East African Journal of Health and Science

The Hills and The Valleys: A Synthesis of CSA’s counter-opposition strategies to Comprehensive Sexuality Education Content and Delivery in Kenya

Ndayala Phoebe Didi — 2025-10-11

The implementation of Sexual and Reproductive Health and Rights (SRHR) and Comprehensive Sexuality Education (CSE) in Kenya faces persistent opposition, particularly from conservative and faith-based communities, presenting significant challenges to CSE program acceptance and delivery. This paper examines the perception of resistance to the adoption of CSE in Kenya. It further analyses the strategies employed to address these challenges. Among these strategies are engaging religious leaders, promoting culturally sensitive content, and rebranding CSE as 'Reproductive Health Education which offers lessons for future advocacy. We present a comprehensive analysis of the CSE opposition landscape and engagement strategies through a systematic review of three Centre for the Study of Adolescence (CSA) assessment reports carried out between 2023 and 2024. The research specifically examines the economic, cultural, religious, political, and educational barriers to CSE, while assessing the effectiveness of various strategies and engagement approaches to countering opposition to CSE in Kenya. Through rigorous systemic review of CSA's programmatic experiences, the study identifies critical patterns in opposition manifestation, particularly around content appropriateness, age-specific considerations, and cultural-religious compatibility. The findings reveal a complex interplay between stakeholder concerns and successful intervention strategies. The research highlights CSA's successful integration of digital media platforms, use of youth champions, and youth-led advocacy initiatives, which have proven particularly effective in enhancing SRHR discussions among young people. The evidence-based recommendations include regular community awareness to address misconceptions, engagement of religious leaders and conservative groups to reduce opposition. Strengthening monitoring and evaluation of opposition management efforts, enhancing cross-sectoral collaboration, and building sustainable community support mechanisms for CSE programs.

Unpacking Resistance: Contentions, Criticisms, and Consensus-Building in Kenya’s CSE Landscape

Ndayala Phoebe Didi, PhD — 2025-10-11

Comprehensive Sexuality Education (CSE) remains a contested aspect of sexual and reproductive health policy in Kenya. Despite policy development, full-scale implementation has faced persistent barriers, largely due to resistance from faith-based leaders, government officials, and parliamentary caucuses who cite moral, cultural, and parental concerns. This systematic review and stakeholder analysis, with particular reference to the CSA (2024) report From Great Divides to Building Common Ground for CSE, explores the contentious issues shaping CSE discourse. Findings highlight cultural resistance, political hesitation, misinformation, and opposition from conservative movements as major barriers to implementation. Additional challenges include stigma, disputes over age-appropriateness, teacher discomfort, and fragmented responses to adolescent reproductive health needs. Respondents emphasised the urgent need for comprehensive, age-appropriate, inclusive, and culturally sensitive CSE to address adolescent pregnancies and poor SRHR outcomes. The study concludes that repositioning CSE as a rights-based public health intervention requires sustained values-driven advocacy, continuous stakeholder engagement, and evidence-based communication strategies to counter misinformation. Strengthened coordination among civil society organisations and alignment of CSE with community norms are essential for advancing inclusive, context-sensitive SRHR programming and contributing to Kenya’s broader commitments to adolescent health and gender equity

Comprehensive Sexuality Education, Sexual and Reproductive Health and Rights,

Advocacy, Opposition,

Anti-rights

Sub-Granting for Localisation: Aligning Donor Priorities with Local Leadership in Kenya-Lessons from the Centre for the Study of Adolescence

