School of Public health & Community Development

Effects of the COVID-19 pandemic on maternal health care services utilization and pregnancy outcomes at a tertiary hospital in western Kenya

2024-11-25T00:00:00Z

Effects of the COVID-19 pandemic on maternal health care services utilization and pregnancy outcomes at a tertiary hospital in western Kenya Kubuta, P.O; Wameyo, C; Odero, W The coronavirus disease 2019 (COVID-19) pandemic occasioned significant disruptions in the delivery of healthcare services globally. There is limited knowledge on the effect of the pandemic on the utilization of maternal healthcare services and its effects on pregnancy outcomes in the Western Kenya region. The article can be accessed in full via:https://www.ajol.info/index.php/eamj/article/view/283187

Participatory development and initial pilot run of the Shauriana program to integrate sexual health and mental health support for young gay and bisexual men and other men who have sex with men in Kenya

2025-03-06T00:00:00Z

Participatory development and initial pilot run of the Shauriana program to integrate sexual health and mental health support for young gay and bisexual men and other men who have sex with men in Kenya Laura Jadwin-Cakmak, Gary W Harper, Elijah Ochieng, K Rivet Amico, Teddy Aloo, Felix Okutah, Edwin Gumbe, Kennedy Olango, Duncan O Okall, Fredrick O Otieno, Wilson Odero, Susan M Graham Gay and bisexual men and other men who have sex with men (GBMSM) are at elevated risk for HIV, especially in rights-constrained settings such as Kenya, where stigma and discrimination have impeded access to HIV prevention. This article describes the development and pilot run of a theory-based and culturally relevant peer-led program called Shauriana (“we counsel each other”), which combines health education and integrated Next Step Counseling (iNSC) to promote sexual and mental health and well-being. Shauriana was developed using participatory methods in collaboration with GBMSM community members using the ADAPT-ITT framework and tested through an initial pilot run with 10 participants to refine and finalize program materials and procedures. The team monitored attendance and obtained participant feedback through quantitative evaluation and in-depth exit interviews that were thematically analyzed. The majority of participants (90%) attended all 4 core sessions and completed study visits on time. All participants completed an exit interview, providing feedback on program content and format, challenges/barriers, recommendations, impact, and recommending Shauriana to others. We identified key elements for positive engagement with the program, including being peer-led, maintaining privacy and confidentiality, using iNSC to provide guidance while maintaining autonomy, and taking a holistic approach by focusing on mental health and issues affecting GBMSM’s lives. We share modifications made in response to feedback and an overview of the final program sessions and structure. Pilot participants reported positive experiences engaging in Shauriana and shared that the program was highly relevant to their lives. Refined intervention procedures and materials are being tested in a subsequent randomized controlled trial. Lessons learned throughout the participatory development process and confirmed in exit interviews center on the importance of community engagement, local GBMSM leadership, and holistic, autonomy-supporting programming for young GBMSM in Kenya.

‘It kills the freedom or the spirit of people being who they are’: impact of sexuality-based stigma and discrimination on the lives of gay and bisexual men in Kenya

2025-01-01T00:00:00Z

‘It kills the freedom or the spirit of people being who they are’: impact of sexuality-based stigma and discrimination on the lives of gay and bisexual men in Kenya Juan C Jauregui, Katherine A Lewis, Darius M Moore, Adedotun Ogunbajo, Wilson W Odero, Jeffrey Wambaya, Daniel P Onyango, Laura Jadwin-Cakmak, Gary W Harper Gay and bisexual men (GBM) in Kenya are subjected to frequent experiences of sexuality-based stigma and discrimination, yet how GBM navigate these experiences and their impact on mental health has remained understudied. The aim of this study was to understand how GBM in Kenya respond to everyday experiences of sexuality-based stressors. We conducted 60 individual in-depth interviews with GBM between the ages of 20-46 residing in Kisumu and Nairobi. The following four key themes regarding how GBM in Kenya respond to sexuality-based stressors emerged: enacting identity protection strategies, using alcohol and other substances, avoiding healthcare providers and services, and being hypervigilant to avoid violence. These findings highlight the urgent need for interventions that reduce sexuality-based stigma and improve access to safer social and healthcare spaces for GBM in Kisumu and Nairobi. https://doi.org/10.1080/17441692.2025.2489713

Impact of age, HIV1, sickle-cell genotypes, and interferon-gamma gene upstream variants on malaria disease outcomes in a longitudinal pediatric cohort

