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Background In sub-Saharan Africa, common mental disorders (CMDs) like depression and anxiety are under-investigated amongst young people living with HIV (YLWH). To address the gap, in Kenya we: a) determined the prevalence of CMDs among YLWH compared to their uninfected peers; b) investigated HIV status as an independent predictor of CMDs in young people; c) investigated CMDs risk and protective indicators with more focus on YLWH. Methods Between November 2018 and September 2019, 819 young people aged 18–24 years (407 HIV-infected) were recruited from two Counties on the Kenyan coast. Locally adapted pre-existing mental health measures, Patient Health Questionnaire (9-item) and Generalized Anxiety Disorder scale (7-item), were administered among other questionnaires via audio computer-assisted self-interview. Logistic regression was used to determine the correlates of CMDs. Results Prevalence of CMDs was significantly elevated among YLWH compared to their uninfected peers i.e. 29% vs. 12%; p < 0.001 for depressive symptoms, 19% vs. 8%; p < 0.001 for anxiety symptoms, and 16% vs. 5%; p < 0.001 for comorbid depressive and anxiety symptoms. HIV status independently predicted depressive symptoms and its co-occurrence with anxiety symptoms. Among YLWH, negative life events, higher perceived HIV-related stigma and low adherence to antiretroviral therapy were the risk indicators for elevated CMDs. Among HIV-uninfected youths, death of both parents was a risk indicator for elevated depressive symptoms. Protective indicators against CMDs among youths with and without HIV included higher social support and health-related quality of life. Conclusion At the Kenyan coast, YLWH have significantly higher burden of CMDs compared to their uninfected peers. Being HIV-positive as a youth in this setting is predictive of more depressive symptoms and its comorbidity with anxiety symptoms. YLWH at high risk of CMDs in coastal Kenya can benefit from early detection, referral and treatment if routine screening for CMDs is integrated in their care package. The mental wellbeing of bereaving HIV-unaffected youths could be improved through continued support to help them come to terms with their loss. At the community level, programmes strengthening the social capital or improving the overall quality of life of youths with or without HIV may be beneficial to their mental health.

Background In sub-Saharan Africa, there is paucity of research on substance use patterns among young people living with HIV (YLWH). To address the gap, we sought to: i) determine the prevalence of substance use, specifically alcohol and illicit drug use, among YLWH compared to their HIV-uninfected peers; ii) investigate the independent association between young people’s HIV infection status and substance use; iii) investigate the risk indicators for substance use among these young people. Methods Between November 2018 and September 2019, a cross-sectional study was conducted at the Kenyan coast recruiting 819 young people aged 18–24 years (407 HIV-positive). Alcohol and drug use disorders identification tests (AUDIT and DUDIT) were administered via audio computer-assisted self-interview alongside other measures. Logistic regression was used to determine substance use risk indicators. Results The point prevalence of current substance use was significantly lower among YLWH than HIV-uninfected youths: current alcohol use, 13% vs. 24%, p <  0.01 ; current illicit drug use, 7% vs. 15%, p <  0.01 ; current alcohol and illicit drug use comorbidity, 4 vs. 11%, p <  0.01 . Past-year prevalence estimates for hazardous substance use were generally low among young people in this setting (< 10%) with no significant group differences observed. Being HIV-positive independently predicted lower odds of current substance use, but not hazardous substance use. There was overlap of some risk indicators for current substance use between young people with and without HIV including male sex, khat use and an experience of multiple negative life events, but risk indicators unique to either group were also identified. Among YLWH, none of the HIV-related factors was significantly associated with current substance use. Conclusions At the Kenyan coast, substance use is a reality among young people. The frequency of use generally appears to be low among YLWH compared to the HIV-uninfected peers. Substance use prevention initiatives targeting young people, regardless of HIV infection status, are warranted in this setting to avert their potential risk for developing substance use disorders, including dependence. The multifaceted intrapersonal and interpersonal factors that place young people at risk of substance use need to be addressed as part of the substance use awareness and prevention initiatives.

