Anne Ngunjiri

Global inequities in the burden of antimicrobial resistance (AMR), between and within populations, are heavily influenced by the social and structural determinants of health. Yet, AMR action has had limited attention to equity, and social approaches to AMR haven’t routinely gone beyond an exploration of knowledge and awareness around ABU. This represents a missed opportunity to design equitable interventions and policy across One Health. We report the results of a critical interpretive synthesis of the social and structural drivers of AMR in Low- and Middle-Income Countries and present a conceptual framework of these drivers, linking to the Sustainable Development Goals (SDGs). We emphasise the limitations of a biomedical dominance in AMR research, highlighting the value of wider bodies of evidence for understanding the drivers of AMR to support equity and justice. We argue AMR interventions need action across the SDGs to target the root causes and address significant gaps in evidence.

Climate change is a global crisis that disproportionately affects vulnerable agrarian communities, exacerbating food insecurity and health risks. This qualitative study explored the relationship between climate change and health in the following two rural sub-counties of Kilifi County, Kenya: Ganze and Magarini. In fall 2023, we conducted 16 focus group discussions with adolescent girls (14–17), young adults (18–30), and older adults (31+). Thematic analysis revealed that climate change adversely affects health through key social determinants, including economic instability, environmental degradation, limited healthcare access, food insecurity, and disrupted education. Participants reported increased food scarcity, disease outbreaks, and reduced access to medical care due to droughts and floods. Economic hardship contributed to harmful survival strategies, including transactional sex and school dropout among adolescent girls. Mental health concerns, such as stress, substance use, and suicidal ideation, were prevalent. These findings highlight the wide-ranging health impacts of climate change in agrarian settings and the urgent need for comprehensive, community-informed interventions. Priorities should include improving nutrition, reproductive and mental health services, infectious disease prevention, and healthcare access.

In May 2020, Kenya declared Gender-Based Violence (GBV) a health emergency amid the COVID-19 pandemic. Domestic and intimate partner violence typically rises during crises, regardless of economic status (Spangaro et al., 2021). Before COVID-19, around 45% of women and girls in Kenya had experienced violence (Musembi et al., 2022). Although Kenya’s constitution has addressed GBV since 2010 and gender equity initiatives have been promoted, the pandemic exacerbated GBV, particularly in rural areas, due to lockdowns and movement restrictions. This study examines the lessons learned from Kenya’s COVID-19 response and proposes policies and processes that integrate ethical leadership to effectively combat GBV and advance gender equity. This exploratory phenomenology study involved conducting semi-structured interviews with pregnant women, mothers, policymakers and government representatives. The qualitative narratives reveal several critical issues and areas for improvement in addressing gender-based violence (GBV) and related challenges during the COVID-19 pandemic in Kenya. Both policymakers and pregnant women highlighted a lack of effective leadership, public policy and application of gender equity principles, with deeply ingrained patriarchal norms hindering progress. This study aims to improve responses to GBV during crises and promote gender equity through ethical leadership. By examining the impacts of COVID-19 on GBV and assessing the influence of intersectoral factors like employment, healthcare and financial aid, it seeks to provide actionable insights for effective interventions. The findings can inform strategies to prevent and address GBV in crises while ensuring inclusivity and justice. This aligns with international initiatives like the UN’s Sustainable Development Goals and the “Leave No One Behind” agenda, fostering more resilient and equitable communities.

Purpose: Before COVID-19, Kenya was among the countries in sub-Saharan Africa already dealing with high Gender-Based Violence (GBV) issues. Kenya had experienced prior convoluted emergencies and endemics, which had an inordinate impingement on women and girls that heightened their vulnerability to GBV. The Kenyan Ministry of Public Service and Gender reported that in 2020, there was an increase of 36% in GBV cases (Roy et al., 2021). COVID-19 had a devastating effect in rural communities, whereby women were most impacted. This study aims to understand the lessons learned from public leaders in implementing policies that could address GBV through better leadership approaches.Design/methodology/approach: This is an exploratory-qualitative study in which six participants comprised of policymakers or government representatives that were interviewed in semi-structured interviews.Findings: The qualitative narratives provided evidence that suggests a complex relationship between the COVID-19 lockdowns and movement restrictions policies and played a direct factor in the rise in GBV in vulnerable populations. The individual country policies and sectoral policies varied in how vulnerable women's needs were addressed, which led to diverse socioeconomic and health consequences.Originality/value: This research delineates the impacts of the failure of Kenyan leaders to implement gender focused COVID-19 policies and guidelines that considered the physical, mental, violence and the economic impact such emergencies have on women and girls in rural communities.

