Leila Hussein Abdullahi

Background: Policies promote patient-centred tuberculosis (TB) care in Kenya, a high-burden TB country, but implementation remains limited. This study sought to understand the experiences of TB healthcare workers in implementing patient-centred TB services in primary health facilities in Nairobi and explore how the challenges they face can be addressed. Methods: Using collaborative research design, we recruited healthcare workers (n=29) from primary health facilities across three densely populated subcounties in Nairobi and TB stakeholders (n=24) including policymakers and managers. From March to April 2024, we collected data through three workshops with nurses (n=19) and clinical officers/doctors (n=10) and a joint workshop with stakeholders. Participants engaged in group discussions and participatory visual methods to define person-centred care, document practices, identify challenges and develop solutions. Our data analysis applied a framework approach drawing on the social–ecological, TB care cascade and health systems building blocks models. Results: Healthcare workers identified practices for differentiated TB care across age groups, genders, occupations and comorbidities. Implementation faced multiple challenges including structural, health system, community and patient’s individual constraints. Shortages of funding, workforce and capacity affected close-to-community TB screening (Theme 1). Insufficient testing capacity at lower-level facilities led to diagnostic delays (Theme 2). Inflexible clinic hours and medication stockouts requiring frequent facility visits undermined TB treatment and adherence among working populations (Theme 3). Weak collaboration and referral systems limited support for people facing homelessness, substance use or poverty. Healthcare workers proposed enhanced TB training, increased TB workforce, flexible medication delivery, integrated TB services and strengthened intersectoral collaboration with education, labour and social protection sectors (Theme 4). Conclusions: Healthcare workers demonstrate willingness and capacity to deliver patient-centred TB care but require strengthened health systems, ongoing training and sustainable intersectoral partnerships. Scaling up identified practices and innovative tools while addressing systemic barriers could improve TB care delivery and outcomes for underserved populations.

Introduction: persons with disabilities are among the most marginalised groups in Somali society. This paper provides evidence-based information on the prevalence, characteristics of disability, and barriers to disability-inclusive social protection services in Somalia. Methods: the paper is based on a secondary re-examination of data from the Somalia Integrated Household Budget Survey (2022) of 7,212 households. Results: disability prevalence in Somalia was estimated at 16.2% with the most common being physical impairment, affecting 9.8% of the population. The at-risk groups were the elderly population and children. Regionally, disability prevalence was highest in Banadir state: 21.5%. Enrollment rates in social protection schemes were relatively low: 15% of surveyed households. Access to disability-specific services and specialists was generally limited across all disability types, with vision screening being the most accessed service and learning screening being the least accessed service. Access to assistive devices is also very low, with only 4% of people with disabilities who need them receiving them. Access to social protection delivery systems, such as phone, internet, and bank accounts, was also low <20% for each service. Conclusion: the study reveals a high prevalence of disability and low access to social protection and disability-specific services in Somalia, especially among women, rural residents, older people, and those affected by conflict. The study indicates a need for comprehensive disability data collection that reflects the diverse needs and barriers to reinforcing disability-inclusive policy frameworks faced by persons with disabilities in Somalia.

Introduction: Water, sanitation and hygiene (WASH) interventions have been associated with positive outcomes among school-going children. With the protracted water and conflict crises in the Horn of Africa, multiple interventions have been implemented to ensure adequate WASH facilities in basic education institutions. However, research mapping out this evidence is lacking. This scoping review aimed to map out the enablers, barriers and lessons learnt from implementing interventions promoting sustainable WASH in basic education institutions in conflict-affected contexts of the Horn of Africa. Methods: We searched PubMed African Index Medicus, Cochrane Library and Google Scholar from 2015 to 2024. Two independent reviewers conducted screening and data extraction in duplicate. Results were presented descriptively. Results: Our search yielded 3003 articles. This review included eight studies all on mixed-sex students in Ethiopian primary schools between 2015 and 2024. Seven studies were quasi-experimental. Most reported enablers, whereas only one reported sustainability. None reported lessons learnt. Half of the studies reported health outcomes, such as diarrhoea, and only one reported school attendance outcomes. Five studies employed WASH education interventions, such as WASH curricula development in two studies. Three studies reported improved WASH facilities, such as toilets. Six studies reported enablers such as a prior needs assessment and including both sexes in menstrual hygiene. Three studies reported barriers such as poor WASH support facilities (latrines and handwashing) for menstrual hygiene. One study reported training government officials, health champions and school administrators as a method of ensuring sustainability. Conclusions: Published research on this topic is limited in the Horn of Africa, calling for further research. Institutionalising WASH curricula in schools could positively affect students’ outcomes. Successful WASH interventions call for prior needs assessments, incorporating both sexes and improving support facilities for menstrual hygiene interventions and training diverse stakeholders in the education system to ensure sustainability.

