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Background During the COVID-19 pandemic, Nyeri County in Kenya was among the regions reporting a high number of confirmed cases. This exemplified the increased need of addressing potential antimicrobial resistance (AMR) and self-medication during disease outbreaks. This study examined the extent of self-medication with antimicrobials among COVID-19 confirmed cases in the County. Methods A cross-sectional survey using phone-based interviews was conducted in August 2021 among a sample of 280 out of 2317 confirmed COVID-19 cases in the County using a pre-coded questionnaire. Descriptive analyses of frequencies and causal logistic regression were conducted using STATA version 13. Results A total of 193 (68.9%) of the respondents indicated developing COVID-19 related symptoms-mainly cough (41.5%), headache (38.3%), and fatigue (34.7%). Over one-fifth (23.4%) of the respondents had self-medicated with antibiotics, 60.6% of whom did so at the onset of symptoms before the confirmatory test, and 51.5% self-medicating more than once. Common antibiotics used were Azithromycin (40.0%) and Amoxycilline (23.3%), with a considerable 21.7% having difficulty remembering the name of the drugs. Only half (50.4%) of the respondents (128/254) were aware of regulations towards self-medication with antibiotics. Age was the only socio-demographic variable significantly related to reduced self-medication, with older persons less likely to self-medicate. On the other hand, developing COVID-19 symptoms, awareness of COVID regulations, and appreciation of the need for self-medication awareness were related to increased self-medication. Conclusion Being older, developing COVID-19 symptoms, and appreciating self-medication awareness have influential effects on the use of antimicrobials. Public health interventions should be timely during infectious disease outbreaks to prevent undesirable health-seeking behavior such as irrational antimicrobial use. AMR policies should enhance awareness of the risks of self-medication and address barriers that deter people from timely access of health services during disease outbreaks. Further research should be conducted on the self-medication and AMR nexus, especially during health emergencies.

Background In concert with international commitments, the Government of Kenya identified Universal Health Coverage (UHC), mainly through the National Health Insurance Fund (NHIF), as one of its four priority agenda to enable its populations access health care without financial duress. Nevertheless, only about 19.5% of the Kenyan population is enrolled in any insurance health cover. Since 2016, Amref Health Africa and PharmAccess Foundation have been implementing the Innovative Partnership for Universal and Sustainable Healthcare (iPUSH) programme in Navakholo sub-county of Kakamega County. The main objective of this study is to examine use of health insurance cover among Women of Reproductive Age (WRA) in Navakholo sub-county, Kakamega County. Methods We analysed data captured during household registration conducted in February 2021 which embraced a question on use of health insurance cover including NHIF. The dataset consisted 148,957 household members within 32,262 households, 310 villages, and 32 community health units. The data had been collected using mobile phones by trained Community Health Volunteers (CHVs) and transmitted using the Amref electronic data management platform and reposited in a server. Data were analysed through frequency distributions and logistic regression (descriptive and causal methods) using STATA software. Results Insurance coverage, all providers included, in Navakholo sub-county stood at 11% among women aged 15–49 years. This is much lower than the national aggregate reported from sample surveys, but higher than the 7% found in the same survey for the region where Navakholo is situated. Social determinant variables – age, perceived condition of the household, and wealth ranking – are highly significant in the relationship with use of health insurance cover while measures of reproductive health and health vulnerability are not. Conclusion In Navakholo sub-county of Western Kenya, all—health-insurance coverage is lower than the national aggregate estimated from sample surveys. Age, perception of household condition, and wealth ranking are very significantly related to use of a health insurance cover. Frequent household registrations should be conducted to help monitor the trends and impact of health insurance campaigns. Training – upstream and downstream – on community household registration and data processing should be conducted to arrive at better quality data.

Background Several malaria vaccines are currently in clinical trials and are expected to provide an improved strategy for malaria control. Prior to introduction of a new vaccine, policymakers must consider the socio cultural environment of the region to ensure widespread community approval. This study investigated the acceptance of a malaria vaccine by child caregivers and analysed factors that influence these. Methods Interviews from a standard questionnaire were conducted with 2,003 caregivers at 695 randomly selected health facilities across Kenya during the Kenya Service Provision Assessment Survey 2010. Multinomial regression of quantitative data was conducted using STATA to analyse determinants of caregivers accepting malaria vaccination of their child. Results Mothers represented 90% of caregivers interviewed who brought their child to the health facility, and 77% of caregivers were 20-34 years old. Overall, 88% of respondents indicated that they would accept a malaria vaccine, both for a child in their community and their own child. Approval for a vaccine was highest in malaria-endemic Nyanza Province at 98.9%, and lowest in the seasonal transmission area of North Eastern Province at 23%. Although 94% of respondents who had attended at least some school reported they would accept the vaccine for a child, only 56% of those who had never attended school would do so. The likelihood of accepting one’s own child to be immunized was correlated with province, satisfaction with health care services in the facility attended, age of the caregiver, and level of education. Conclusions Results from this study indicate a need for targeted messages and education on a malaria vaccine, particularly for residents of regions where acceptance is low, older caregivers, and those with low literacy and school-attendance levels. This study provides critical evidence to inform policy for a new malaria vaccine that will support its timely and comprehensive uptake in Kenya.