Christine Wambui Njuguna, PhD — 2025-10-11

This study examines the implementation of Locally Led Development (LLD) principles by the Centre for the Study of Adolescence (CSA) in Kenya, with a specific focus on sub-grant management practices and their implications for sustainability and operational efficiency within non-profit ecosystems. Using a qualitative research design, the case study draws on document reviews, key informant interviews, and focus group discussions with CSA staff and Sub-Implementing Partners (SIPs) and donors. Findings highlight the central role of resource diversification, particularly through community-led funding approaches, financial accountability, underpinned by real-time monitoring systems and finance, subaward and transparency fostering protocols, in ensuring effective and transparent grant management. Strategic capacity strengthening of SIPs, CSA’s emphasis on adaptive management demonstrated through proper understanding of the SIPs, facilitated through organisational capacity assessments, regular follow-ups, contingency planning, and flexible budgeting, were established as key enablers. Key challenges identified include the unpreparedness of SIPs for the complexity of compliance requirements, rigidity among some SIPs to change, heavy technical support needed by smaller SIPs, adverse effects of currency fluctuations on budget predictability, and significant administrative demands on both CSA and SIPs. The CSA experience offers lessons for organisations seeking to institutionalise LLD principles in development programming across similar contexts. To strengthen locally led sub-grant management, the study recommends a multi-pronged approach: investment in structured, needs-based capacity strengthening for SIPs; enhanced financial accountability through digital systems; institutionalisation of adaptive management practices that promote responsiveness; a graduated compliance framework; adoption of strategies to promote local resource mobilisation; increased donor flexibility and establishment of a learning agenda across the Sub-granting cycle. Further, support mechanisms to address organisational rigidity, improved budgeting and monitoring tools to track progress, and streamlined administrative processes to minimise operational burdens are imperative.

The Silent Impact of Pandemic: COVID-19 and Adolescent-Youth Reproductive Health in Acholi Sub-Region in Uganda

Agatha Alidri — 2025-10-20

From a gender perspective, this study investigated the consequences of COVID-19 on adolescent and youth reproductive health in Acholi Sub-region, Northern Uganda. The study aimed to: i) analyse the impact of the COVID-19 lockdown on adolescent and youth reproductive health and gender relations, ii) explore treatment-seeking behaviours among adolescents and youth, iii) equip health workers with skills to address reproductive health challenges, and iv) enhance their capacity to conduct gender-sensitive research during crises. A qualitative approach and longitudinal design was used, employing one-on-one interviews, community engagement sessions, radio talk shows, and observations. The study involved participants from Gulu Regional Referral Hospital, Reproductive Health Uganda, outreach programs, and urban neighbourhoods, including adolescents, youth, health workers, and key informants. It was conducted across Gulu City, Gulu District, Obongi District, and Adjumani District, encompassing 34 schools, the Northern Uganda Youth Development Centre, Gulu Juvenile Prison, and Gulu University. Findings indicated a significant increase in gender-specific challenges, including a rise in teenage pregnancies, unwanted pregnancies, early marriages, and cross-generational sexual relationships. Male adolescents faced psychological stress due to unemployment and the inability to fulfil societal expectations, while female adolescents disproportionately experienced reproductive health risks. The study concludes that the COVID-19 pandemic severely impacted Ugandan youth's reproductive health, with adolescent females experiencing more disempowerment and risky behaviours. The study recommends implementation of targeted and gender-sensitive interventions, strengthening collaboration among health workers, adolescents, youth groups and community leaders, promotion of mental health empowerment programs, as well as continued strengthening of health system responsiveness to youth needs.

Antibiotic Resistance Profile of Pathogenic Bacteria Isolated from Raw Cow’s Milk within Bureti Sub-County, Kericho, Kenya

Faith Soi — 2025-10-29

Milk is an important source of nutrients to human beings and animals, but due to its high-water activity and nutritional value, it serves as an excellent medium for the growth of many kinds of microorganisms. Continuous application of antibiotics in dairy farming leads to antibiotic residues, which may find their way into the human body through the food chain. Antibiotic resistance is a global public health challenge threatening the ability to treat common infections using available antibiotics. This study focused on determining the microbial load, isolation, and characterisation of pathogenic microorganisms in milk and assessing their antimicrobial resistance profiles. A total of 384 raw cow’s milk samples collected from milk vendors in Bureti sub-County, Kericho, were analysed. Total bacterial load was determined using Plate Count Agar. Bacteria were isolated using selective media and characterised using morphological and biochemical methods. The total bacterial load was found to range from 2.109 x 10⁵ to 2.912 x10⁵ cfu/ml. The microorganisms isolated were E. coli, S. aureus, Klebsiella spp, Salmonella spp., Enterobacter spp, yeast cells, and Proteus spp. The highest resistance against tetracycline at 83.9%, kanamycin at 71.42%, streptomycin at 76.47%, and Sulphamethoxazole-Trimethoprim at 70% was shown by Salmonella spp, S. aureus, E. coli, and Klebsiella Spp. Based on the above findings, it is evident that the milk sold to the public has been contaminated by milk pathogens, which could have emanated from the farm or during milk transportation to the market. It is also evident that all the bacterial pathogens isolated in this study were resistant to streptomycin, which could be a result of the regular use of the antibiotics in the dairy sector. Therefore, there is a need to upscale hygienic conditions in the dairy sector to avert the frequent use of antibiotics that lead to the emergence of antibiotic-resistant strains.