Climate change threatens health and social development gains in Kenya, necessitating health policy planning for risk reduction and mitigation. To understand the state of knowledge on climate-related health impacts in Kenya, a scoping review of 25 years of environmental health research was conducted. In compliance with a pre-registered protocol, nine bibliographic databases and grey literature sources were searched for articles published from 2000 to 2024. Of 19,234 articles screened, 816 full texts were reviewed in duplicate, and a final 348 articles underwent data extraction for topic categorisation, trend analysis, and narrative summary. Most of the studies (97%, n = 336) were journal articles, with 64% published after 2014 (n = 224). The health topics centred on vector-borne diseases (45%, n = 165), primarily vector abundance (n = 111) and malaria (n = 67), while mental health (n = 12) and heat exposure (n = 9) studies were less frequent. The research was geographically concentrated on the Lake Victoria Basin, Rift Valley, and Coastal regions, with fewer studies from the northern arid and semi-arid regions. The findings show a shift from a focus on infectious diseases towards broader non-communicable outcomes, as well as regional disparities in research coverage. This review highlights the development of baseline associations between environmental exposures and health outcomes in Kenya, providing a necessary foundation for evidence-informed climate change and health policy. However, challenges in data and study designs limit some of the evidentiary value.

Climate change threatens health and social development gains in Kenya, necessitating health policy planning for risk reduction and mitigation. To understand the baseline state of knowledge of environmental determinants of health in Kenya relevant to climate change, a comprehensive scoping review was undertaken. Compliant with a pre-registered protocol, nine bibliographic databases and grey literature sources were searched for articles published from 2000-2023. Two-stage screening was conducted on 17,394 articles; 635 full-texts were screened in duplicate. A final 353 articles underwent data extraction for topic categorisation, bibliometric analysis, and narrative summary. This was comprised of 344 (97%) journal articles, 59% of which were published after 2014 (n=207). Main study designs included observational (n=211) and modelling studies (n=64). Health topics centred on vector-borne diseases (41%, n=147), primarily vector abundance (n=102) and malaria (n=60), while injury or death (n=10), mental health conditions (n=7) and heat exposure (n=7) studies were less frequent. Environmental health research in Kenya is largely conducted in the Lake Victoria Basin, Rift Valley and Coastal regions, with fewer studies from the northern arid and semi-arid regions. Findings of this review suggest a growing and diverse field of predominantly observational research with an increasing focus on social determinants and policy-relevant themes, however research on vector-borne disease dwarfs other health outcomes and sparsely populated but climatically fragile regions are less represented in published literature. Addressing existing gaps in baseline evidence underpinning associations between the environment and health outcomes will benefit climate change attribution research and support future development of evidence-informed climate change and health policy in Kenya.

