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.
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.
Posted 11/05/2022. Yingxi Zhao and colleagues used data from a national health facility assessment to understand the capacity of Kenya internship hospital to provide internship training for medical doctors. They highlight the major gaps in staffing, equipment and service availability in those hospitals and call for more stringent and regular review and re-accreditation of internship hospitals to provide appropriate and well-resourced training.
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.
Posted 06/05/2022. Animal studies suggest an important role of iron in neurodevelopment. In this systematic review, Agnes Mutua, Sarah Atkinson and colleagues found limited evidence for the effects of iron supplementation on neurodevelopment in African children despite the high burden of iron deficiency in this population. Further well-conducted studies are needed.
Posted 12/04/2022. Evidence on the costs of delivering COVID-19 vaccines are useful inputs in planning for resource mobilization, and can inform vaccine priority setting decisions. Stacey Orangi, Edwine Barasa and colleagues present the unit costs of procuring and delivering the COVID-19 vaccine in Kenya across various vaccination strategies. These cost estimates can be used to inform local policy and may further inform parameters used in cost-effectiveness models.
Posted 08/04/2022. Kwashiorkor, a type of severe malnutrition associated with oedema, has been known for centuries but its mechanism remains elusive. This research by Jay Berkley and colleagues confirmed that low plasma albumin levels are necessary but not sufficient for oedema formation. Our findings suggest that lymphatic drainage may be impaired, which is a new discovery.
Posted 25/03/2022. Alun Davies and colleagues used Participatory Video (PV) to explore how engagement with researchers influenced Kenyan school students\u2019 perceptions of research and aspirations. PV highlighted the complex context in which engagement is situated where students\u2019 time and attention is competed for against curricular, extracurricular, and social-cultural factors. We emphasise the importance of ensuring that engagement benefits students.
Posted 18/03/2022. Steven Wambua and colleagues analysed monthly reports on utilization of outpatient and immunization services between Jan-2018 and Mar-2021 by all health facilities in Kenya to quantify the impact of COVID-19 on the utilization of the health services. Data was obtained from the District Health Information Software 2 (DHIS 2). We observed varied effects of the pandemic, with significant drops in attendance for most outpatient services while immunisation services remained unaffected.
Posted 04/03/2022. In a secondary analysis of a transfusion trial, Kathryn Maitland and colleagues showed that of 3188 children with severe anaemia (haemoglobin < 6 g/dl) 41% received a whole blood transfusion. Compared with whole blood, children receiving packed cells had a worse haemoglobin correction by 8 hours, required more additional transfusions and had longer hospital stays. We found no adverse effects of whole blood compared to packed cells.
Posted 02/03/2022. There are many benefits of vaccinating population against COVID-19 including a reduction in transmission, likelihood of severe disease, and pressure on health system. We assessed geographic inequalities in vaccine access in Kenya over the past year and show that despite on-going efforts, only 30% of adult population will have been vaccinate by April 2022, highlighting the disproportionate access to vaccine is Africa population.
Posted 25/02/2022. The burden of neurological impairments in older children from Africa remains unknown. Modelling empirical and literature estimates, Jonathan Abuga and colleagues demonstrate the high burden of fatal and non-fatal outcomes associated with active and lifetime epilepsy, and moderate/severe impairments in cognitive, motor, vision and hearing functions among older children (5-14) residing in a rural setting along the Kenyan coast. Interventions to prevent premature mortality and improve the wellbeing of these children are needed
Posted 22/02/2022. In many sub-Saharan African countries, including Kenya, the use of mortality and morbidity audits in maternal and perinatal/neonatal care as an avenue for learning and improving care delivery is sub-optimal due to structural, organizational, and human barriers. In this exploratory qualitative study, Joyline Jepkosgei and colleagues examined process-related factors that generally influence M&M audits including health workers\u2019 interactions and their experiences, institutional cultures, and broader health system contextual influences, which remain inadequately explored.
Posted 16/02/2022. Severe malaria is a medical emergency requiring prompt supportive and parenteral (intravenous/intramuscular) treatment. Beatrice Amboko and colleagues showed the inadequacy of the readiness of primary public health facilities to deliver appropriate pre-referral care to children with severe malaria in Kenya between 2017 and 2021.
Posted 15/02/2022. In this cost of illness study, Aishatu Adamu and colleagues found that in children aged <5 years, a week-long hospitalisation with pneumonia or invasive pneumococcal disease resulted in substantial costs to the health provider and households. Expenses were catastrophic for a third of the households, and for over half of the poorest households.