Leadership Communication and Healthcare Employee Performance During Crises: A PLS-SEM Study of Level-Four Hospitals in Kenya

Eileen Atieno Rasowo — 2025-11-06

The outbreak of the COVID-19 pandemic has focused interest on the critical role that leadership can play during times of crisis. Although the subject of healthcare employees’ performance in crisis has received much scholarly probing, the potential contribution of leadership communication towards circumventing the daunting challenges experienced during such times has not been sufficiently documented. Therefore, this study evaluated the role of leadership communication on employee performance during times of crises, deploying a Partial Least Squares Structural Equation Modelling (PLS-SEM) framework. It was anchored on the transformational leadership theory proposed by Bass. The study targeted 1193 healthcare employees working in level-four hospitals in Kenya. From this population, a sample of 248 healthcare employees was calculated using the Taro Yamane formula. Stratified sampling was then used to select specific employees representing various sections of each hospital, including heads of section, nursing, dental, laboratory, public health, health records, clinical officers, medical officers, and physiotherapy. The findings showed that level-four hospitals emphasised leadership communication, effects of engagement clarity, and authenticity during the COVID-19 pandemic, allowing employees to offer satisfactory healthcare performance. The PLS-SEM results affirmed that authenticity (b=0.261, p<0.05) and clarity (b=0.312, p<0.05), as leadership communication facets, were significant predictors of healthcare employee work performance during crises. The study concludes that leadership communication can be leveraged to improve healthcare employee work performance during crises. Therefore, healthcare stakeholders should enhance leadership communication mechanisms in level-four hospitals to strengthen healthcare employee performance during crises.

Predictors of Metabolic Disorders among Adolescents Aged 13-17 Years ln Lang’ata Sub-County, Nairobi, Kenya

Leela Sunil Mahajan — 2025-11-10

Background: There has been a documented surge in the prevalence of metabolic disorders, notably obesity, in Kenya, especially in urban areas, constituting a severe epidemiological health problem. This study aimed to determine the predictors of metabolic disorders among adolescents aged 13-17 years in Lang’ata Sub-County, Nairobi County, Kenya, since diabetes and hypertension are the ones of concern in the school health program. Methods: A cross-sectional survey design was employed. A total of 216 adolescents aged 13–17 years enrolled in 5-day schools were randomly selected. Data were collected using a questionnaire and analysed using SPSS software Version 28. Socio-demographic variables were analysed using univariate descriptive statistics, while categorical variables were analysed using inferential statistics and logistic regression. The study was underpinned by the Socioecological Model, which considers individual, interpersonal, organisational, and environmental influences on adolescent health behaviours related to metabolic outcomes. Results: The prevalence of metabolic disorders was 13%. Multivariate regression analysis revealed the following protective factors: attending public schools (AOR 0.60, 95% CI 0.38–0.91), participating in sporting activities in school AOR 0.60 (95% CI 0.42–0.85); P<0.001and those who took part in home-based activities AOR 0.20 (95% CI 0.08–0.49); P<0.001. Protective factors against adolescent depression as AOR <1. Significant risk factors included being female (AOR 3.50, 95% CI 2.10–5.80, P<0.001) and having a family history of lifestyle disorders (AOR 2.10, 95% CI 1.30–3.40, P<0.001). Conclusions: The study demonstrated that females had a higher prevalence of metabolic disorders (obesity and pre-hypertension) than males. Key determinants included the type of school attended, previous lifestyle disease diagnosis, and family history of lifestyle disorders. Addressing these factors through awareness and targeted interventions is crucial for managing metabolic disorders among adolescents.

