East African Journal of Health and Science

The Psychological Burden of Cancer in Nairobi County, Kenya

Phillip Soita, Anne Omare — Tue, 17 Jun 2025 00:00:00 +0200

Cancer is a major public health concern globally, and Kenya is no exception(Deo et al., 2022). Incidence and mortality rates associated with cancer are steadily increasing worldwide (Sung et al., 2021). While significant attention has been directed toward physical and economic impacts, the psychological dimensions remain under-addressed, especially in low- and middle-income countries. This study explores the psychological burden experienced by cancer patients in Nairobi County, Kenya, examining the emotional, social, and mental health challenges, alongside coping mechanisms and the support systems available to them. The study's broad objective was: to assess the psychological burden among cancer patients in Nairobi County and explore coping mechanisms and barriers to psychosocial support whereas the specific objectives were: to determine the prevalence of anxiety and depression among cancer patients; To examine the coping mechanisms employed by cancer patients; To identify the barriers to accessing psychosocial support and to assess mental health service utilization in Nairobi’s cancer care facilities. Employing a mixed-methods approach, the study sampled 200 patients from leading cancer treatment facilities in Nairobi. Results reveal high levels of anxiety, depression, and stigma, compounded by limited access to psychosocial care. The findings highlight an urgent need for integrated mental health services and policy reform

Clinical Etiology and Histopathologic Correlation of Exfoliative Erythroderma at the Kenyatta National Hospital

Karen Waithera Wainaina, Priscilla Angwenyi, Beatrice Wangari Ndege — Wed, 25 Jun 2025 11:37:50 +0200

Background: Exfoliative erythroderma is a dermatologic emergency characterised by diffuse skin redness and scaling involving at least 70% body surface area. It is a clinical presentation that is usually indicative of an underlying primary process. Once a clinical diagnosis of exfoliative erythroderma is made, prompt supportive measures should be instituted while seeking to identify the underlying cause of this presentation. The correlation between clinical and histopathological diagnoses has not been determined for the Kenyan population. Purpose of the study: To assess the frequency of causes of exfoliative erythroderma and their histopathologic correlation at Kenyatta National Hospital. Methodology: This was an ambispective study conducted in Kenyatta National Hospital wards and clinics. All adult patients with exfoliative erythroderma who meet the study criteria will be included. A total sample size of 94 patients was included in the study. Descriptive analysis was done where demographic, clinical and histopathological factors were summarised using mean and standard deviation as well as median and interquartile range. A sensitivity analysis was performed to correlate clinical findings and histopathological findings. Results: The median age was 45 (interquartile range: 30 – 60 years, and 53% of them were male. Clinical causes of EE revealed that most of the patients with EE were due to psoriasis (38.3%), followed by malignancies (21.3%) and eczema (18.1%). Clinical findings revealed that the common causes of EE included dermatoses (57.45%), with psoriasis (24.2%) followed by eczema (18.1%). Malignancies (21.3%) were the second most common group and the commonest systemic disease, followed by drug reactions (12.7%). HIV was present in 7.5% of the cases. The findings showed that 63% (n =57) of the patients had a biopsy done, although the frequency was lower in the retrospective arm, 57% (n =42), compared to the prospective arm of the study, 88% (n =15). The findings from the histopathological findings revealed that 39.2% were malignancies, followed by psoriasis 25.5%) and immunobullous disease (17.7%). The sensitivity analysis revealed that immunobullous (100%) and malignancy (92.3%) had a high level of sensitivity as well as specificity, which was 97.7% and 92.6%, respectively, although eczema and psoriasis were least correlated with histopathological findings. Conclusion: Clinical findings were better correlated with malignancy and immunobullous findings with high sensitivity and specificity, although the other histopathology findings, such as psoriasis and eczema, were poorly correlated. Thus, there is a continued need to adopt a biopsy‐first protocol for all new presentations of EE to maximise diagnostic yield.

Prevalence and Factors Associated with Psoriatic Arthritis among Psoriasis Patients on Follow-up at the Dermatology and Rheumatology Units, Kenyatta National Hospital, Kenya

Jane Achungo, Pamela Njuguna, Paul Etau — Thu, 26 Jun 2025 12:24:46 +0200

Background: Psoriatic arthritis (PsA) is a serious and potentially debilitating condition that frequently occurs in individuals with psoriasis. The burden of PsA ranges between 6 – 42 percent globally and occurs in approximately 30% of patients with psoriasis. However, the burden of PsA has not been fully investigated within the local context. Purpose of the study: To determine the prevalence and factors associated with psoriatic arthritis among psoriasis patients on follow-up at the Dermatology and Rheumatology units, Kenyatta National Hospital. Methodology: This was a cross-sectional study conducted at Kenyatta National Hospital. A consecutive sampling technique was used to sample 80 patients diagnosed with psoriasis. A structured questionnaire was used to collect data. The CASPAR criteria were used to screen for PsA. The prevalence of PsA was obtained as a proportion of patients with PsA over the total sample size and expressed as a percentage. Bivariate and multivariable analyses were done to investigate factors associated with PsA using binary logistic regression. A STATA version 16 was used to analyse the data. Results: The Majority of the patients were male (65%), 47.5% were aged between 31 and 49 years, with the youngest being four years and the oldest being 75 years. Further, 52.5% had psoriasis for more than 48 months, and 33.8% had a family history of psoriasis. The average PASI score was 11.5 (SD=8.9). The common type of psoriasis was plaque (70%), and the common site of psoriasis included the extremities (78.8%). The prevalence of psoriasis arthritis was 23(28.8%) with a 95%CI: 19.4% to 40.2%. The common psoriatic arthritis subtypes included polyarticular arthritis (39.1%), spondylarthritis (26.1%), and oligoarticular arthritis (21.7%). The multivariable analysis revealed that significant factors associated with Psoriatic Arthritis include gender (females, aOR = 10.11, 95% CI: 1.12, 91.61, p = 0.040), history of smoking (aOR = 21.37, 95% CI: 2.45, 186.71, p = 0.006), nail involvement (aOR = 5.44, 95% CI: 2.69, 42.1, p = 0.006), onycholysis morphology (aOR = 11.39, 95% CI: 1.42, 91.50, p = 0.022), Oil drops (aOR = 12.11, 95% CI: 1.44, 34.12, p = 0.034), and the PASI score (aOR = 2.11, 95% CI: 1.34, 6.11, p < 0.001). Conclusion and recommendations: Psoriatic arthritis (PsA) burden is high, with polyarticular arthritis being the most common subtype. Female gender, smoking history, nail involvement, onycholysis morphology, Oil drops, and a higher PASI score are key contributors to the likelihood of developing PsA. Early monitoring for these factors is recommended.