Posted 08/02/2022. There has been very little research on the epidemiology of severe malaria for over 20 years. Alice Kamau and colleagues analysed 52,000 malaria admissions from 49 settings across East Africa. Under high transmission, malaria hospitalisation was concentrated in children <5. Severe malaria anaemia is currently the most common severe disease presentation. Spatially and age targeting interventions, including chemoprevention and vaccines, will have the maximum benefit in areas where prevalence of infection is \u226510%.
Posted 19/01/2022. Rita Njeru, Sassy Molyneux and colleagues examine the role of community health workers in supporting post-discharge recovery in young undernourished children. The authors argue that a targeted and multi-pronged approach initiated before or on discharge is needed, supported by clear guidance and training. The ways in which any new tasks or personnel are incorporated into hospital and broader health system hierarchies and systems need careful planning and tracking.
Posted 08/12/2021. The prevalence of malaria parasite in the population is a key metric used for disease stratification. At sub-national levels, this prevalence is strikingly heterogenous, transcending national borders in Kenya, Tanzania and Uganda. Approximately 12.7 million people in East Africa continue to live in areas with over 30% prevalence. This mapping by Victor Alegana and colleagues highlights why countries must work together to reduce burden and prevent further malaria deaths.
Posted 26/11/2021. Steven Wambua and colleagues analysed monthly reports in 204 Kenyan hospitals and quantified the impact of COVID-19 on utilization of inpatient services. Data was obtained from the District Health Information Software 2 (DHIS 2). We observed significant drops in monthly volumes of live-births, over-fives admissions for medical, and surgical care with the greatest declines in the under-five\u2019s admissions.
Posted 22/09/2021. Kelvin Mokaya, Sarah Atkinson and colleagues found that children with severe malaria anaemia have higher risk of non-typhoidal Salmonella bacteraemia, and lower levels of the iron-regulating hormone, hepcidin (even with Salmonella coinfection) compared to other forms of malaria. Reduced hepcidin may increase iron availability for bacterial growth in the Salmonella-containing vacuole.
Posted 01/09/2021. Rob Paton, Alice Kamau and colleagues analysed a data series of over 6000 hospital records of malaria admissions among children aged 3 months to 9 years. A 25% reduction in transmission halved the rate of severe malaria hospitalization. Severe malaria remains a burden predominantly in children under 5 years, regardless of the level of malaria transmission.
Posted 27/08/2021. Demographic and epidemiological changes have prompted thinking on the need to broaden the child health agenda to include care for paediatric complex and chronic conditions, however such expansion is threatened by workforce shortages. Yingxi Zhao and colleagues reviewed how task sharing could support expanded paediatrics services provision in LMICs, especially beyond acute infectious diseases and malnutrition that are widely and historically shifted.
Posted 30/07/2021. A reliable catchment area is essential to define community needs (education, health care and social care) and population denominators. However, catchments are often implemented based on convenience disregarding implications on accuracy, planning and service seeking behaviour. Peter Macharia and colleagues revisit the issue by considering common approaches, key issues, and best practices in defining a reliable service catchment area
Posted 23/07/2021. Effective management and leadership are essential for everyday health system resilience, but health managers are often under-prepared and under-supported in these roles. Particular challenges have been observed in communication skills, emotional competence and supportive oversight. Jacinta Nzinga and colleagues share their learning from implementing a package of leadership development interventions in Kenya
Posted 13/07/2021. The overwhelming COVID-19 case numbers and deaths expected in African countries, as seen elsewhere following identification of the first COVID-19 cases, have not materialised. However, through serosurveillance of blood donors, Ifedayo Adetifa, Sophie Uyoga and colleagues demonstrate widespread SARS-CoV-2 infection in Kenya despite the lower COVID-19 cases and associated mortality.
Posted 22/06/2021. Diagnosis of bacterial meningitis in low- and middle-income countries is challenging due to limited laboratory capacity. Christina Obiero and colleagues conducted a revalidation study of previously identified signs of meningitis in children aged \u226560 days and found that KCH-2002 signs had lower sensitivity. Although bacterial meningitis is now uncommon following conjugate vaccination in Kenya, identifying cases is more difficult and support for basic cerebrospinal fluid analysis is crucial.
