mopeia, Central Mozambique
Posted 25/03/2025. Malaria vectors in Mopeia, Mozambique were found resistant to all classes of insecticides used in malaria control. New insecticide classes or non-insecticide-based tools are urgently needed. Resistance markers to dieldrin suggest potential selective pressure by agricultural pesticides. Coordinated and rational insecticide usage between health and agriculture sectors is needed. By Marta Maia.
Comparing HemoCue® and Quantitative Buffy Coat® and Coulter Counter-measured haemoglobin concentrations in African children with acute uncomplicated malaria: a Bland–Altman analysis
Posted 19/03/2025. Malaria studies often involve blood transfusion to severe malarial anaemic children. Accurate Anaemia diagnosis is crucial for effective management. Hence, important to determine the level of agreement among haemoglobin concentrations measurement methods. HemoCue® should be used with caution in settings where decisions about blood transfusions are made. By Mavuto Mukaka
Catastrophic expenditure associated with childhood hospitalisation for acute illness in Kenya and Uganda: a cross-sectional study
Posted 04/02/2025. In Kenya and Uganda, hospital care for under-fives is intended to be free. James Berkley and colleagues studied families’ healthcare, travel, other costs, and loss of earnings due to child admissions at six hospitals. 74% to 92% of households experienced ‘catastrophic’ expenditure (depending on the definition used) in relation to monthly income.
Detection of low frequency artemisinin resistance mutations, C469Y, P553L and A675V, and fixed antifolate resistance mutations in asymptomatic primary school children in Kenya
Posted 31/01/2025. This is an important finding for Kenya, artemisinin resistance k13 mutations previously identified in Uganda (C469Y and A675V) and SE Asia (P553L) are described. Though at low frequencies, 4%, 1.7% and 1.2%, respectively, they sound the alarm for studies to determine their impact on the efficacy of artemisinin-based combination therapies. By Isabella Oyier
After neonatal care, what next? A qualitative study of mothers’ post-discharge experiences after premature birth in Kenya
Posted 28/01/2025. Each year, 15 million babies are born prematurely, with Sub-Saharan Africa and Asia accounting for over half. Weak healthcare systems and poverty in SSA worsen outcomes for mothers and babies. This study by Justinah Maluni and Dorothy Oluoch explores the challenges mothers face post-discharge and suggests strategies to improve care and reduce mortality and readmission rates.
Understanding health system responsiveness to public feedback at the sub-national level: Insights from Kilifi County, Kenya
Posted 22/01/2025. Nancy Kagwanja and colleagues examined public feedback in health systems, focusing on its forms, channels, processing, and responses. Feedback mechanisms often operated in isolation, excluding vulnerable groups. Organisational challenges, such as inadequate resources, weak policies and power dynamics limited effectiveness. Integrating diverse mechanisms and addressing system capacities are vital for improved responsiveness.
Prospective clinical surveillance for severe acute respiratory illness and COVID-19 vaccine effectiveness in Kenyan hospitals during the COVID-19 pandemic
Posted 13/11/2024. Ruth Lucinde, Anthony Etyang and colleagues conducted a prospective longitudinal hospital-based sentinel surveillance at 16 public hospitals in Kenya during the COVID-19 pandemic to describe the clinical and demographic pattern of patients admitted with severe acute respiratory illness (SARI), and evaluate COVID-19 vaccine effectiveness. They identified key risk factors for mortality and reported a moderate vaccine effectiveness of 59% against progression to inpatient mortality.
Fractional Doses of Pneumococcal Conjugate Vaccine — A Noninferiority Trial
Posted 10/10/2024. Pneumococcal Conjugate Vaccines (PCV) have had a tremendous impact on childhood morbidity but only 2/3 of children receive a PCV. One obstacle to wider protection is cost. Kate Gallagher, Anthony Scott and others at KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya, showed that a 40% fractional dose of PCV13 had non-inferior immunogenicity to a full dose, suggesting similar benefits could be delivered for lower cost.