Factors Affecting Utilisation of Partograph among Healthcare Workers in Bukoba District Council, Kagera Region, Tanzania

Mangi Job Ezekiel, Mercy Obadiah Kagaruki, Salim Juma Mpimbi, Idda Hubert Mosha — Mon, 30 Jun 2025 22:28:18 +0200

The World Health Organization (WHO) acknowledges that the effective use of partograph helps prevent maternal and neonatal deaths, identify abnormalities, and inform appropriate labour management. In Tanzania, the national Emergency Obstetric Neonatal Care (EmoNC) assessment has consistently reported low utilisation of partographs. However, little is known about the local factors hindering partograph use. Therefore, this study assessed factors affecting the utilisation of partographs among healthcare workers in Health facilities in Bukoba DC in the Kagera region. To address this, a quantitative descriptive cross-sectional design was adopted. The sample size for this study comprised 224 nurses and 79 clinicians recruited from Bukoba DC. Stratified random sampling was utilised to select study participants from the identified health facilities. Data were collected through structured questions, and data analysis was achieved through descriptive and multivariate analysis using the Statistical Package for Social Science (SPSS version 27). The study found that 80.8% of healthcare workers (HCW) used the partograph, while 19.2% did not. Its use was correlated with age and educational attainment. HCWs who were 27 years of age or older were 10% less likely than those under 26 to use the partograph (AOR = 0.904, CI 95% = 0.834-0.979, p = 0.013). Compared to those with less than two years of college education, HCWs with three years or more were 1.1 times more likely to do it (AOR = 1.141, CI 95% = 1.054-1.235, p = 0.001). HCWs who performed 6–10 deliveries in a 24-hour shift were also 9.6% less likely to use the partograph than those who performed 1–5 deliveries. Similarly, compared to those in the reproductive and child health (RCH) department, healthcare workers in the labour ward unit were 9.9% less likely to use the partograph (AOR = 0.901, CI 95% = 0.822-0.988, p = 0.027). The study shows that while most healthcare workers use partographs, there are gaps in knowledge and attitudes about their use, especially in reducing maternal and newborn deaths. To improve this, facilities should prioritise resources, implement continuous training, and ensure regular availability of partograph forms and monitoring equipment.

Quality of Life and Associated Factors among Patients Diagnosed with Pemphigus Vulgaris Attending Clinic at Kenyatta National Hospital

Leah Wangari Karanja, Roopkamal K. Saini, Beatrice Wangari Ndege — Tue, 01 Jul 2025 10:08:52 +0200

Background: Pemphigus vulgaris (PV) is a rare autoimmune disorder that affects the skin and mucous membranes. Prevalence of PV ranged from 0.38 to 30 per 100,000 people, with more than 50% of these patients having a low quality of life. The visible nature of PV lesions can lead to emotional distress, affecting self-esteem and body image. PV patients may face social isolation due to misunderstandings about the disease's contagiousness. However, the quality of life of these patients has not been exhaustively investigated. Purpose of the study: To determine the quality of life and associated factors among patients diagnosed with pemphigus vulgaris attending the dermatology clinic at Kenyatta National Hospital. Methodology: This was an analytical cross-sectional study utilising quantitative and qualitative approaches conducted at Kenyatta National Hospital. A consecutive sampling technique was used to sample 76 PV patients attending the dermatology clinic. The quality of life was assessed using the Dermatology Life Quality Index (DLQI). A structured questionnaire including these validated tools and patient-specific information such as demographic and clinical characteristics, depression level and quality of life. Descriptive analysis was done where the mean DLQI score was calculated and scores were characterised using the DLQI validated scoring, which was summarised using frequencies and percentages. Student t-test and ANOVA were conducted to investigate differences in DLQI scores based on patient characteristics and presenting symptoms. Significance was assessed at a p-value less than 0.05. Performed using Stata version 17. Thematic analysis was performed, where themes and subthemes were obtained. Conducted using Dedoose v7.1.1. Results: The average age was 47.9±14.2 years, and 69.7% were female. Clinical characteristics revealed that 48.7% had the disease for between 2 – 5 years, and 31.6% had a family history of autoimmune disorders. Common symptoms included blisters (65.8%) and itching (42.1%). Strong social support was seen in 52.6% of the patients. The mean DLQI score for the 76 patients in this study was 13.0 (Standard Deviation [SD] ± 7.7), indicating a medium to high impact of the disease on their quality of life. Further, 26.3%, 34.2% and 22.4% had medium impact, high impact, and very high impact. Female patients, inpatients, social support, duration of disease, current medication, family history, as well as presenting with itching, were associated with a higher impact on their quality of life. There was also limited knowledge of disease and treatment experiences, and emotional coping was a key identified theme. Conclusions and recommendations: There is a significant impact of PV on patients' quality of life, particularly among females, those on active medication, and those with a family history of autoimmune disorders. Itching exacerbates symptoms, and limited knowledge about PV's autoimmune nature is prevalent. There is a need for patient education on PV’s causes and management.