Background In response to poor maternal, newborn, and child health indicators in Magadi sub-county, the “Boma” model was launched to promote health facility delivery by establishing community health units and training community health volunteers (CHVs) and traditional birth attendants (TBAs) as safe motherhood promoters. As a result, health facility delivery increased from 14% to 24%, still considerably below the national average (61%). We therefore conducted this study to determine factors influencing health facility delivery and describe barriers and motivators to the same. Methods A mixed methods cross-sectional study involving a survey with 200 women who had delivered in the last 24 months, 3 focus group discussions with health providers, chiefs and CHVs and 26 in-depth interviews with mothers, key decision influencers and TBAs. Adjusted odds ratios (aOR) and 95% confidence intervals (CI) using logistic regression were calculated to identify predictive factors for health facility delivery. Thematic analysis was done to describe barriers and motivators to the same. Results Of the women interviewed, 39% delivered at the health facility. Factors positively associated with health facility deliveries included belonging to the highest wealth quintiles [aOR 4.9 (95%CI 1.5–16.5)], currently not married [aOR 2.4 (95%CI 1.1–5.4)] and living near the health facility [aOR 2.2 (95%CI 1.1 = 4.4)]. High parity [aOR 0.7 (95%CI 0.5–0.9)] was negatively associated with health facility delivery. Barriers to health facility delivery included women not being final decision makers on place of birth, lack of a birth plan, gender of health provider, unfamiliar birthing position, disrespect and/or abuse, distance, attitude of health providers and lack of essential drugs and supplies. Motivators included proximity to health facility, mother’s health condition, integration of TBAs into the health system, and health education/advice received. Conclusion Belonging to the highest wealth quintile, currently not married and living near a health facility were positively associated with health facility delivery. Gender inequity and cultural practices such as lack of birth preparedness should be addressed. Transport mechanisms need to be established to avoid delay in reaching a health facility. The health systems also need to be functional with adequate supplies and motivated staff.

Background Malaria is a leading cause of morbidity and mortality in children younger than 5 years in Kenya. Within the context of planning for a vaccine to be used alongside existing malaria control methods, this study explores sociocultural and health communications issues among individuals who are responsible for or influence decisions on childhood vaccination at the community level. Methods This qualitative study was conducted in two malaria-endemic regions of Kenya--South Coast and Busia. Participant selection was purposive and criterion based. A total of 20 focus group discussions, 22 in-depth interviews, and 18 exit interviews were conducted. Results Participants understand that malaria is a serious problem that no single tool can defeat. Communities would welcome a malaria vaccine, although they would have questions and concerns about the intervention. While support for local child immunization programs exists, limited understanding about vaccines and what they do is evident among younger and older people, particularly men. Even as health care providers are frustrated when parents do not have their children vaccinated, some parents have concerns about access to and the quality of vaccination services. Some women, including older mothers and those less economically privileged, see themselves as the focus of health workers' negative comments associated with either their parenting choices or their children's appearance. In general, parents and caregivers weigh several factors--such as personal opportunity costs, resource constraints, and perceived benefits--when deciding whether or not to have their children vaccinated, and the decision often is influenced by a network of people, including community leaders and health workers. Conclusions The study raises issues that should inform a communications strategy and guide policy decisions within Kenya on eventual malaria vaccine introduction. Unlike the current practice, where health education on child welfare and immunization focuses on women, the communications strategy should equally target men and women in ways that are appropriate for each gender. It should involve influential community members and provide needed information and reassurances about immunization. Efforts also should be made to address concerns about the quality of immunization services--including health workers' interpersonal communication skills.