This protocol lays the groundwork for a community-centered investigation into the intersection between climate change and violence against women and girls. Providing a standardized framework, this paper will enable researchers to collect and analyze data on severe weather patterns and their potential impact on violence within communities. The interlinkage between violence and climate is an emerging field of research. There is a need for a comprehensive understanding of the intersection of these two issues focusing on the manifestations of violence, specific vulnerabilities, and coping strategies. This protocol outlines a qualitative research approach employed in Kilifi County, Kenya. The study will include key informant interviews with community leaders and policymakers, along with focus group discussions with women, adolescent girls, and men. Community engagement is a crucial component of this work as it will ensure that the research is conducted ethically and respectfully and ensure that the findings are relevant and applicable to the community being studied. This study will contribute to a deeper understanding of the complex dynamics between violence against women and girls and climate change, informing policies, interventions, and advocacy efforts and elevating the voices of women and girls to promote gender equity in the face of climate change challenges.

Severe weather events can be a catalyst for intimate partner violence, particularly in agricultural settings. This research explores the association between weather and violence in parts of East Africa that rely on subsistence farming. We used IPUMS-DHS data from Uganda in 2006, Zimbabwe in 2010, and Mozambique in 2011 for intimate partner violence frequency and EM-DAT data to identify weather events by region in the year of and year prior to IPUMS-DHS data collection. This work is grounded in a conceptual framework that illustrates the mechanisms through which violence increases. We used logistic regression to estimate the odds of reporting violence in regions with severe weather events. The odds of reporting violence were 25% greater in regions with severe weather compared to regions without in Uganda (OR = 1.25, 95% CI: 1.11–1.41), 38% greater in Zimbabwe (OR = 1.38, 95% CI: 1.13–1.70), and 91% greater in Mozambique (OR = 1.91, 95% CI: 1.64–2.23). Our results add to the growing body of evidence showing that extreme weather can increase women’s and girls’ vulnerability to violence. Moreover, this analysis demonstrates that climate justice and intimate partner violence must be addressed together.

Introduction: Technology advancements have enhanced artificial intelligence, leading to a user shift towards virtual assistants, but a human-centered approach is needed to assess for acceptability and effectiveness. The AGILE chatbot is designed in Kenya with features to redefine the response towards gender-based violence (GBV) among vulnerable populations, including adolescents, young women and men, and sexual and gender minorities, to offer accurate and reliable information among users. Methods: We conducted an exploratory qualitative study through focus group discussions (FGDs) targeting 150 participants sampled from vulnerable categories; adolescent girls and boys, young women, young men, and sexual and gender minorities. The FGDs included multiple inquiries to assess knowledge and prior interaction with intelligent conversational assistants to inform the user-centric development of a decision-supportive chatbot and a pilot of the chatbot prototype. Each focus group comprised 9–10 members, and the discussions lasted about two hours to gain qualitative user insights and experiences. We used thematic analysis and drew on grounded theory to analyze the data. Results: The analysis resulted in 14 salient themes composed of sexual violence, physical violence, emotional violence, intimate partner violence, female genital mutilation, sexual reproductive health, mental health, help-seeking behaviors/where to seek support, who to talk to, and what information they would like, features of the chatbot, access of chatbot, abuse and HIV, family and community conflicts, and information for self-care. Conclusion: Adopting a human-centered approach in designing an effective chatbot with as many human features as possible is crucial in increasing utilization, addressing the gaps presented by marginalized/vulnerable populations, and reducing the current GBV epidemic by moving prevention and response services closer to people in need.