Prevalence of Depression and Associated Factors among Adult Patients Admitted to Medical and Surgical Wards at Bossaso Town Hospitals, Puntland, Somalia

Safia Mohamed Salaad, Asma Mohamed Hussein — Wed, 02 Jul 2025 00:00:00 +0200

Depression disorder presents with depressed mood, loss of interest or pleasure, decreased energy, feelings of guilt or low self-worth, disturbed sleep or appetite, poor concentration, problems with thinking and making decisions. Further, to the best of our knowledge, no study has been conducted to determine depression and associated factors among adult patients admitted to medical and surgical wards in the study area. Objective: To assess the prevalence of depression and associated factors among adult patients admitted to medical and surgical wards at Bossaso town hospitals, Puntland, Somalia. Method: A hospital-based cross-sectional study design was conducted among 416 patients admitted to medical and surgical wards from June 2022 to July 2022. Three hospitals were selected using simple random sampling. Sample frame: The study participants were selected by using a simple random sampling technique using hospital registration books. Depression was assessed Patient Health Questionnaire - 9 item. Data was coded and entered into EpiData version 3.1 software and exported to SPSS version 20 for analysis. Logistic regression model was used to identify independent predictors of depression, and a statistically significant result was determined at a p-value less than 0.05. Results: The prevalence of depression was found to be 20.9% (95% CI: 16., 24.0). In the multivariable logistic regression, female sex (AOR = 2.1, 95% CI: 1.14-4.0), duration of hospital stays 1-2 week (AOR = 2.7, 95% CI: 1.45-5.31), admission at surgical ward (AOR = 2.6, 95% CI: 1.48-4.56), previous history of mental illness (AOR=2.5,95% (1.41-4.75) and being cigarette smoking (AOR = 3.0,95% CI: 1.60-5.68) were factors significantly associated with depression. Conclusion: The prevalence of depression among admitted patients was high. Female sex, duration of hospital stays, admission to surgical ward, previous history of mental illness and being cigarette smoking were factors significantly associated with depression

Hygiene and Safety Measures Practised by Roadside Meat Vendors of Namawojjolo and Lukaya Food Markets, Uganda

Annet Nanfuka, Eunice Akello Mewa, Harold Anindo Rachuonyo — Fri, 04 Jul 2025 16:15:13 +0200

Handling and preparation of roadside roasted meats may often be compromised, considering the general conditions of the makeshift structures and the common minimal education levels of vendors. The study’s objectives were to assess hygiene and safety practices applied in handling, preparing, and vending of roadside roasted meats. Conducted in October 2024 at Namawojjolo and Lukaya, two major food markets along central Uganda's busiest highways, the research used an observational checklist and questionnaires to collect data from 90 meat vendors selling roasted beef, chicken, or goat meat on compliance with best known practices. Descriptive results on hygienic and handling practices were generated, and scores above 70% were used as a hallmark for best practice. Only 6.7% instituted complete sanitation and hygienic practices, while 88.9% did not store leftover meat in refrigerators. Among them, 67.8% kept meat in clean containers, 5.6% stored utensils on clean shelves, and 6.7% had clean roasting areas. Most (93.3%) separate raw meat from ready-to-eat meat, and 37.8% had stalls without rodents. Hygienically, 75.6% wore aprons while working, among whom 85.3% were considered clean aprons, 46.7% had hair covered, 91.1% had short and clean fingernails, 93.3% washed hands with soap, 1.1% covered food while presenting to customers, and 11.1% wore jewellery while working. Training on food safety was undertaken by 63.3% and 78.9% served food in paper bags. Personal hygiene practices of most vendors were fairly good, but most lacked sanitation facilities and demonstrated relatively low knowledge of best and acceptable practices in meat handling. There is a need for more sensitisation and provision of sanitation facilities to vendors to improve both the quality and safety of roadside vendor products

Evaluating the Antimicrobial Activity of Crude Extracts from Leaves, Flowers and Roots of Iris versicolor and Nerium oleander Plants Against Escherichia coli and Staphylococcus aureus