Nutritional Strategies to Optimise the Probiotic Antimicrobial Efficacy of Lactobacillus acidophilus NCFM against Enteric Pathogens: Comparative Analysis between Natural Bee Honey and Mineralised Sugars

Vitalis Barasa Namiti — 2025-11-13

The human gastrointestinal tract is home to a complex and dynamic community of microorganisms that collectively influence health, nutrition, and disease. Pathogens have evolved mechanisms to exploit host resources more aggressively, often at the expense of both the host and beneficial microbes, whereas probiotic organisms rely on mutualistic interactions with the host and are generally restricted to dietary and endogenous substrates present in the gut. Pathogens frequently adopt invasive and parasitic strategies, directly extracting nutrients from host tissues. Within this ecosystem, probiotic bacteria play critical roles in maintaining gut homeostasis, enhancing immune defences, inhibiting pathogens, and supporting digestive processes. However, their efficacy is variable and often dependent on nutrient availability. Optimising nutritional support may enhance probiotic growth and antimicrobial activity. This study highlights the critical role of nutritional strategies in optimising the antimicrobial efficacy of Lactobacillus acidophilus NCFM against enteric pathogens. The comparative evaluation between mineralised sugar (sugar + mineral supplementation) and honey as nutritional strategies for Lactobacillus acidophilus NCFM highlights important metabolic and ecological considerations in optimising probiotic antimicrobial efficacy. The central difference lies in how these substrates interact with the Embden–Meyerhof–Parnas (EMP) glycolytic pathway and in their subsequent ability to drive lactic acid accumulation, bacteriocin synthesis, and pathogen inhibition. The findings confirm the inherent superiority of honey, but also give a crucial nuance that glucose with sufficient minerals will likely be the only possible substitute that can match the performance of honey. This evidence points to the fact that honey has an exceptionally high probiotic stimulation potency, and no other sugar other than mineralised-glucose (glucose+minerals) can equal this potency. Honey outperformed other sugars because it served as a source of energy to the metabolism of L. acidophilus and as an independent antimicrobial agent.

Influence of Financial Rewards on Job Retention among Critical Care Nurses in Selected Public and Private Hospitals in Kenya

Joanne Jeptoo Laboso — 2025-11-13

Critical care nursing is a pivotal element in the provision of healthcare services. The presence of proficient critical care nurses is fundamental to achieving optimal patient outcomes. Nevertheless, most public and private hospitals in Kenya often face difficulties retaining qualified critical care nurses. These challenges have been attributed to many factors, chief among them being poor financial compensation. Therefore, this study assessed the influence of financial rewards on nurse retention in selected public and private hospitals in Kenya. The study focused on two prominent healthcare facilities: Tenwek Hospital, a private level six hospital in Bomet County, and Moi Teaching and Referral Hospital (MTRH) in Uasin Gishu County. It adopted a descriptive survey research design. The target population comprised 149 critical care nurses from the two hospitals. A census sampling approach was utilised due to the relatively small population size of 149 critical care nurses. The data for the study was collected using a structured questionnaire, whose response rate was 89.3% (133 questionnaires). Descriptive statistics, including frequencies, percentages and mean scores, were generated on the collected data using SPSS Version 28. Inferential statistics were used to examine the relationship between financial compensation and retention of critical care nurses. From the findings, financial rewards demonstrated a strong positive correlation with job retention (r = 0.920, p < 0.01), highlighting that adequate compensation plays a crucial role in influencing a nurse’s decision to remain in their current role. Therefore, financial incentives such as competitive salaries and bonuses significantly motivated nurses to stay. Based on these conclusions, the study recommends that hospitals review and improve their compensation packages, incorporating regular salary reviews and performance-based incentives to boost retention.

Demographic and Clinical Risk Factors Contributing to Prolonged Mechanical Ventilation in ICU Patients at Tenwek Hospital