Background Tuberculosis (TB) remains a public health concern in Kenya despite the massive global efforts towards ending TB. The impediments to TB prevention and care efforts include poor health systems, resource limitations and other sociopolitical contexts that inform policy and implementation. Notably, TB cases are much higher in men than women. Therefore, the political economy analysis (PEA) study provides in-depth contexts and understanding of the gender gaps to access and successful treatment for TB infection. Design PEA adopts a qualitative, in-depth approach through key informant interviews (KII) and documentary analysis. Setting and participants The KIIs were distributed among government entities, academia, non-state actors and community TB groups from Kenya. Results The themes identified were mapped onto the applied PEA analysis framework domains. The contextual and institutional issues included gender concerns related to the disconnect between TB policies and gender inclusion aspects, such as low prioritisation for TB programmes, limited use of evidence to inform decisions and poor health system structures. The broad barriers influencing the social contexts for TB programmes were social stigma and cultural norms such as traditional interventions that negatively impact health-seeking behaviours. The themes around the economic situation were poverty and unemployment, food insecurity and malnutrition. The political context centred around the systemic and governance gaps in the health system from the national and devolved health functions. Conclusion Broad contextual factors identified from the PEA widen the disparity in targeted gender efforts toward men. Following the development of effective TB policies and strategies, it is essential to have well-planned gendered responsive interventions with a clear implementation plan and monitoring system to enhance access to TB prevention and care.

The Evidence Informed Decision Making (EIDM) field has evolved faster in the past decade. This progress shows a need for capacity enhancement amongst evidence producers and evidence users in EIDM training. Through the Enhance DELTAS programme, led by the African Institute for Development Policy (AFIDEP), the project provided research uptake and policy engagement training, mentorship and webinars to awardees of the Developing Excellence in Leadership, Training and Science (DELTAS) Africa initiative, led by the African Academy of Sciences (AAS). Two workshops were offered to individual early career DELTAS researchers in policy engagement and evidence uptake, referred to as ENHD101, and among research leaders to enhance institutional capacity on policy engagement and evidence uptake, (ENHD102). Overall, the programme attracted 31 early career researchers and 20 research leaders over the eight months of training, mentorship and webinars. Following the programme, the early career researchers understood the importance of EIDM for better health policies and programmes. In addition, the team appreciated the complexities of the policymaking processes as they developed the policy engagement strategy for their research. The implementation of the EIDM knowledge was reflected during the mentorship of research fellows with policy briefs as the end product. Notably, research leaders, appreciated their role in strengthening the capacity for EIDM in decision-making spaces. Although none of the research leaders participated in strengthening the capacity for EIDM during the programme, the team anticipated improving in the long run. In addition, the research leaders developed and implemented institutional strategies for policy engagement and research uptake through the use of social media to influence policymakers. In conclusion, the project supported the capacity building of African researchers in EIDM. It was evident that enhancing knowledge and skills on EIDM through an integrated approach to include training, mentorship, and webinars demonstrated enhanced capacity for policy engagement and evidence uptake.

Background Tuberculosis (TB) remains a public health concern despite the massive global efforts towards ending TB. Kenya is among the high burdened countries globally with the TB prevention and care efforts hampered by poor health systems, resource limitations and other socio-political contexts that inform policy and implementation. Notably, TB cases are much higher in men than women, and therefore, the political economy analysis study provides in-depth contexts and understanding of the gender gaps to access and successful treatment for TB infection. Methods The Political Economy Analysis (PEA) adopted a qualitative in-depth approach that targeted 16 Key Informant Interviews (KIIs). The Key Informant Interviews (KIIs) were distributed among government entities, academia, non-state actors, and community TB groups. Results The themes identified were mapped onto the applied PEA analysis framework domains. The contextual and institutional issues included gender concerns related to the disconnect between TB policies and gender inclusion aspects, such as low prioritization for TB programs, limited use of evidence to inform decisions and poor health system structures. The broad barriers influencing the social contexts for TB programs were social stigma and cultural norms such as traditional interventions that negatively impact health-seeking behaviors. The themes around the economic situation were poverty and unemployment, food insecurity, and malnutrition. The political context centered around the systemic and governance gaps in the health system from the national and devolved health functions. Conclusion Overall, broad contextual factors identified from the political economy analysis widens the disparity in targeted gender efforts toward men. Following the development of effective TB policies and strategies, it is important to have well-planned gendered responsive interventions with a clear implementation plan and monitoring system to enhance access to TB prevention and care. Strength and limitations The study provides insights into the political, economic, and social contexts influencing TB prevention and care efforts. Additionally, to the best of our knowledge, this will be the first PEA to evaluate the TB program from a gendered perspective. As a limitation, the study is missing the voices and lived experiences of men leaving with TB as this was not part of the study scope. As such, we do not have their perspectives as they may better articulate some barriers faced with access and uptake of TB prevention and management programs.