Tue, 08 Jul 2025 13:19:57 +0200

Bacterial infections are prevalent in most parts of Kenya and cause diseases like pneumonia, typhoid, cholera, and meningitis. This has contributed to unsustainable socio-economic development following the emergence of antimicrobial-resistant strains of bacteria and, hence, the need for alternative strategies that are effective against bacteria and environmentally safe. This study evaluated the antimicrobial activity of crude extracts from leaves, flowers and roots of Iris versicolor and Nerium oleander plants against Escherichia coli and Staphylococcus aureus. The plant parts were macerated and extracted to obtain phytochemicals that were then identified under different classes of compounds by treating them with varying reagents following standard laboratory procedures. To assess antimicrobial activity, discs were infused with an antimicrobial compound derived from the leaf, flower, and root extracts of N. oleander and I. versicolor at a concentration of 1000 µg/ml. Bacterial isolates (inoculum) were then introduced into plates containing Mueller-Hinton agar media. Infused discs were dispensed aseptically on the plates. The discs were pressed to ensure contact between the agar and the disc and incubated at 37 °C for 24 hrs. The Kirby-Bauer method was used to assess the antibacterial efficacy of the plant extracts against the bacterial strains Staphylococcus aureus and Escherichia coli. The crude plant extracts showed a greater zone of inhibition ranging from 2.5 mm to 3.2 mm in diameter, irrespective of the plant part and the test micro-organism. The methanolic crude extract of N. oleander leaves showed a greater zone of inhibition against Staphylococcus aureus at 3.1 mm and 2.9 mm against E. coli. The zone inhibited by the crude extract on S. aureus showed no growth of the micro-organisms; this was observed on all the crude extracts, irrespective of the extracting solvent, on both E. coli and S. aureus. The methanolic crude extract of N. oleander flowers showed a greater zone of inhibition against S. aureus at 2.9 mm. The hexane crude extract of I. versicolor leaves showed the least zone of inhibition against E. coli at 2.2 mm in diameter. This showed that the plant crude extracts exhibited much higher activity against S. aureus, followed by E. coli

Case Report on Right Pulmonary Embolism with Pulmonary Hypertension and Cor Pulmonale with a Differential Diagnosis of Pulmonary Tuberculosis

Nana Antwi-Boasiako Ansong, Maldwyn Ansah, Divine Amenuke — Tue, 08 Jul 2025 20:12:34 +0200

A pulmonary embolism is an acute emergency resulting from blood clots being released into the lung vasculature. In patients receiving medical care, the frequency of pulmonary embolisms (PE) ranges from 0.14% to 61.5%, and the death rate from PE is between 40% and 69.5% (2). Pulmonary embolism is most frequently caused by thrombi from deep veins, especially in the lower extremities. Additional factors that might lead to pulmonary embolism include air embolus, amniotic fluid embolus, fat embolus, which is typically connected to the fracture of big bones, and deep vein thrombosis of the upper limbs, pelvis, renal, and from the right. The disease normally affects the lungs and may lead to Cor pulmonale and pulmonary hypertension. This short case report presents a 43-year-old male with a chronic history of cough productive of bloody sputum, weight loss, and a recent history of syncope. History and clinical examination findings were suggestive of pulmonary tuberculosis complicated by pulmonary thromboembolism. Investigations done were suggestive of pulmonary embolism. Conclusion: An unusual presentation of tuberculosis and pulmonary embolism in a 43-year-old male in a tertiary hospital in Ghana

Assessment of Socio-Demographic and Economic Characteristics and Nutritional Status of Children in Navakholo Sub-County, Kakamega County, Kenya

Hazel Awuor Okech, Agatha Christine Onyango, PhD — Wed, 09 Jul 2025 21:49:23 +0200

Child undernutrition remains a major public health concern in Kenya, especially in rural areas where food production does not always lead to improved nutritional outcomes. Despite national and county-level progress, localised disparities persist, highlighting the need for sub-county-level evidence. This study assessed the nutritional status of children aged 12–60 months and examined the influence of socio-demographic and socio-economic factors on stunting, wasting, and underweight in Navakholo Sub-County, Kakamega County. A cross-sectional study was conducted among 384 agricultural households using structured questionnaires and anthropometric assessments, with nutritional status classified using WHO child growth standards. Bivariate and multivariate logistic regressions were used to assess associations. Stunting prevalence was 23.4%, underweight 4.9%, wasting 1%, and overweight 5.5%. Stunting was significantly associated with Protestant religion (AOR=5.697; CI=1.881–17.260), geographic location—children in Shinoyi-Shikomari-Esumeiya Ward had reduced odds (AOR=0.324; CI=0.130–0.806)—and household head education, with the highest risk among children whose household heads had no formal education (AOR=21.012; CI=1.180–374.085). Wasting was associated with household income between KES 7,000–9,000 (AOR=5.143; CI=1.345–19.667) and tertiary education of the household head (AOR=12.110; CI=1.001–146.568). Underweight was associated with caregiver age 42–49 years (AOR=0.080; CI=0.009–0.688), having two (AOR=4.345; CI=2.259–8.356) or three or more children under five (AOR=8.951; CI=2.504–31.996), and was least likely among children in Bunyala East (AOR=0.070; CI=0.016–0.305). Localised disparities in child nutrition in Navakholo Sub-County are driven by socio-demographic and economic factors, highlighting the need for targeted, context-specific interventions

Adverse Birth Outcomes in Kenya: Prevalence and Key Health-Related Predictive Factors- A Cross-Sectional Analysis of KDHS 2022 Data

Vincent Kiprono Mukthar, PhD, Lily Chepketer Ng’eno — Thu, 10 Jul 2025 12:07:45 +0200