2025-04-16T00:00:00Z

Impact of age, HIV1, sickle-cell genotypes, and interferon-gamma gene upstream variants on malaria disease outcomes in a longitudinal pediatric cohort Raballah, Evans; Anyona, B.Samuel; Osata, W.Shamim.et.al This prospective cohort study explored the association between two upstream IFN-γ variants (rs2069709: G>T and rs2069705: A>G) and hazard factors for malaria outcomes in a longitudinal cohort of children (n=941, 3–36 mos.), followed for three years. The impact of age, sex, previous malaria exposure, HIV1 infection, and sickle-cell genotypes (HbAA, HbAS, and HbSS) was also investigated. Reduced malaria episodes were associated with older age at enrollment [HR=0.957 (95% CI=0.953–0.961) per month, P<2.2e-16], HIV1 infection [0.687 (0.545–0.866), P=0.001], being female [0.910 (0.859–0.964), P=0.040], and HbAS [0.823 (0.754–0.898), P=0.005]. The GA/ TA diplotype [0.376 (0.230–0.614), P=0.002] also reduced the hazard of malaria, while TA haplotype increased susceptibility [1.749 (1.159–2.640), P=0.029]. Factors protecting against the development of SMA [Hemoglobin (Hb<6.0 g/dL)] included older age [0.927 (0.913–0.942) per month, P<2.2e-16], previous malaria episodes [0.576 (0.542–0.614, P=9.5e-32)], HbAS [0.553 (0.400-0.766), P=0.015]. The rs2069705AG genotype increased the hazard of SMA [1.697 (1.002–2.875), P=0.042]. Reduced hazard of mortality was observed for older children [0.898 (0.857–0.941), P<2.2e-16], while a higher hazard was present in HIV-infected children [12.475 (6.380-24.392), P<2.2e-16], and in those with HbSS [6.341 (1.944–20.686), P=0.007]. The GG haplotype increased the mortality hazard [1.817 (0.936– 3.527), P=0.078]. The results here highlight critical factors influencing the hazard of malaria, SMA, and mortality

Diagnostic accuracy of PfHRP2-based malaria rapid diagnostic tests and antigenemia persistence in Kenyan children from a holoendemic region: implications for case management and surveillance

2025-05-22T00:00:00Z

Diagnostic accuracy of PfHRP2-based malaria rapid diagnostic tests and antigenemia persistence in Kenyan children from a holoendemic region: implications for case management and surveillance Wasena, A. Sharley; Onyango, O.Clinton; Osata, W.Shamim.et.al Malaria remains a significant cause of childhood morbidity and mortality, with Plasmodium falciparum Histidine-Rich Protein 2 (PfHRP2)-based malaria rapid diagnostic tests (mRDTs) widely used in endemic regions where microscopy is sometimes not feasible. While these tests offer high sensitivity, persistent PfHRP2 antigenemia and gene deletions can cause false-positive and false-negative results, compromising their accuracy for malaria case management and surveillance. This study evaluated the diagnostic performance and antigen persistence of PfHRP2-mRDTs using data from a longitudinal birth cohort of 750 children followed monthly from birth to 36 months in a holoendemic region of Kenya. Malaria diagnosis was performed using both microscopy and mRDTs, with a total of 15,006 clinical events recorded from 573 children between 2017 and 2023. Data from an independent acute febrile cohort of 937 children (<5 years) followed for 14 days was analyzed to validate the findings. The mRDT showed a high sensitivity of 97.27% but a moderate specificity of 65.00% in acute febrile illness, indicating frequent false-positive results. The positive predictive value was low (35.10%), suggesting that confirmatory testing is needed, while the negative predictive value was high (98.89%), reinforcing the reliability of mRDTs in ruling out malaria. Persistent PfHRP2 antigenemia was observed, with a median antigen clearance time of 51.14 days, respectively. Higher initial parasite densities (>50,000/μL) were associated with a slower antigen decay rate (p = 0.001), highlighting the challenge of interpreting positive mRDT results after treatment. Validation using the acute febrile cohort showed that mRDT specificity exceeded 95% at initial diagnosis and follow-up. Overall, PfHRP2-based mRDTs remain valuable for frontline malaria diagnosis but are limited by antigen persistence, leading to false positives in follow-up testing. Where feasible, integration of confirmatory diagnostic methods, such as microscopy or molecular assays, could improve the performance of malaria case management and clinical decision making, particularly in high-transmission settings.

Distribution of nontuberculous Mycobacteria among presumptive drug resistance tuberculosis patients from a ministry of health drug resistance surveillance program, in western Kenya

2025-08-19T00:00:00Z

Distribution of nontuberculous Mycobacteria among presumptive drug resistance tuberculosis patients from a ministry of health drug resistance surveillance program, in western Kenya Okumu, Albert; Odeny, Lazarus; Ochieng, John Benjamin.et.al Nontuberculous Mycobacteria (NTM) species are emerging pathogens causing Pulmonary diseases with no definitive treatment. Molecular techniques enable characterization and drug resistance profiling, this study sought to determine NTM prevalence, circulating species, and distribution factors among presumptive multidrug-resistant tuberculosis (MDR-TB) patients in western Kenya.