Mourine Achieng Ooro — 2025-11-14

Prolonged mechanical ventilation (PMV) remains a significant clinical challenge in intensive care units (ICUs). Approximately 30% of ventilated patients require PMV with attendant risk for higher morbidity, mortality, and healthcare expenditure. In spite of progress in critical care, little is known about the predictors and outcomes of PMV in low-resource settings. This study investigated the prevalence, demographic and clinical risk factors, and outcomes of prolonged mechanical ventilation in ICU patients at Tenwek Hospital. A retrospective cohort design was employed, reviewing medical records of adult ICU patients (≥18 years) who received invasive mechanical ventilation for more than seven consecutive days between January and December 2024. Patients were included if they had complete clinical documentation, ventilator parameters, and outcome data; those receiving only non-invasive ventilation or with missing critical records were excluded. Descriptive statistics and inferential analysis were used to analyse data. All associations were tested at p < 0.05. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were reported, with model stability ensured by maintaining a minimum of 10 events per predictor variable. Among 173 mechanically ventilated adults, 72.3% experienced prolonged mechanical ventilation. Multivariable logistic regression pinpointed acute respiratory distress syndrome (ARDS; adjusted OR = 5.25, 95% CI: 2.35-11.75) and chronic obstructive pulmonary disease (COPD; adjusted OR = 5.28, 95% CI: 2.38-11.73) as the strong predictors, followed by pneumonia (adjusted OR = 1.82, 95% CI: 0.80-4.14) and sepsis (adjusted OR = 1.56, 95% CI: 0.69-3.52). Daily sedation vacation reduced the odds of PMV by 81% (adjusted OR = 0.19, 95% CI: 0.08–0.46), while early mobility protocols diminished them by 37% (adjusted OR = 0.63, 95% CI: 0.28-1.42). These findings underscore the high burden of prolonged ventilation and recommend that simple, low-cost interventions such as structured sedation breaks and early mobilisation may significantly reduce the duration of ventilation and improve outcomes.

Exposure to Social-Media HIV Testing Messages and HIV Self-Testing Among Young University Adults in Dar es Salaam, Tanzania: A Cross-Sectional Study

Peter Abraham Kabelege — 2025-11-14

Digital platforms have become an important tool for promoting public health interventions, including HIV prevention behaviours. In Tanzania, since 2022, the Ministry of Health, together with other stakeholders, has been promoting HIV self-testing (HIVST) messages under the “JIPIME” campaign, a Kiswahili term meaning “test yourself,” across various social media platforms to increase awareness and uptake among young people. However, little is known about the level of exposure to these messages among young adults and whether such exposure influences HIVST uptake. Therefore, this study assessed exposure to HIV testing content on social media and examined its association with HIVST uptake among university students aged 18–24 years in Dar es Salaam. To address this, an analytical cross-sectional study was conducted among adults aged 18–24 years from Kampala International University in Tanzania (KIUT) and the Dar es Salaam Institute of Technology (DIT). A total sample of 365 students was recruited using multistage cluster sampling, comprising 193 from DIT and 172 from KIUT. Data were collected using self-administered questionnaires. Descriptive statistics, including means, standard deviations, and percentages, were computed, while chi-square tests and multivariable logistic regression were used to examine associations between exposure to HIV testing content and HIVST uptake (p < 0.05, 95% CI). The study found that 52% (n = 191) of participants reported encountering HIV testing-related content on social media, while 48% had not. The overall uptake of HIV self-testing was 21%. Among those who had self-tested, 80% had been exposed to HIV testing content on social media. In the adjusted analysis, exposure was significantly associated with higher odds of ever self-testing (AOR = 12.0, 95% CI: 2.41–24.52, p < 0.01). Limited knowledge of how to use HIVST kits emerged as the main barrier to uptake. The findings demonstrate that exposure to HIV testing content on social media substantially influences HIVST uptake among young adults. Expanding targeted digital outreach and addressing knowledge gaps on the correct use of HIVST kits are critical strategies for improving uptake and advancing HIV prevention efforts among youth in Tanzania.

Influence of Socio-Cognitive Factors on Intention to Emigrate among Nurses Working in Nakuru County, Kenya

Mercy Chepkemoi Koech — 2025-11-15

Nurse emigration is the process by which nurses move from their home country to another country in search of better job opportunities, higher salaries, improved working conditions, and international experience. In Kenya, nurse emigration is a growing challenge often attributed to deficits in Human Resource Standards. This high level of emigration imposes additional costs on the government and taxpayers due to repeated training cycles and disruptions in the delivery of quality healthcare services. Beyond HR-related factors, demographic, psychological, and psychosocial dimensions also play a critical role. Understanding these factors in conjunction with HR standards is essential for improving healthcare delivery and workforce stability. This study investigated nurses’ intention to migrate within the context of Nakuru County, Kenya. It involved a sample of 150 nurses employed across seventeen health facilities in the Nakuru West Sub-County. Guided by Social Cognitive theory, the study adopted a cross-sectional design to explore the effects of socio-cognitive factors on emigration intention. Results revealed that 80.7% (n=150) of nurses firmly intend to emigrate, with 74.7%(n=150) already enrolled in immigration processes. The United States was the most preferred destination, followed by the United Kingdom (18.7%, n=150), Australia (10.7%, n=150), and Canada (4.7%, n=150). Socio-cognitive factors significantly influenced emigration intention: motivation (β = 0.353, p < .05), attention (β = 0.346, p < .05), and self-efficacy (β = 0.348, p < .05). These variables explained a substantial portion of the variance in emigration intention, underscoring their predictive strength. These findings highlight the urgent need to address cognitive determinants of nurse emigration to reduce emigration intention.