Background: Adverse birth outcomes (ABOs) including low birth weight, stillbirths, and early neonatal deaths remain a major public health concern in Kenya, contributing significantly to maternal and child morbidity and mortality. This study aimed to assess the prevalence and health-related predictors of ABOs using data from the 2022 Kenya Demographic and Health Survey (KDHS). Methods: A cross-sectional analysis was conducted using data from 17476 women aged 15–49 who had given birth in the five years preceding the survey. Adverse Birth Outcomes were defined as any occurrence of low birth weight, stillbirth, or early neonatal death. Statistical analyses included descriptive, bivariate, and multivariable binary logistic regression using SPSS version 28, accounting for sampling weights and survey design. Adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were used to identify significant predictors. Results: The prevalence of Adverse Birth Outcomes was 11.1% which was contributed by 8% of preterm babies, 2.3% Low Birth Weight and 2.0% Neonatal Births. The key health-related factors that predict Adverse Birth Outcomes included number of ANC visits {with higher odds to those who scheduled ANC visits(≥8) (AOR = 2.947; 95% CI: 1.734–5.006), compared to women who had less than three visits}, timing of the first ANC visits {delaying the first ANC visit until after the first trimester resulted in lower odds of Adverse Birth Outcomes (ABOs) – AOR: 0.673; 95% CI: 0.412–0.729}, and parity/birth order{Multiparity exerted a protective effect among multiparous women showing decreased odds of adverse outcomes compared with primiparous women-AOR = 0.507; 95% CI: 0.461–0.559}. Conclusions: Adverse Birth Outcomes of over 10% of the population in Kenya remain a significant concern. Among the health-related factors that predict Adverse Birth Outcomes are the frequency of ANC visits (a paradoxical finding that demonstates that ANC visits frequency is significantly associated with higher ABOs), the timing of initiation of ANC visits and parity, which should be the focus of implementing targeted interventions to improve birth outcomes

Perceptions of Healthcare Providers on Quality of Services and Their Satisfaction During Implementation of Free Maternity Services Policy in a National Referral Hospital, Kenya

Christine Mwikali Musee, PhD, Judith Mutindi Mweu, Lydia Okutoyi — Thu, 10 Jul 2025 16:24:47 +0200

In Kenya, the Ministry of Health policies shape healthcare affordability and access. A free maternity policy was announced with executive directives for immediate implementation without considering hospital human resource capacities, processes and financial requirements. Subsequently, the study site experienced a 100% increase in hospital deliveries under constrained human resources, supplies, infrastructure and other resources. Thus, objectives assessed the perceptions of healthcare providers on the quality of services and their satisfaction during the implementation of the free maternity services policy in a national referral hospital, Kenya. Through a cross-sectional design, this survey purposively collected data from 50 doctors and nurses using questionnaires, with quantitative and qualitative aspects, and 20 Key informants, being managers and/or team leaders (till saturation was achieved). Quantitative data was analysed using Stata version 12 to yield frequencies and percentages, and qualitative data was thematically coded and analysed using NVivo version 15. Some opinions have been quoted directly. Findings obtained showed response rate of 50(100%); skills, personal preparedness, deployment, support-supervision (p value 0.05), workload, job satisfaction, capacity to cope with increased patients, availability of various resources, cleaning agents, cleanliness (p value 0.003), and quality of care were rated between excellent-poor. Key informants said, “…the workload is very high. We are doing our best and living one day at a time…access to healthcare has increased…it is not sustainable…with overstretched infrastructure, no supplies…mothers are sharing beds, confidentiality and privacy is remarkably reduced…litigations…complaints may increase...’In conclusion, there was a mismatch between the increased number of clients and the already existing strains in staffing, resources, and infrastructure. Although the majority of healthcare providers faced a myriad of challenges during this period, they identified the capacity to provide quality services and expressed satisfaction.

Timeliness and Appropriateness of Maternal Care and Its Influence on Perinatal Outcomes: A Community-Based Study in Kakamega County, Kenya

Catherine Mutonyi Simiyu — Thu, 17 Jul 2025 00:00:00 +0200

Background: Perinatal mortality remains a critical concern in Sub-Saharan Africa, with Kenya reporting rates above global targets. Lurambi and Butere sub-counties in Kakamega County exhibit perinatal mortality rates nearly double the national average, despite increased facility-based deliveries. Objectives: The study aimed to assess how the timeliness and appropriateness of maternal care influence perinatal outcomes in these high-burden settings. Methodology: A community-based cross-sectional design was employed. Quantitative data were collected from 520 mothers who delivered within the past two years using structured questionnaires, while qualitative data were gathered through key informant interviews with healthcare workers. Maternal care was assessed across the antenatal, intrapartum, and postnatal periods. Quantitative data were analysed using SPSS, and logistic regression was applied to identify predictors of perinatal mortality. Qualitative data from key informant interviews were manually analysed by coding responses into thematic categories. The resulting themes were organised and interpreted about the Three Delays Model, highlighting issues relevant to delays in receiving appropriate maternal and newborn care. Results: Revealed that while 78 percent of mothers attended four or more antenatal visits, only 39 percent received the full care package. Inadequate labour monitoring was significantly associated with perinatal death (AOR = 0.1; 95 percent CI: 0.04 to 0.43), as was lack of timely postnatal care (AOR = 51.2; 95 percent CI: 12.0 to 218.9). Newborns experiencing delayed or inappropriate facility care were nearly three times more likely to die (AOR = 0.3; 95 percent CI: 0.1 to 0.6). Systemic challenges included staff shortages, poor documentation, and weak referral mechanisms. Conclusions: The Third delay contributes to perinatal death. The quality and responsiveness of antenatal care are more critical than mere attendance. Intrapartum care showed poor labour monitoring, increasing the risk of adverse events. Delays in postnatal checkups and inadequate management of newborn complications raised the risk of death. Recommendations: Strengthen the quality and responsiveness of antenatal services, enhance intrapartum care and timely postnatal checkups and improve management of newborn complications, specifically during referrals

Diversity, Patterns of Distribution, and Bayesian Projected Trends of the Ecological Impact of Invasive Alien Plant Species in the Mount Cameroon Region