The infusion of vasopressors is a standard treatment for shock, and international guidelines recommend administering these medications through central venous catheters (CVCs) due to concerns about potential extravasation and local tissue injury with peripheral intravenous (PIV) administration. However, CVCs are often unavailable in resource-variable settings due to lack of human and material resources. Previous studies have assessed the safety of vasopressor infusion through PIV catheters but have considered only limited patient populations or a short infusion time or have used retrospective designs that may have failed to capture mild complications. The primary objective of this study is to observe and describe the incidence of complications among patients receiving vasopressor infusion via PIV administration. The secondary objective is to assess whether the safety of PIV vasopressor administration is noninferior to the safety of administration via CVC. This prospective observational study is being conducted at African Inland Church (AIC) Kijabe Hospital, a 360-bed tertiary care teaching hospital in rural Kenya. All patients (adult, obstetric, and pediatric) receiving intravenous vasopressor infusions who are admitted to the intensive care unit or high-dependency unit will be included. Patients will be followed up on twice daily from the start of vasopressor infusion to 72 hours after vasopressor discontinuation or death, whichever occurs first. Demographic, physiological, laboratory, therapeutic, and outcome data will be collected. Consecutive enrollment began in October 2023 and is ongoing. As of July 2025, we have enrolled 190 patients. We anticipate that the time to enroll the number of patients required to reach our power goal will be 24 months. This study in a resource-variable setting will allow for more accurate and comprehensive data collection on vasopressor administration and potential complications as they arise, whereas most previous studies have been retrospective in nature. In addition, this is the first study of its kind to include both adult and pediatric patients within a mixed intensive care unit population with broad etiologies of shock, which could improve generalizability.

Background: In 2014, a pilot study was conducted to test the feasibility of linking clinic attendance data for young adults at two health facilities to the population register of the Kilifi Health and Demographic Surveillance System (KHDSS). This was part of a cross-sectional survey of health problems of young people, and we tested the feasibility of using the KHDSS platform for the monitoring of future interventions. Methods: Two facilities were used for this study. Clinical data from consenting participants aged 18-24 years were matched to KHDSS records. Data matching was achieved using national identity card numbers or otherwise using a matching algorithm based on names, sex, date of birth, location of residence and the names of other homestead members. A study form was administered to all matched patients to capture reasons for their visits and time taken to access the services. Distance to health facility from a participants’ homestead was also computed. Results: 628 participated in the study: 386 (61%) at Matsangoni Health Centre, and 242 (39%) at Pingilikani Dispensary. 610 (97%) records were matched to the KHDSS register. Most records (605; 96%) were matched within these health facilities, while 5 (1%) were matched during homestead follow-up visits.  463 (75.9%) of those matched were women. Antenatal care (25%), family planning (13%), respiratory infections (9%) and malaria (9%) were the main reasons for seeking care. Antenatal clinic visits (n=175) and malaria (n=27) were the commonest reasons among women and men, respectively. Participants took 1-1.5 hours to access the services; 490 (81.0%) participants lived within 5 kilometres of a facility. Conclusions: With a full-time research clerk at each health facility, linking health-facility attendance data to a longitudinal HDSS platform was feasible and could be used to monitor and evaluate the impact of health interventions on health care outcomes among young people.

Background: In 2014, a pilot study was conducted to test the feasibility of linking clinic attendance data for young adults at two health facilities to the population register of the Kilifi Health and Demographic Surveillance System (KHDSS). This was part of a cross-sectional survey of health problems of young people, and we tested the feasibility of using the KHDSS platform for the monitoring of future interventions. Methods: Two facilities were used for this study. Clinical data from consenting participants aged 18-24 years were matched to KHDSS records. Data matching was achieved using national identity card numbers or otherwise using a matching algorithm based on names, sex, date of birth, location of residence and the names of other homestead members. A study form was administered to all matched patients to capture reasons for their visits and time taken to access the services. Distance to health facility from a participants’ homestead was also computed. Results: 628 participated in the study: 386 (61%) at Matsangoni Health Centre, and 242 (39%) at Pingilikani Dispensary. 610 (97%) records were matched to the KHDSS register. Most records (605; 96%) were matched within these health facilities, while 5 (1%) were matched during homestead follow-up visits.  463 (75.9%) of those matched were women. Antenatal care (25%), family planning (13%), respiratory infections (9%) and malaria (9%) were the main reasons for seeking care. Antenatal clinic visits (n=175) and malaria (n=27) were the commonest reasons among women and men, respectively. Participants took 1-1.5 hours to access the services; 490 (81.0%) participants lived within 5 kilometres of a facility. Conclusions: With a full-time research clerk at each health facility, linking health-facility attendance data to a longitudinal HDSS platform was feasible and could be used to monitor and evaluate the impact of health interventions on health care outcomes among young people.