Posted 18/06/2021. Grace Irimu and colleagues show that newborns account for 46% of admissions and 66% of deaths among children 0-13years in Kenyan hospitals. Most deaths are caused by preventable and treatable causes. The authors call for need to prioritize newborn care for Kenya to achieve the SDGs target.
Posted 16/06/2021. The progress made in treatment of malaria is threatened by the emergence of resistance to current first line treatments artemisinin-based combination therapies (ACTs). There are currently no good alternatives for the treatment of uncomplicated malaria in the African setting in the event of resistance emerging to antimalarials that are in the ACTs. Mainga Hamaluba, Rob van der Pluijm and colleagues demonstrate that triple artemisinin combination therapies (TACTs) can potentially be used safely to prevent, delay or manage uncomplicated malaria in our setting.
Posted 08/06/2021. Alice Kamau and colleagues show that passively collected routine health facility data does offer opportunities to detect malaria \u2018hotstops\u2019 down to the village level, at an affordable cost. It will be important, however, to refine the current surveillance tools such that they have the potential of collecting information at sufficiently precise scale.
Posted 28/05/2021. Reagan Mogire, Sarah Atkinson and colleagues show that the prevalence of vitamin D deficiency (<50\u2009nmol/L) is low (7.8%) in African children, although 37.1% have insufficient levels (50\u201375\u2009nmol/L). Risk factors for vitamin D deficiency include high latitude, older age, winter and rainy seasons, Gc2 vitamin D binding protein genotype and malaria.
Posted 12/05/2021. Jacob Kazungu, Edwine Barasa and colleagues examined the level and inequality in health insurance coverage in 36 sub-Saharan African countries. They found that insurance coverage in sub-Saharan Africa is both low and pro-rich; only 8 of the 36 countries examined had a mean level of insurance coverage of above 10%.
Posted 28/04/2021. While Health and Demographic Surveillance Systems (HDSS) involving verbal autopsy provide essential data on deaths, births and other health-related events in LMICs where alternative sources are limited, Vicki Marsh and colleagues argue that current regulatory frameworks do not sufficiently recognise their nature as a form of non-traditional epidemiological research. Ethical challenges include risks of uncompensated burdens that alternative regulatory approaches may more successfully identify.
Posted 23/04/2021. COVID-19 case management is one of the key interventions in country responses to the pandemic. Angela Kairu, Edwine Barasa and colleagues estimate the unit costs for COVID-19 case management in Kenya useful in informing policy decisions around resource allocation, planning and budgeting, and development of appropriate healthcare purchasing arrangements. The findings illustrate that COVID-19 case management costs are substantial, ranging between two and four times the average claims value reported by Kenya\u2019s public health insurer.
Posted 31/03/2021. Patient safety is a key goal of WHO but identifying harms and developing strategies to deliver safe care has been given little attention. Mike English and colleague describe a \u2018portfolio\u2019 approach to safety improvement in four broad categories: prioritising critical processes, improving the organisation of care, control of risks and enhancing responses to hazardous situations that we believe is relevant to low resource settings. We focus attention on the possible roles of practitioner groups and professional associations as key to advancing patient safety through collaboration and skill development in this field
Posted 26/02/2021. Malaria and iron deficiency are common in Africa and malaria may cause iron deficiency through a hepcidin-mediated block in iron absorption. Using sickle cell trait to proxy malaria exposure, John Muriuki, Sarah Atkinson and colleagues found that an intervention that halves malaria incidence would also reduce iron deficiency by approximately 50% in African children.
Posted 22/02/2021. Paper continues to be an important medium for recording inpatient care in low\u2010 and middle\u2010income countries. Naomi Muinga and colleagues synthesise evidence on how paper\u2010based nursing records have been developed within inpatient settings to support documentation of nursing care, and that a human\u2010centred design approach might better meet users' needs
Posted 12/02/2021. The majority of digital health projects have failed to translate into scaled, routine services, leaving many health leaders cautious and uncertain of how to proceed. Chris Paton and colleagues identify factors that can influence successful and sustainable integration of digital health within local health systems in low resource settings.
Posted 05/02/2021. Measles immunity gaps have widened following disruptions of routine immunisation and supplementary activities due to COVID-19 pandemic in Kenya. While COVID-19 restrictions temporarily reduced the risk of a measles outbreak, Caroline Mburu, Ifedayo Adetifa and colleagues estimate that this risk will rapidly rise once the restrictions are lifted. Implementing delayed supplementary immunisation activities will be critical for prevention of measles outbreaks.