Mon, 21 Jul 2025 11:36:02 +0200

Invasive alien plant species (IAS) are a major threat to biodiversity, ecosystem function, and sustainable land use, especially in tropical hotspots like the Mount Cameroon region. Despite its ecological significance, comprehensive data on the diversity, distribution, and projected impacts of IAS in this region have been lacking. This study systematically inventoried IAS, analysed their spatial and habitat distributions, assessed their effects on native plant communities, and modelled future expansion trends. Between September 2019 and November 2021, a field survey was conducted across 120 permanent plots (1,000 m² each) in four representative sites—Buea, Bakingili, Limbe, and Idenau-covering roadsides, farmlands, and forests. Species identification, cover estimation, and habitat characterisation followed standardised protocols. Diversity indices (Shannon-Wiener, evenness, richness, Sørensen similarity) were calculated for invaded and uninvaded plots. GIS mapping and Bayesian hierarchical modeling were employed to assess spatial patterns, environmental drivers, and project IAS expansion from 2020 to 2030. A total of 25 IAS from 16 families and 24 genera were identified, with Asteraceae and Poaceae being most salient. Annual herbs constituted 70% of the IAS flora. Species richness and evenness were highest in Buea (H’=2.57, S=17, E=0.91) and lowest in Bakingili. Roadsides and farmlands exhibited significantly higher IAS abundance than forests (p=0.036). Bayesian projections indicated a progressive expansion of IAS, with Chromolaena odorata, Tithonia diversifolia, and Eleusine indica expected to be the most aggressive invaders, and the cumulative IAS-occupied area projected to exceed 75,000 m² by 2030. Invaded sites showed marked declines in native species diversity and evenness. These findings highlight the urgent need for targeted, site-specific management interventions, particularly along roadsides and for rapidly expanding species. Integrating field inventories, GIS, and Bayesian modeling provides robust insights for prioritising eradication and control strategies to mitigate the ecological and economic impacts of IAS in the Mount Cameroon region.

Preparedness and Nurse-Associated Factors of Forensic Nursing Care among Nurses at Kenyatta National Hospital’s Accident and Emergency Department

Christopher M. Obuya, Sherry Oluchina, PhD, Elijah G. Mwangi, PhD — Thu, 24 Jul 2025 00:00:00 +0200

The approach to the fight against violence, a global menace with both health and legal consequences, is multipronged. The discipline of nursing can effectively contribute through forensic nursing. This sub-speciality focuses on bridging the gap between legal and health systems for potential forensic patients. Establishing the level of preparedness of nurses to provide forensic nursing care and identifying nurse-related factors, particularly in Accident and Emergency (A&E) departments, in the face of high incidences of violence in our neighbourhoods should be prioritised. The A&E department, as the port of entry for victims/survivors of violence at Kenyatta National Hospital (KNH), was purposely selected for the study. A convergent mixed-method research design was employed for the study, whereby a sample of (n=81) respondents selected by a consecutive sampling technique completed filling a modified Knowledge Questionnaire over Forensic Nursing Practice (KQFNP), over eight weeks for quantitative data. Key informant interviews were conducted and data were captured manually among seven (n=7) purposely selected sections in charge of collecting complementary qualitative data. The Chi-square test of significance p<.05 was used in hypothesis testing, while logistic regression analysis was used to predict determinants of preparedness, with findings presented using tables and figures. Qualitative data were transcribed, thematically analysed, and presented in verbatim and narrations. A majority (81.5%, n=66) of study respondents had a low level of preparedness to provide forensic nursing care, a finding reinforced by key informants (KI-1)… “Assessment and identification of forensic patients are limited to sexual assault clients. Our focus is basically on clinical care.” The years of experience post-licensure (Fisher exact value= 9.838; p value= 0.006), training in forensic evidence collection and preservation (Fisher exact value= 9.933; p value= 0.002), and training in expert witnessing in the courts of law (Fisher exact value= 6.488; p value= 0.019) were statistically significantly associated with preparedness. Those trained in evidence collection and preservation, and expert witnessing were 6.8 times and 16.3 times more likely to be prepared compared to untrained (COR= 6.750; 95% CI =2.018-22.582; P=0.002) and (COR= 16.250; 95% CI =1.557-169.618; P=0.020) respectively. The majority of nurses in the A&E department at KNH have low levels of preparedness to provide forensic nursing care. The years of experience post licensure, training in forensic evidence collection, and expert witnessing were statistically significantly associated with preparedness. Develop and implement targeted in-service educational initiatives to address gaps in formal training in forensic nursing. Tailor training interventions leveraging on identified demographic factors.

Forecasting Years Lived in Poor Health in Kenya: A Comparative Analysis of ARIMA and LSTM Models with Implications for East African Health Policy

Andrew Karani, Ren Dongxiao — Thu, 31 Jul 2025 16:55:04 +0200

Kenya's life expectancy increased from 55.5 to 64.7 years (1990-2024), but years lived in poor health (GAP) have not declined proportionally, creating substantial public health planning challenges. Evidence-based forecasting of GAP trends is essential for health system resource allocation, yet no systematic forecasting methodologies exist for East African health systems. This study compared ARIMA and LSTM forecasting models for predicting Kenya's GAP trends and established methodological frameworks for health system planning across East Africa. Comparative time series analysis was conducted using Global Burden of Disease Study 2021 data spanning 1990-2021 for Kenya, Uganda, and Tanzania health systems, with 32 annual observations for each country. ARIMA and LSTM models were developed and validated using identical specifications, with performance evaluated using RMSE, MAE, and Diebold-Mariano statistical tests for significance. ARIMA significantly outperformed LSTM in Kenya (RMSE: 5.67 vs 6.66, p<0.001), reflecting stable health system patterns suitable for systematic planning, while LSTM demonstrated superior performance in Uganda (RMSE: 8.47 vs 15.03) and Tanzania (RMSE: 7.30 vs 10.10), indicating more complex health dynamics requiring sophisticated modelling approaches. Kenya's predictable GAP patterns enable reliable ARIMA-based forecasting for health system planning, while regional variations necessitate context-specific methodological approaches across East African health systems. This study provides the first systematic GAP forecasting framework for East Africa, offering health policy makers evidence-based tools for resource allocation while establishing methodological foundations for public health planning that can strengthen health systems across the region