Public service motivation, public sector preference and employment of Kenyan medical doctor interns: a cross-sectional and prospective study
Posted 11/09/2024. Daniel Mbuthia and colleagues surveyed 356 Kenyan medical doctors, to understand what influences their career choices at labour market entry, specifically understanding the role of public service motivation. They highlighted that nearly all surveyed doctors are public service oriented, many doctors stated intention to work in the public sector but were unable due to lack of job opportunities. Unfortunately, 13% of the doctors were unemployed one year after completing their internship.
The mRNA content of plasma extracellular vesicles provides a window into molecular processes in the brain during cerebral malaria
Posted 06/09/2024. Kioko Mwikali, Abdirahman Abdi and colleagues at KEMRI-Wellcome Trust used extracellular vesicles circulating in plasma to noninvasively study the progression of cerebral malaria in children. This provides a mechanism for identifying diagnostic biomarkers and developing therapeutic strategies.
Examining liminality in professional practice, relational identities, and career prospects in resource-constrained health systems: Findings from an empirical study of medical and nurse interns in Kenya
Posted 03/09/2024. Yingxi Zhao, Stephanie Nzekwu and colleagues examined new Kenyan doctors' and nurses' experiences of transitioning from training to practising as health professionals, drawing on the concept of liminality. The research highlighted three dimensions of liminal experiences in professional practice, relational inter- and intra-professional identity and status, and professional careers.
Linking Cerebral Malaria Pathogenesis to APOE-Mediated Amyloidosis: Observations and Hypothesis
Posted 06/08/2024. Kioko Mwikali, Abdirahman Abdi and colleagues found that the CSF proteome of cerebral malaria is more similar to Alzheimer's Disease than to acute bacterial meningitis, with cerebral malaria showing elevated amyloidosis. This finding might benefit the search for treatment and management of both Alzheimer's Disease and cerebral malaria.
Relation Between the Dantu Blood Group Variant and Bacteremia in Kenyan Children: A Population-Based Case-Control Study
Posted 02/08/2024. Plasmodium falciparum malaria is a strong predisposing factor for bacteraemia. Silvia Kariuki and colleagues investigated the impact of the rare malaria-protective Dantu blood group variant on susceptibility to bacteraemia. We found that Dantu was significantly protective against bacteraemia only during a high malaria transmission period. This suggested that the protective effect of Dantu on bacteraemia is secondary to its protective effect against malaria.
Tungiasis among children in Kenya is associated with poor nutrition status, absenteeism, poor school performance and high impact on quality of life
Posted 31/05/2024. Tungiasis is a neglected tropical skin disease. Lynne Elson and colleagues aimed to determine its impact on school children in nine counties of Kenya. They found infected children experience considerable pain, itching, difficulty sleeping and feel ashamed, leading to lower school attendance, concentration and exam scores, than uninfected children.
Nutritional supplementation in children with severe pneumonia in Uganda and Kenya (COAST-Nutrition): a phase 2 randomised controlled trial
Posted 21/05/2024. Severe pneumonia is a leading cause of illness and hospitalization in African children, resulting in poor outcomes. Kathryn Maitland and colleagues tested if adding ready-to-use therapeutic food to diets improves the recovery of children in Uganda and Kenya. The study found no significant benefits, suggesting future research should focus on high-risk, undernourished children.
Characterising support and care assistants in formal hospital settings: a scoping review
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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.
A global core outcome measurement set for snakebite clinical trials
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
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
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.
Improving in-patient neonatal data quality as a pre-requisite for monitoring and improving quality of care at scale: A multisite retrospective cohort study in Kenya
Posted 11/11/2022. In this study, Timothy Tuti and colleagues discuss the characteristics of a neonatal inpatient dataset from a network of Kenyan hospitals that allows for exploration of trends in performance and could support better impact evaluation, exploration of links between health system inputs and outcomes, and scrutiny of variation in quality of hospital care.