Posted 26/01/2021. Appropriate and well-resourced medical internship training is important to ensure psychological health and well-being of doctors in training and also to recruit and retain these doctors. Yingxi Zhao and colleagues identified and described a large number of tools designed for measuring medical internship experience, to help medical educators and human resource managers make an evidence-based decision on designing surveys to understand interns\u2019 experience of training.
Posted 15/01/2021. Yellow Fever is a re-emerging disease whose incidence has increased globally in the last three decades. Although very successful, the stocks of the YF vaccine are often insufficient. Derick Kimathi, George Warimwe and colleagues assessed the immunogenicity and safety of fractional (1/5th) doses. Our results support fractional dosing of all four WHO-prequalified YF vaccines in general adult population as a dose-sparing strategy.
Posted 08/01/2021. Patient safety is much less well studied in low-resource settings than in higher income settings. Mike English and colleagues suggest how concepts being employed to advance patient safety thinking in higher income settings could be usefully applied by practitioners in low-resource settings. The ability to diagnose system weaknesses should become a core skill for those leading teams, wards, departments or facilities in low-resource settings
Posted 31/10/2020. Existing neonatal prognostic models are suited for advanced care settings; however, they use parameters that are not available in low-resource settings. Jalemba Aluvaala and colleagues demonstrate that two novel models - NETS and SENSS - using basic routine data can accurately predict in-hospital mortality which may allow us to better understand neonatal mortality.
Posted 09/10/2020. Children with severe anaemia are more likely to get bacterial infections. Kelvin Mokaya, Sarah Atkinson and colleagues discuss how severe anaemia interferes with iron regulation, and how this promotes bacterial growth in blood and dampens immune responses to these bacteria. The authors also suggest possible studies that can be used to explore their hypothesis.
Posted 29/09/2020. In a collaborative effort to investigate the mechanism of protection conferred by the rare Dantu blood group variant, found at highest frequency in East Africa, Silvia Kariuki and colleagues found a strong correlation between red blood cell membrane tension and parasite invasion ability. Increased membrane tension led to resistance to parasite invasion, and Dantu red blood cells had higher average membrane tension, meaning that a greater proportion resisted invasion. The findings from this study could inform the design of drugs that imitate this increased membrane tension to prevent or treat malaria.
Posted 03/09/2020. Cian Wade, Mike English and colleagues brought together a large body of evidence to inform recommendations for Kenya on neonatal analgesic guidelines for routine procedures. They describe the process by which a group of local experts translated systematic review and meta-analysis findings into context-specific clinical guidelines. The work emphasises the value of breastfeeding or breast milk as an important and feasible therapeutic strategy for alleviating neonatal pain.
Posted 18/08/2020. In November 2018 twenty-nine participants, representing 21 institutions from 11 countries, participated in a first international \u201cschool engagement\u201d workshop hosted by the KEMRI-Wellcome Research Programme in Kilifi, Kenya. Alun Davies and colleagues report on the broad range of goals and approaches for engagement between health researchers and school students.
Posted 17/07/2020. In this editorial, Sam Kinyanjui and colleagues argue that establishing science preparedness, which is an integral component of emergency preparedness, should be embedded within long-term investment in research capacity. They illustrate how African-led research capacity building consortia including IDeAL have contributed to Africa\u2019s preparedness for the COVID-19 pandemic.
Posted 07/07/2020. In a country with 25 million newborns, children and adolescents, how many paediatricians are there and where are they? This paper by Mike English and colleagues seeks to start a debate on how to deliver paediatric services in LMIC in the future.
Posted 03/07/2020. Under declining malaria transmission on the Kenyan coast Kilifi, Alice Kamau, Bob Snow and colleagues show that children continue to bear the brunt of mild and severe disease. There was no significant malaria disease or mortality burden in adults. This is contrary to current modelled approaches to malaria disease burden among African adults.
Posted 30/06/2020. Interferon-gamma (IFN-g) is upregulated during malaria infection and influences erythropoiesis and iron status. Kelvin Mokaya, Sarah Atkinson and colleagues found that children carrying the IFNG+2200C allele, a variant previously associated with higher IFN-g levels, had a modestly increased risk of anaemia and iron deficiency after the malaria season. Larger studies are needed to validate this finding.
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