Health-Seeking Behaviours among Healthcare Providers in Selected Public Health Facilities in Uasin Gishu County, Kenya

Felicity Kaptuya Bowen — 2025-11-17

Health-seeking behaviour is a growing concern worldwide. However, among healthcare providers (HCPs) in resource-limited settings, such as Kenya, poor health-seeking behaviours (HSB) exacerbate the risks for mortality, delayed care, and compromised patient safety. Despite alignment with Sustainable Development Goal 3 and Kenya's universal health coverage agenda emphasises preventive care, HCPs often prioritise patient needs over their own well-being. This study sought to explore HSB patterns among HCPs, identify socio-demographic factors, facilitators, and barriers influencing HSB, and examine associations between HSB and health perceptions in Uasin Gishu County, Kenya. A cross-sectional descriptive quantitative research design was employed. The study target population was 1483, comprising 1047 nurses, 206 doctors, and 230 clinical officers, drawn from across Levels 3–6 facilities. Guided by the Health Belief Model, data were collected through self-administered questionnaires using a multistage sampling approach (n = 322). Analysis used SPSS Version 28, with descriptive statistics, Chi-square tests, and multinomial regression. Ethical approval was obtained from the Institutional Scientific Ethics and Research Committee; informed consent was secured from all participants. Nearly half (48.47%) of HCPs exhibited good HSB (mean score=9.78), with 42.94% average and 8.59% poor; self-medication was common (55.73%). These scores were based on a structured HSB rating (from 0-30), where numbers approaching 0 meant poor HSB, those between 10-20 meant average, and those above 20 implied good HSB. Significant socio-demographic associations included age (χ² = 25.4, p < 0.001), marital status (p = 0.012), health insurance (OR = 4.76, 95% CI = 1.42–15.9, p = 0.011), and religion (p = 0.028). Positive health perceptions were strongly correlated with good HSB (χ² = 20.38, p = 0.0046), facilitated by flexible schedules (M = 2.31) and prompt services (M = 2.32), but hindered by limited preventive screenings (M = 1.93) and gaps in institutional support. These findings underscore the need for tailored interventions to bolster HCP well-being. Recommendations include comprehensive health insurance coverage, policies mandating regular check-ups, self-care education, and stigma-free access to foster resilient healthcare workforces and enhance care quality.

Prevalence of Anaemia Among Pregnant Adolescents in Kakamega County, Kenya

Apwacho Rosemary Muholo — 2025-11-18

Anaemia in pregnancy remains a major public health challenge, with pregnant adolescents at increased risk due to their dual nutritional needs. This study assessed the intake of iron and folic acid supplements (IFAS) and anaemia prevalence among pregnant adolescents in Kakamega County, Kenya. A descriptive cross-sectional study was conducted among 120 pregnant adolescents attending antenatal care at Malava County Hospital. Data were collected using pre-tested questionnaires and analysed using SPSS version 29.0. Results showed that 95.8% (n=115) of participants adhered to IFAS, while 4.2% (n=5) reported intake less than five days a week. Despite high adherence, anaemia prevalence remained notable, with 51% having normal haemoglobin levels, 44% mild anaemia, and 5% moderate anaemia. Education level, timing of first ANC visit, distance to health facilities, and nutrition counselling were significant determinants of adherence. The findings highlight the importance of strengthening adolescent-friendly antenatal services, improving access to supplements, and addressing barriers such as myths, side effects, and limited social support. Tailored interventions integrating community awareness, health worker training, and peer support may enhance IFAS adherence and reduce anaemia among pregnant adolescents