Objectives Developing countries face the greatest cervical cancer disease burden and mortality with suboptimal immunisation uptake. This review explores the communication strategies adopted, successes, challenges and lessons learnt in sub-Saharan countries to enhance human papillomavirus (HPV) immunisation. Design Systematic review and meta-analysis. Data sources PubMed, Hinari, Cochrane Library, Trip database, CINAHL, Web of Science, Scopus and seven grey resources were searched through May 2022. Eligibility criteria We included observational studies addressing communication strategies for HPV immunisation uptake. Data extraction and synthesis Two independent reviewers used standardised methods to search, screen and code included studies. Data extraction and assessment of risk of bias were done in duplicate to enhance validity of the results. Meta-analysis was conducted using the random-effects model. Findings were summarised and synthesised qualitatively. Results Communication intervention to facilitate decision-making achieved uptake rate of 100% (95% CI 0.99% to 1.00%), followed by intervention to enable communication, which achieved 92% (95% CI 0.92% to 0.92%). Communication intervention to inform and educate achieved 90% (95% CI 0.90% to 0.90%). Targeting both healthcare workers and community leaders with the communication intervention achieved 95% (95% CI 0.91% to 0.98%), while teachers and school boards achieved 92% (95% CI 0.84% to 1.01%). Targeting policymakers achieved 86% (95% CI 0.78% to 0.93%). Based on the method of communication intervention delivery, use of training achieved an uptake rate of 85% (95% CI 0.84% to 0.87%); similarly, drama and dance achieved 85% (95% CI 0.84% to 0.86%). However, use of information, education and communication materials achieved 82% (95% CI 0.78% to 0.87%). Conclusion HPV vaccine communication is critical in ensuring that the community understands the importance of vaccination. The most effective communication strategies included those which educate the population about the HPV vaccine, facilitate decision-making on vaccine uptake and community ownership of the vaccination process immunisation. PROSPERO registration number CRD42021243683.

Background: High-risk human papillomavirus (HR-HPV) is the primary cause of cervical cancer, leading to over 311 000 global deaths, mainly in low- and middle-income countries. Kenyan women living with HIV (WLHIV) face a disproportionate burden of HR-HPV.Objectives: We determined the prevalence of HR-HPV infections and their association with cervical cytology findings among Kenyan WLHIV.Method: We conducted a cross-sectional study among WLHIV attending the HIV care and treatment clinic at the Kenyatta National Hospital (KNH), Kenya’s national referral hospital. Study nurses collected a cervical sample with a cytobrush for HR-HPV genotyping using Gene Xpert® assays and HPV Genotypes 14 Real-TM Quant V67-100FRT. Bivariate analysis explored the associations.Results: We enrolled 647 WLHIV (mean age of 42.8 years), with 97.2% on antiretroviral therapy (ART) and 79% with a suppressed viral load ( 50 copies/mL plasma). The prevalence of any and vaccine-preventable HR-HPV was 34.6% and 29.4%, respectively, with HPV 52 being the most common genotype (13.4%). Among WLHIV with HR-HPV infections, 21.4% had abnormal cervical cytology. Women with multiple HR-HPV infections were more likely to have abnormal cytology compared to those with single HR-HPV infections (34.9 vs 9.3%, adjusted odds ratio [aOR] = 6.2, 95% confidence interval [CI]: 2.7–14.1, P = 0.001). Women with HR-HPV infection (single or multiple) were more likely to be on the second-line ART regimen compared to those without HR-HPV infections (53.1% vs 46.7%, aOR = 2.3, 95% CI: 1.3–4.1, P = 0.005).Conclusion: Among WLHIV at KNH, abnormal cytology was common and more frequent among women with multiple HR-HPV infections.