Last mile delivery of COVID-19 vaccination to populations aged 15 years and above in Nyeri County, Kenya, March 2021-June 2022

Wed, 06 Aug 2025 18:30:13 +0200

Background: The COVID-19 pandemic in 2019 wreaked havoc on global economies and nearly paralysed health systems in some areas. Though mortality was moderate in African countries, the pangs of the disease were felt through the disruption of economic activities. Experimenting for vaccines started by December 2019 and Pfizer and AstraZeneca vaccines were authorised for emergency use in the same month. Mass immunisation campaigns started immediately. Kenya received its first vaccine consignment, AstraZeneca, on March 6, 2021 and commenced the rollout campaigns. This paper aims to highlight strategies and interventions towards the successful implementation of COVID-19 vaccination in Nyeri County. Interventions: Nyeri established the COVID-19 Vaccine Deployment Committee (CVDC), mandated to provide technical leadership, planning and strategising on the implementation process. The vaccination roll-out strategies that were adopted included capacity building of healthcare workers and establishment of COVID-19 vaccination static sites, among others. There is a paucity of data in the county on how strategic interventions affected vaccination coverage, as a campaign of such magnitude has not been carried out previously. Additionally, there was a lot of system downtime in the initial phases of the vaccination exercise, leading to manual registration, which could have led to a loss of data. Nyeri county population is varied; some sub-counties have a good road network connectivity, which could contribute to better access to vaccination. Results: Nyeri County had a total of 791,910 persons and had targeted to vaccinate 510,023 persons aged 15 years and above, from March 2021 to June 2022. 67.7% (95% CI: 67.55% - 67.81%) of persons were given the first dose of Covid 19 vaccine, while 40.3% (95% CI: 40.2% - 40.4%) of persons were given at least two doses of the COVID-19 vaccine. Increase in vaccination static sites from 5 to 17 resulted in an upward trend in vaccine uptake between March 2021 and June 2022, where 27,263 people received the first dose. Outreaches conducted brought an additional 55,071 individuals to be vaccinated. Supplemental Immunisation Activities contributed to 85,149 persons on the COVID-19 vaccine first dose. More females, at 55.20% (95% CI: 55.04%, 55.37%), accepted the vaccine than males at 44.80% (95% CI: 44.63% - 44.96%). Persons above 50 years returned for the second dose in comparison to ages below 40 years. Lessons learnt: Aggressive roll-out campaigns, involving stakeholders at the onset of vaccine roll-out and targeted demand creation, placed the country at the forefront in the last-mile vaccine delivery. Conclusion and implications: More than two-thirds of the adult population in Nyeri County received at least 1 dose of the COVID-19 vaccine during that period. Documentation of best practices will help policymakers implement strategies that will deliver vaccines to the last mile. Counties struggling with low coverage can use some of the best practices to improve the uptake of vaccines.

A Case Study Paper on the Prevalence and Impact of Childhood Trauma with Violence

Obiajurum Anthonia Odili — Thu, 14 Aug 2025 20:04:47 +0200

Maria Johnson is a 40-year-old, Biracial African American and Caucasian social worker who was referred by her primary care provider (PCP) with a complaint of heightened anxiety as well as persistent nightmares. As her ability to function at work and maintain friendships has decreased. Ms. Johnson lived with her husband of 20 years up until 8 months ago, at which time he abruptly ended their relationship to immediately entered a new relationship a couple of months later. They have a 20-year-old daughter together who is currently living independently as a college student, who Ms. Johnson believes has been greatly affected by their separation. She states that the feeling of her daughter losing a two-parent household has caused her an alarming amount of stress, fear, and anxiety. She has been feeling unusually fatigued, accompanied by difficulty focusing. She has repeatedly sought out reassurance from her mother and sister, but found that she could not be consoled by them as she worried about being “too much of a burden.” A few months prior to this session, Ms. Johnson began to avoid leaving the house. She had a fear that she would get kidnapped. Initially, she refused to go to the grocery store because the area she recently moved to had three recent kidnappings of a child and 2 women. She then began to get her groceries delivered, but refused to have contact with the delivery person. That soon progressed to her only working from home and not going in the field to see clients, which led to a demotion. Ms. Johnson added, “This is getting out of control, I honestly feel like something bad is going to happen to me”. She then added, “The only time my mind is at ease is when I am at home or with my daughter.” Ms. Johnson has a history of childhood trauma, including domestic violence and parental substance abuse. As a teenager, she experienced domestic violence and parental substance abuse, which added to her trauma history. Over the years, she has managed to suppress those early childhood memories for years, but began experiencing symptoms after she moved into her new home post-separation, triggering memories of her past experiences. Ms. Johnson goes on to express how she always struggled with her biracial identity, as she was often caught between two different cultures. This led to her not feeling accepted by either culture. Her experiences of cultural expectations and racism have contributed to her feelings of isolation and trauma. At her initial session, Ms. Johnson said she was “extremely anxious and got easily startled”, which started after her husband left. She reported feeling worthless, guilty, hopeless, and having constant thoughts about death. She lost 15 pounds and was fatigued from poor sleep patterns.