Factors associated with tuberculosis drug resistance among presumptive multidrug resistance tuberculosis patients identified in a DRTB surveillance study in western Kenya

2024-12-01T00:00:00Z

Factors associated with tuberculosis drug resistance among presumptive multidrug resistance tuberculosis patients identified in a DRTB surveillance study in western Kenya Albert Okumu, James Orwa, Ruth Sitati, Isaiah Omondi, Ben Odhiambo, Jeremiah Ogoro, George Oballa, Benjamin Ochieng, Steve Wandiga, Collins Ouma Multidrug-resistant tuberculosis (MDR-TB) is caused by M. tuberculosis (Mtb) with resistance to the first-line anti-TB medicines isoniazid (INH) and rifampicin (RIF). In Western Kenya, there is reported low prevalence of drug resistant strains among HIV tuberculosis patients, creating a need to determine factors associated with drug resistance patterns among presumptive MDR-TB patients. To determine factors associated with drug resistance patterns among presumptive MDR-TB patients in western Kenya. Three hundred and ninety (3 9 0) sputum sample isolates from among presumptive multidrug TB patients, were analyzed for TB drug resistance as per Ministry of Health (MoH) TB program diagnostic algorithm. Frequency and percentages were used to summarize categorical data while median and interquartile range (IQR) were used for continuous data. Multivariable logistic regression was carried out to identify factors associated with TB drug resistance. Out of 390 participants enrolled, 302/390 (77.4 %) were males, with a median age of 34 years. The HIV-infected were 118/390 (30.3 %). Samples included 322 (82.6 %) from presumptive patients, while 68/390 (17.4 %) were either lost to follow-up patients, failures to first-line treatment or newly diagnosed cases. A total of 64/390 (16.4 %) of the isolates had at least some form of drug resistance. Out of 390, 14/390 (3.6 %) had MDR, 12 (3.1 %) were RIF mono-resistance, 34 (8.7 %) had INH, while 4 (1 %) had ethambutol resistance. The category of previously treated patients (those who received or are currently on TB treatment) had a 70 % reduced likelihood of resistance (aOR: 0.30; 95 % CI: 0.13–0.70). In contrast, older age was associated with an increased likelihood of resistance to INH and RIF, with an adjusted odds ratio of 1.04 per year (95 % CI: 1.00–1.08). Prompt MDR-TB diagnosis is essential for appropriate patient care, management, and disease prevention and control. We recommend active surveillance on drug resistant TB in these regions to detect drug resistance patterns for rapid disease management. https://www.sciencedirect.com/science/article/pii/S2405579424000536

Uro-pathogens: Prevalence of bacterial agents, and antimicrobial susceptibility profiles of urinary tract infections among pregnant women living with HIV in Kisumu County, Kenya

2025-01-01T00:00:00Z

Uro-pathogens: Prevalence of bacterial agents, and antimicrobial susceptibility profiles of urinary tract infections among pregnant women living with HIV in Kisumu County, Kenya KISUBA, K; GUYAH, B; AWUOR, S.O; OUMA, C During pregnancy, urinary Tract Infections (UTIs) are among the most common infections, particularly in women living with HIV worldwide, and can lead to poor perinatal and maternal outcomes. This study determined the prevalence of UTIs during pregnancy, associated risk factors, and antimicrobial susceptibility profiles of associated bacterial pathogens in pregnant women living with HIV attending a highvolume hospital in Kisumu County, Kenya. http://www.doi.org/10.52768/2766-7820/3421

Measuring the effect of antenatal family planning counseling on the intention for early postpartum family planning among postpartum mothers in Western Kenya

2025-01-30T00:00:00Z

Measuring the effect of antenatal family planning counseling on the intention for early postpartum family planning among postpartum mothers in Western Kenya SHISANYA, Morris; KIPMEREWO, Mary; MOREMA, Everlyne; OUMA, Collins Maternal and Child Health (MCH) care continuum provides a great opportunity for PPFP interventions integration especially antenatal FP counseling. This study measured the effect of antenatal FP counseling on the intention for early PPFP among postpartum mothers in Kisumu County. https://ejrh.org/index.php/ejrh/article/view/834/274

Assessing the application of adapted theory of planned behaviour in predicting postpartum family planning intentions in a pragmatic randomized control trial in Western Kenya

2025-02-05T00:00:00Z

Assessing the application of adapted theory of planned behaviour in predicting postpartum family planning intentions in a pragmatic randomized control trial in Western Kenya SHISANYA, Morris Senghor; KIPMEREWO, Mary; MOREMA, Everlyne; OUMA, Collins In developing countries like Kenya, addressing the high population growth rate necessitates a focus on early Postpartum Family Planning (PPFP) use. Despite the critical need for PPFP, few researchers explore the application of health behaviour change theories to enhance FP use among postpartum women. This study assesses the application of adapted Theory of Planned Behaviour (TPB) in predicting intention for early PPFP in postpartum women in Western Kenya. https://doi.org/10.1371/journal.pone.0315029