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.
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.
Posted 05/12/2023. The adoption of \u2018Care Assistants\u2019 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.
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.
Posted 28/11/23. Medical internship is a key period for doctors\u2019 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\u2019 career intentions in Kenya and Uganda, and emphasized the importance of job availability and context in influencing doctors\u2019 career choices.
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 \u201cmedical internship experience scale\u201d.
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\u2019 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.
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.
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.
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
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.
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\u2019s efforts to do so were operationalised, offering insights into some of the challenges faced.
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.
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.
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.
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.
Posted 21/03/23. A collaborative study between Abdirahman Abdi's lab at KEMRI-Wellcome Trust, Kenya, and Prof Marti\u2019s 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.
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.
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.
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\u2019 lived experiences which included social and organizational power relationships, personal characteristics, and worldviews. Our findings emphasize the need to consider actors\u2019 lived experiences when intervening to strengthen responsiveness.
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.
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.
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.
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.
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.
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
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.
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.
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.
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