The effectiveness of community health worker training, equipping, and deployment in reducing COVID-19 infections and deaths in rural Western Kenya: A comparison of two counties.

COVID-19 and other pandemics remain significant threats to population health, particularly in rural settings where health systems are disproportionately weak. There is a lack of evidence on whether trained, equipped, and deployed community health workers (CHWs) can lead to significant reductions in COVID-19 infections and deaths. Our objective was to measure the effectiveness of deploying trained and equipped CHWs in reducing COVID-19 infections and deaths by comparing outcomes in two counties in rural Western Kenya, a setting with limited critical care capacity and limited access to COVID-19 vaccines and oral COVID-19 antivirals.

Challenges to the right to health in sub-Saharan Africa: reflections on inequities in access to dialysis for patients with end-stage kidney failure.

Realization of the individual's right to health in settings such as sub-Saharan Africa, where health care adequate resources are lacking, is challenging. This paper demonstrates this challenge by illustrating the example of dialysis, which is an expensive but life-saving treatment for people with kidney failure. Dialysis resources, if available in sub-Saharan Africa, are generally limited but in high demand, and clinicians at the bedside are faced with deciding who lives and who dies.

Effect of health systems strengthening in influencing maternal and neonatal health outcomes in Bungoma County, Kenya.

Introduction: maternal and neonatal health status indicators have steadily improved over time in Kenya. Significant challenges remain, including persistent inequities between population subgroups, and a health system that delivers variable quality care and inconsistent access to care. This paper highlights results of an ex-post evaluation to assess the impact of maternal and health systems strengthening intervention to improve newborn health outcomes in Bungoma County, Kenya, focusing on access to and quality of maternal and neonatal care.

Perspectives of stakeholders of the free maternity services for mothers in western Kenya: lessons for universal health coverage.

Background: The strategic aim of universal health coverage (UHC) is to ensure that everyone can use health services they need without risk of financial hardship. Linda Mama (Taking care of the mother) initiative focuses on the most vulnerable women, newborns and infants in offering free health services. Financial risk protection is one element in the package of measures that provides overall social protection, as well as protection against severe financial difficulties in the event of pregnancy, childbirth, neonatal and perinatal health care for mothers and their children.

The effectiveness and characteristics of mHealth interventions to increase adolescent's use of Sexual and Reproductive Health services in Sub-Saharan Africa: A systematic review.

Background: mHealth innovations have been proposed as an effective solution to improving adolescent access to and use of Sexual and Reproductive Health (SRH) services; particularly in regions with deeply entrenched traditional social norms. However, research demonstrating the effectiveness and theoretical basis of the interventions is lacking.

Aim: Our aim was to describe mHealth intervention components, assesses their effectiveness, acceptability, and cost in improving adolescent's uptake of SRH services in Sub-Saharan Africa (SSA).

Sexual and reproductive health knowledge and behaviour of adolescent boys and girls aged 10-19 years in western Kenya: evidence from a cross-sectional pilot survey.

This paper reports findings of a pilot survey of adolescent sexual and reproductive health (ASRH) knowledge and behaviour in Homabay County of western Kenya. The study was based on a cross-sectional survey of 523 male and female adolescents aged 10-19 years from 32 Community Health Units (CHUs). Bivariate analysis of gender differences and associations between ASRH knowledge and behaviour was followed with two-level logistic regression analysis of predictors of ASRH behaviour (sexual activity, unprotected sex, HIV testing), taking individual adolescents as level-1 and CHUs as level-2.

Evaluation of Implementation Level of Community Health Strategy and Its Influence on Uptake of Skilled Delivery in Lurambi Sub County-Kenya.

Background: Despite the widespread application of the community health strategy (CHS) in Kenya and evidence of its effectiveness in reducing health outcomes at the household level, data from Kakamega County, of which Lurambi sub-county is part of, still showed that skilled birth delivery was at 47% against the national estimateof 62% and a target of 90%. However, there was limited evidence on the level of CHS implementation and its association with the uptake of skilled delivery.

Methods: The study employed a cross-sectional analytic design.

Under vaccination of children among Maasai nomadic pastoralists in Kenya: is the issue geographic mobility, social demographics or missed opportunities?

Background: Nomadic lifestyle has been shown to be a significant factor in low immunization coverage. However, other factors which might aggravate vaccination uptake in nomadic pastoralists are poorly understood. Our study aimed at establishing the relative influence of social demographics, missed opportunities, and geographical mobility on severe under vaccination in children aged less than two years living in a nomadic pastoralist community of Kenya.

Contextual variations in costs for a community health strategy implemented in rural, peri-urban and nomadic sites in Kenya.

Background: Many low and middle income countries have developed community health strategies involving lay health workers, to complement and strengthen public health services. This study explores variations in costing parameters pertinent to deployment of community health volunteers across different contexts outlining considerations for costing program scale-up.

Methods: The study used quasi experimental study design and employed both quantitative and qualitative methods to explore community health unit implementation activities and costs and compare costs across purposively selected sites that differed socially, economically and ecologically.