Citizen science is gaining increasing prominence as a tool for science and engagement. However, despite being a potentially valuable tool for sustainable development, citizen science has little visibility in many developing countries. We undertook a collaborative prioritisation process with experts in conservation and the environment to assess the potential of environmental citizen science in East Africa, including its opportunities, benefits and barriers. This provided principles that are applicable across developing countries, particularly for large‐scale citizen science. We found that there was great potential for citizen science to add to our scientific knowledge of natural resources and biodiversity trends. Many of the important benefits of citizen science were for people, as well as the environment directly. Major barriers to citizen science were mostly social and institutional, although projects should also consider access to suitable technology and language barriers. Policy implications. Citizen science can provide data to support decision‐making and reporting against international targets. Participation can also provide societal benefits, informing and empowering people, thus supporting the United Nations’ Sustainable Development Goals. In developing countries, innovation is needed to further develop culturally relevant citizen science that benefits participants and end users. This should be supported through regional networks of stakeholders for sharing best practice. Foreign Language Swahili Sayansi ya wananchi inaendelea kuongezeka kwa umaarufu kama chombo cha sayansi na ushiriki. Hata hivyo, licha ya kuwa chombo cha thamani cha maendeleo endelevu, sayansi ya wananchi haionekani sana katika nchi nyingi zinazoendelea. Tulifanya mchakato wa ushirikiano wa kutoa vipaumbele pamoja na wataalamu wa uhifadhi na mazingira ili kuchunguza uwezekano wa sayansi ya wananchi ya mazingira katika Afrika ya Mashariki, ikijumuisha fursa, faida na vikwazo. Hii ilitoa kanuni zinazoweza kutumika katika nchi zinazoendelea, hasa kwa sayansi ya wananchi kwa kiwango kikubwa. Tuligundua kuwa kuna uwezo mkubwa wa sayansi ya wananchi ili kuongeza ujuzi wetu wa kisayansi kuhusu nyenzo za asili na mielekeo ya bioanuwai. Faida muhimu nyingi za sayansi ya wananchi zilikuwa kwa watu, lakini moja kwa moja kwa mazingira pia. Vikwazo vikuu kwa sayansi ya wananchi vilikuwa kijamii na kitaasisi hasa, ingawa miradi inapaswa pia kufikiria upatikanaji wa teknolojia zinazofaa na vikwazo vya lugha. Athari za sera ni kama ifuatavyo. Sayansi ya wananchi inaweza kutoa data kusaidia kuunda maamuzi na kuandika ripoti ili kufikia malengo ya kimataifa. Ushiriki unaweza pia kutoa faida za jamii, kuwajulisha na kuwawezesha watu na kwa hiyo kuunga mkono Malengo ya Maendeleo ya Umoja wa Mataifa. Katika nchi zinazoendelea kunahitaji kuwa na ubunifu ili kuendeleza sayansi ya wananchi inayofaa utamaduni inayopata washiriki na watumiaji wa mwisho. Hii inapaswa kuungwa mkono kupitia mitandao ya kikanda ya washikadau kwa kugawana taratibu bora.

Digital health technologies (DHTs) represent a promising strategy to improve access to HTS (HIV testing services), particularly among underserved higher-risk populations often missed by current programming, including young adults under 25 years. In 2017, Kenya's Ministry of Health introduced BeSure™, a DHT providing information on HIV, self-testing, and facility geo-location. Given increased risks for HIV among injured populations, this study assessed the acceptability of BeSure™ as a DHT for enhancing HTS in a Kenyan emergency department. Using purposive sampling, participants were provided a brief description of the tool BeSure™ and then completed in-depth interviews using a semistructured guide between August and November 2023. Deductive and inductive analyses were applied using a codebook based on a published framework for healthcare intervention acceptability, examining core themes of affect, burden, ethicality, coherence, opportunity cost, and perceived effectiveness. Among 24 participants, the median age was 25, half were female, and 58% had achieved secondary education or below. Few participants (21%) were aware of BeSure™ prior to data collection. Barriers to awareness included limited marketing of the tool and apathy toward health-related matters. However, strategic advertisement within healthcare encounters and through social media platforms including TikTok and Facebook (especially for young adult participants) could facilitate awareness. Barriers to potential use include low access to technology in rural communities, persisting stigma toward HIV, and low perceived HIV risk (especially among older participants). Despite these barriers, participants across age groups found the tool widely acceptable across the predetermined domains. These qualitative data highlight the acceptability of DHTs for HTS enhancement among injured populations in Nairobi, Kenya. Findings underscore the limited awareness of BeSure™ among this higher-risk population, suggesting that targeted advertisement, demand creation, and stigma reduction strategies are critical to successful implementation of these technologies.

Emergency department-based HIV self-testing (ED-HIVST) could increase HIV-testing services to high-risk, under-reached populations. This study sought to understand the injury patient acceptability of ED-HIVST. Injury patients presenting to the Kenyatta National Hospital Accident and Emergency Department were enrolled from March to May 2021. Likert item data on HIVST assessing domains of general acceptability, personal acceptability, and acceptability to distribute to social and/or sexual networks were collected. Ordinal regression was performed yielding adjusted odds ratios (aOR) to identify characteristics associated with high HIVST acceptability across domains. Of 600 participants, 88.7% were male, and the median age was 29. Half reported having primary care providers (PCPs) and 86.2% reported prior HIV testing. For each Likert item, an average of 63.5% of the participants reported they 'Agree Completely' with positive statements about ED-HIVST in general, for themselves, and for others. In adjusted analysis for general acceptability, those <25 (aOR = 1.67, 95%CI:1.36-2.08) and with prior HIV testing (aOR = 1.68, 95%CI:1.27-2.21) had greater odds of agreeing completely. For personal acceptability, those with a PCP (aOR = 3.31, 95%CI:2.72-4.03) and prior HIV testing (aOR = 1.83, 95%CI:1.41-2.38) had greater odds of agreeing completely. For distribution acceptability, participants with a PCP (aOR = 2.42, 95%CI:2.01-2.92) and prior HIV testing (aOR = 1.79, 95%CI: 1.38-2.33) had greater odds of agreeing completely. ED-HIVST is perceived as highly acceptable, and young people with prior testing and PCPs had significantly greater favourability. These data provide a foundation for ED-HIVST programme development in Kenya.