An Analysis of Geospatial Patterns and Diarrhoeal Prevalence in Children Under Five: A Case Study of Matungulu and Mavoko Sub-Counties, Kenya

Winfred Mbinya Manetu, Kennedy Nyabuti Ondimu, Amon Mwangi Karanja — Thu, 14 Aug 2025 20:05:03 +0200

Despite ongoing advancements in prevention efforts, diarrhoea remains a critical public health challenge, particularly threatening the health of infants and young children. The rising prevalence of childhood diarrhoea, especially in developing nations, has emerged as a pressing concern within public health discourse. This study examined both the prevalence and spatial distribution of diarrhoea-related illness among children under the age of five, with the goal of enhancing the monitoring and implementation of effective intervention programs. Data were collected from 398 mothers or caregivers of children under five years through a structured survey. The prevalence rate was determined by dividing the number of reported diarrhoea cases by the total number of children in the sampled households. To analyse spatial distribution patterns, the study employed spatial statistical techniques, including Moran’s I and Getis-Ord Gi*. Findings indicated a high two-week prevalence rate of childhood diarrhoea, affecting 34% of children under five in Mavoko and Matungulu Sub-Counties. Mavoko reported a higher rate at 37%, compared to 27% in Matungulu. Hotspot analysis using Moran’s I and Getis-Ord Gi* identified the western parts of Mavoko, specifically Athi River, Mlolongo, and sections of Katani and Kinanie, as areas with significantly high diarrhoea prevalence. These spatial insights highlight the need for geographically targeted interventions. The study recommends prioritising high-prevalence hotspots through improved access to safe water, expansion of sewerage systems, enhanced waste management, and strengthened hygiene promotion programs. Such targeted measures, combined with sustained surveillance and community engagement, could significantly reduce disease burden and improve child health outcomes within and beyond the study area

The Role of Nutrition Therapy in Recovery from Severe Burns: A Case Report from Muhimbili National Hospital, Mloganzila

Tue, 19 Aug 2025 18:45:41 +0200

Background: Severe burn injuries are associated with profound hypermetabolic and catabolic responses that significantly increase nutritional requirements. Effective nutritional management is crucial for promoting wound healing, minimising complications, and improving recovery outcomes, especially in resource-limited settings. Purpose: This case report aims to highlight the practical and individualised nutritional strategies used to manage a patient with extensive burn injuries in a low-resource ICU setting. Methods: A 30-year-old male was admitted to Muhimbili National Hospital–Mloganzila following a motor traffic accident, sustaining deep second-degree burns over 53% of his total body surface area (TBSA), including the trunk, back, forearms, lower limbs, and buttocks. Upon admission, he presented with fluid imbalance, hypoalbuminemia, and functional feeding limitations. Nutritional needs were calculated using the Curreri formula, and a tailored nutrition care plan was developed. Fluid resuscitation followed the Parkland formula. Meals were provided from both hospital and home sources, supplemented with high-protein oral feeds, zinc (15 mg), and vitamin C (500 mg). Caregiver involvement and nursing support were integrated into the feeding process. Key Results: The individualised nutrition plan, supported by interdisciplinary collaboration and caregiver education, contributed to achieving target nutritional intake and clinical improvements. The patient showed gradual recovery with stabilised albumin levels, improved wound healing, and reduced complications. Conclusion: In resource-limited settings, effective burn nutrition therapy is feasible using locally available foods, targeted supplementation, and multidisciplinary coordination. Early assessment, tailored interventions, caregiver engagement, and regular monitoring are critical to successful burn recovery outcomes

Mapping Health Research Capacity Building Initiatives in Kenya: A Scoping Review

Wed, 20 Aug 2025 13:46:09 +0200

Health research capacity building (HRCB) is fundamental to the development of resilient health systems, the production of locally relevant evidence, and the advancement of evidence-based policy in low- and middle-income countries such as Kenya. Despite notable progress, Kenya’s HRCB landscape remains fragmented, donor-dependent, and heavily concentrated in urban academic institutions, with limited national coordination or systematic evaluation. This scoping review aimed to comprehensively map HRCB initiatives implemented in Kenya between 2010 and 2025, identifying key thematic areas, geographical coverage, and institutional actors. The review followed the Arksey and O’Malley methodological framework, augmented by the Joanna Briggs Institute (JBI) guidelines and the PRISMA 2020 checklist. Eligibility criteria were defined using the Population–Concept–Context (PCC) framework, focusing on individuals, institutions, and programs engaged in research training, mentorship, infrastructure development, policy engagement, and collaboration within the Kenyan context. A total of 110 records were identified through systematic searches of peer-reviewed databases (PubMed, Google Scholar, ResearchGate) and grey literature sources, including reports from government agencies, academic institutions, and development partners. After screening and full-text review, 31 studies were included in the final synthesis. Data were charted using thematic matrices and analysed narratively. Five key themes emerged: training and mentorship, institutional strengthening, research networks and collaborations, research-to-policy linkages, and equity considerations, including regional and gender disparities. While programs such as CARTA, Afya Bora, and KEMRI-led initiatives demonstrated impact, challenges included inadequate rural reach, persistent gender imbalances, limited sustainability, and weak national ownership. Findings reveal a lack of standardised monitoring indicators and minimal integration of HRCB into broader health and education systems. This review underscores the urgent need for a coordinated national HRCB framework that promotes inclusivity, local leadership, and long-term sustainability. Such efforts are essential to optimise Kenya’s research ecosystem, bridge capacity gaps, and align research development with national health priorities and global goals.