The impact of leadership hubs on the uptake of evidence-informed nursing practices and workplace policies for HIV care: a quasi-experimental study in Jamaica, Kenya, Uganda and South Africa.

Background: The enormous impact of HIV on communities and health services in Sub-Saharan Africa and the Caribbean has especially affected nurses, who comprise the largest proportion of the health workforce in low- and middle-income countries (LMICs). Strengthening action-based leadership for and by nurses is a means to improve the uptake of evidence-informed practices for HIV care.

Methods: A prospective quasi-experimental study in Jamaica, Kenya, Uganda and South Africa examined the impact of establishing multi-stakeholder leadership hubs on evidence-informed HIV care practices.

Validity and reliability of data collected by community health workers in rural and peri-urban contexts in Kenya.

Background: Reliability and validity of measurements are important for the interpretation and generalisation of research findings. Valid, reliable and comparable measures of health status of individuals are critical components of the evidence base for health policy. The need for sound information is especially urgent in the case of emerging diseases and other acute health threats, where rapid awareness, investigation and response can save lives and prevent broader national outbreaks and even global pandemics.

Perceptions of health stakeholders on task shifting and motivation of community health workers in different socio demographic contexts in Kenya (nomadic, peri-urban and rural agrarian).

Background: The shortage of health professionals in low income countries is recognized as a crisis. Community health workers are part of a "task-shift" strategy to address this crisis. Task shifting in this paper refers to the delegation of tasks from health professionals to lay, trained volunteers.

A quasi-experimental assessment of the effectiveness of the Community Health Strategy on health outcomes in Kenya.

Background: Despite focused health policies and reform agenda, Kenya has challenges in improving households' situation in poverty and ill health; interventions to address the Millennium Development Goals in maternal and child health, such as focused antenatal care and immunization of children, are yet to achieve success. Research has shown that addressing the demand side is critical in improving health outcomes. This paper presents a model for health systems performance improvement using a strategy that bridges the interface between the community and the health system.

Short structured general mental health in service training programme in Kenya improves patient health and social outcomes but not detection of mental health problems - a pragmatic cluster randomised controlled trial.

Trial Design: A pragmatic cluster randomised controlled trial.

Participants: Clusters were primary health care clinics on the Ministry of Health list. Clients were eligible if they were aged 18 and over.

PERSPECTIVE ON OPPORTUNITIES FOR RESEARCH AND INTERVENTIONS PROVIDED BY COMMUNITY BASED HEALTH INFORMATION SYSTEM ILLUSTRATED BY THE POTENTIAL USE OF MOTIVATIONAL INTERVIEWING INTERVENTION.

Background: With the growth of Community-Based Health Information (CBHIS) for decision making and service provision in the low income settings, innovative models of addressing Maternal and Newborn Health (MNH) morbidity and mortality are necessary. World Health Organization (WHO) estimates that five hundred thousand mothers and about three million newborns die each year in middle and low income countries.

Objectives: To stimulate interest in utilisation CBHIS for research and interventions, with an illustration of potential using on Motivational Interviewing intervention.

Reliability of community health worker collected data for planning and policy in a peri-urban area of Kisumu, Kenya.

A general introduction of this article is as follows: Reliable and timely health information is an essential foundation of public health action and health systems strengthening, both nationally and internationally (Aqil et al. in Health Policy Plan 24(3): 217-228, 2009; Bradshaw et al. in initial burden of disease estimates for South Africa, 2000.

Knowledge and behaviour as determinants of anti-malarial drug use in a peri-urban population from malaria holoendemic region of western Kenya.

Background: The appropriate use of anti-malarial drugs determines therapeutic efficacy and the emergence and spread of drug-resistant malaria. Strategies for improving drug compliance require accurate information about current practices at the consumer level. This is to ascertain that the currently applied new combination therapy to malaria treatment will achieve sustained cure rates and protection against parasite resistance.

Fear of being tested for HIV at ANC clinics associated with low uptake of intermittent preventive treatment (IPT) of malaria among pregnant women attending Bondo District Hospital, Western Kenya.

Objective: Malaria is a major cause of morbidity and mortality in tropical and subtropical regions, affecting mostly the impoverished sections of the population. Pregnant women living in malaria-endemic areas are at higher risk of malaria infection with higher density of parasitaemia than non-pregnant women. The aim of this study was to assess factors affecting the uptake of IPT among women attending antenatal clinics at Bondo District Hospital, Western Kenya.

Evidence-based dialogue with communities for district health systems' performance improvement.

Despite focused health policies and a reform agenda Kenya has not made a breakthrough in improving the situations of households entrapped in the vicious cycle of poverty and ill health. Consequently, Great Lakes University of Kisumu developed and tested a model for facilitating improvement in the performance of the District Health System (DHS) and, hence, the health status of poor households served. The model consisted of evidence-based dialogue between the communities and service providers, working with service consumers as partners in improving service delivery and outcomes.