For ethical and logistical reasons, population-genetic studies of parasites often rely on the non-invasive sampling of offspring shed from their definitive hosts. However, if the sampled offspring are naturally derived from a small number of parents, then the strong family structure can result in biased population-level estimates of genetic parameters, particularly if reproductive output is skewed. Here, we document and correct for the strong family structure present within schistosome offspring (miracidia) that were collected non-invasively from humans in western Kenya. By genotyping 2,424 miracidia from 12 patients at 12 microsatellite loci and using a sibship clustering program, we found that the samples contained large numbers of siblings. Furthermore, reproductive success of the breeding schistosomes was skewed, creating differential representation of each family in the offspring pool. After removing the family structure with an iterative jacknifing procedure, we demonstrated that the presence of relatives led to inflated estimates of genetic differentiation and linkage disequilibrium, and downwardly-biased estimates of inbreeding coefficients (FIS). For example, correcting for family structure yielded estimates of FST among patients that were 27 times lower than estimates from the uncorrected samples. These biased estimates would cause one to draw false conclusions regarding these parameters in the adult population. We also found from our analyses that estimates of the number of full sibling families and other genetic parameters of samples of miracidia were highly intercorrelated but are not correlated with estimates of worm burden obtained via egg counting (Kato-Katz). Whether genetic methods or the traditional Kato-Katz estimator provide a better estimate of actual number of adult worms remains to be seen. This study illustrates that family structure must be explicitly accounted for when using offspring samples to estimate the genetic parameters of adult parasite populations.

We examined the association between serum aflatoxin B1‐lysine adduct (AFB1‐lys) levels in pregnant women and adverse pregnancy outcomes (low birthweight, miscarriage and stillbirth) through a nested matched case–control study of pregnant women enroled at ≤28 weeks' gestation in Mombasa, Kenya, from 2017 to 2019. Cases comprised women with an adverse birth outcome, defined as either delivery of a singleton infant weighing <2500 g, or a miscarriage, or a stillbirth, while controls were women who delivered a singleton live infant with a birthweight of ≥2500 g. Cases were matched to controls at a ratio of 1:2 based on maternal age at enrolment, gestational age at enrolment and study site. The primary exposure was serum AFB1‐lys. The study included 125 cases and 250 controls. The median gestation age when serum samples were collected was 23.0 weeks (interquartile range [IQR]: 18.1–26.0) and 23.5 (IQR: 18.1–26.5) among cases and controls, respectively. Of the 375 tested sera, 145 (38.7%) had detectable serum AFB1‐lys: 36.0% in cases and 40.0% in controls. AFB1‐lys adduct levels were not associated with adverse birth outcomes on multivariable analysis. Mid‐upper arm circumference was associated with a 6% lower odds of adverse birth outcome for every unit increase (p = 0.023). Two‐fifths of pregnant women had detectable levels of aflatoxin midway through pregnancy. However, we did not detect an association with adverse pregnancy outcomes, likely because of low serum AFB1‐lys levels and low power, restricting meaningful comparison. More research is needed to understand the public health risk of aflatoxin in pregnant women to unborn children. This study finds that nearly 40% of participants were exposed to low levels of aflatoxin B1, which was not associated with adverse pregnancy outcomes. It underscores the necessity for further studies to explore the underlying mechanisms and effects of aflatoxin exposure on pregnancy. Key messages Aflatoxin B1 (AFB1), a commonly ingested toxin, can cross the placental barrier and cause adverse pregnancy outcomes. Two‐fifths of participants had detectable serum AFB1‐lys levels, a marker of aflatoxin exposure, but the low levels recorded were not associated with adverse pregnancy outcomes. Every unit increase in mid‐upper arm circumference (MUAC) during pregnancy was associated with a 6% reduced likelihood of adverse pregnancy outcomes, highlighting the potential protective role of adequate maternal nutrition. There is need for additional studies in different settings on the determinants and mechanisms of the relationship between aflatoxin exposure and adverse pregnancy outcomes.