Combining school-catchment area models with geostatistical models for analysing school survey data from low-resource settings: Inferential benefits and limitations
Posted 23/09/2022. Peter Macharia and colleagues propose a geostatistical modelling framework that accounts for the uncertainty in the residence location of students from school-based infection sample surveys when only school location data are available. The proposed framework offers inferential benefits by leveraging spatial access and school catchment models to improve standard geostatistical approaches.
Pandemic preparedness and responsiveness of research review committees: lessons from review of COVID-19 protocols at KEMRI Wellcome Trust Research Programme in Kenya
Posted 05/08/2022. During a rapidly unfolding catastrophic pandemic, research is most needed to inform on nature, containment and prevention of the pandemic. Ethics review and regulatory authorities are important gatekeepers for research, and can facilitate scientifically rigorous and ethically sound relevant research. Alex Hinga, Dorcas Kamuya and colleagues examined how research review was undertaken during COVID19 in one of the review systems in Kenya, factors that enabled and/or hindered accelerated review including the political landscape, and make some recommendations for review systems in LMICs.
Implementing a comprehensive newborn monitoring chart: Barriers, enablers, and opportunities
Posted 03/08/2022. Naomi Muinga and colleagues report on a process of implementing a co-designed, paper-based newborn monitoring chart in a network of hospitals in Kenya. While the chart was well-received, challenges with full uptake persist and offer opportunities to strengthen the process as well as future implementations.
Phagocytosis of Plasmodium falciparum ring-stage parasites predicts protection against malaria
Posted 29/07/2022. Ring-stages are the predominant parasite forms detected in the blood of humans infected with Plasmodium falciparum. Fauzia Musasia, Faith Osier and colleagues found that their active destruction through antibody-dependent phagocytosis predicted how well individuals responded to an experimental malaria infection. Targeting ring-stages may limit exponential parasite multiplication and prevent the progression to clinical malaria
Incidence of chikungunya virus infections among Kenyan children with neurological disease, 2014–2018: A cohort study
Posted 06/07/2022. Chikungunya Virus (CHIKV) has been associated with neurological illness in many parts of the world, but there have been no reports of CHIKV-associated neurological illness in Africa. This study by Doris Nyamwaya and George Warimwe reveals that CHIKV infections are relatively more common than cerebral malaria and bacterial meningitis among children hospitalized with neurological disease in coastal Kenya, and systematic surveillance should be an urgent priority.
Experience of Kenyan researchers and policy-makers with knowledge translation during COVID-19: a qualitative interview stud
Posted 17/06/2022. Reducing the devastating impact of COVID-19 requires the use of best available evidence to inform responses. Fatuma Guleid, Edwine Barasa and Researchers at the KEMRI-Wellcome Trust carried out knowledge translation (KT) activities to support national COVID-19 policy-making. In the study, we describe our experiences and the impact of KT in responding to public health crises.
Evaluation of an audit and feedback intervention to reduce gentamicin prescription errors in newborn treatment (ReGENT) in neonatal inpatient care in Kenya: a controlled interrupted time series study protocol
Posted 17/05/2022. In this study, leveraging a Kenyan Clinical Information Network, Timothy Tuti, Mike English and colleagues set out to evaluate at the clinical team level, if and how a comprehensive healthcare-specific feedback theory used to design and implement pharmacists-championed feedback strategies could help improve medication prescribing accuracy during inpatient neonatal care.
Low Hemoglobin Levels Are Associated with Reduced Psychomotor and Language Abilities in Young Ugandan Children
Posted 17/05/2022. In this study, Margaret Nampijja, Agnes Mutua, Sarah Atkinson and colleagues found that lower maternal and infant hemoglobin levels were associated with reduced psychomotor scores at 15 months, and lower infant hemoglobin levels were associated with reduced language scores. These findings emphasize the importance of managing maternal and child anemia.