Background The World Health Organization (WHO) and the Government of Kenya alike identify a well-performing health workforce as key to attaining better health. Nevertheless, the motivation and retention of health care workers (HCWs) persist as challenges. This study investigated factors influencing motivation and retention of HCWs at primary health care facilities in three different settings in Kenya - the remote area of Turkana, the relatively accessible region of Machakos, and the disadvantaged informal urban settlement of Kibera in Nairobi. Methods A cross-sectional cluster sample design was used to select 59 health facilities that yielded interviews with 404 health care workers, grouped into 10 different types of service providers. Data were collected in November 2011 using structured questionnaires and a Focus Group Discussion guide. Findings were analyzed using bivariate and multivariate methods of the associations and determinants of health worker motivation and retention. Results The levels of education and gender factors were lowest in Turkana with female HCWs representing only 30% of the workers against a national average of 53%. A smaller proportion of HCWs in Turkana feel that they have adequate training for their jobs. Overall, 13% of the HCWs indicated that they had changed their job in the last 12 months and 20% indicated that they could leave their current job within the next two years. In terms of work environment, inadequate access to electricity, equipment, transport, housing, and the physical state of the health facility were cited as most critical, particularly in Turkana. The working environment is rated as better in private facilities. Adequate training, job security, salary, supervisor support, and manageable workload were identified as critical satisfaction factors. Family health care, salary, and terminal benefits were rated as important compensatory factors. Conclusions There are distinct motivational and retention factors that affect HCWs in the three regions. Findings and policy implications from this study point to a set of recommendations to be implemented at national and county levels. These include gender mainstreaming, development of appropriate retention schemes, competitive compensation packages, strategies for career growth, establishment of a model HRH community, and the conduct of a discrete choice experiment.

Introduction Interventions to improve retention in care after HIV diagnosis are necessary to optimise the timely initiation of antiretroviral therapy (ART) and HIV/AIDS control outcomes. Widespread mobile phone use presents new opportunities to engage patients in care. A randomised controlled trial (RCT), WelTel Kenya1, demonstrated that weekly text messages led to improved ART adherence and viral load suppression among those initiating ART. The aim of this study was to determine whether the WelTel intervention is an effective and cost-effective method of improving retention in care in the first year of care following HIV diagnosis. Methods and analysis WelTel Retain is an open, parallel group RCT that will be conducted at the Kibera Community Health Centre in Nairobi, Kenya. Over a 1-year period, we aim to recruit 686 individuals newly diagnosed with HIV who will be randomly allocated to an intervention or control arm (standard care) at a 1:1 ratio. Intervention arm participants will receive the weekly WelTel SMS ‘check-in’ to which they will be instructed to respond within 48 h. An HIV clinician will follow-up and triage any problems that are identified. Participants will be followed for 1 year, with a primary endpoint of retention in care at 12 months. Secondary outcomes include retention in stage 1 HIV care (patients return to the clinic to receive their first CD4 results) and timely ART initiation. Cost-effectiveness will be analysed through decision-analytic modelling. Ethics and dissemination Ethical approval has been obtained from the University of British Columbia and the African Medical and Research Foundation. This trial will test the effectiveness and cost-effectiveness of the WelTel intervention to engage patients during the first year of HIV care. Trial results and economic evaluation will help inform policy and practice on the use of WelTel in the early stages of HIV care. Trial registration ClinicalTrials.gov NCT01630304.

In 2005, Kenya's Ministry of Health (MOH) in its quest to improve health outcomes developed the Community Health Strategy (CHS) as a key approach. The MOH and partners grappled with the challenge of managing the functionality of the Community Health Units (CHUs). Amref Health Africa in Kenya developed a replicable CHUs Functionality Scorecard for measuring and managing the functionality of CHUs. We designed and piloted the CHU Functionality Scorecard at 114 CHUs in Rift valley province in Kenya. The scorecard categorized CHUs as Functional, Semi-functional, or Non-Functional. We used before and after design to assess the functionality of the CUs. Over seven quarters (January 2012 to September 2013). The proportion of functional CHU increased from 3.5% to 82.9%, Semi-Functional reduced from 39% to 13% while Non-Functional reduced from 58% to 4%. The greatest improvements were noted in Community Health Volunteers (CHVs) receiving stipends, CHVs with referral booklets, monthly dialogue days, actions planning, chalk boards, and CHVs reporting rates. The CHU functionality scorecard is a valuable tool for the management of performance, resource allocation, and decision making. We recommend the adoption of the Functionality Scorecard by the Kenya Government for country-wide application. We recommend: further work in defining Advanced Functionality and incorporating the same into the scorecard; and implementation research on long term sustainability of CHUs.

Effective use of donor aid is critical in achieving the sixth Millennium Development Goal -reversing the HIV/AIDS epidemic by 2015. The Paris Declaration of 2005 identified five key principles for aid effectiveness: ownership, alignment, harmonisation, mutual accountability and managing for results. As civil society organisations play a critical role in implementing HIV/AIDS interventions, it is important that they adhere to these principles. Often, however, they fail to implement interventions conforming with the principles, leading to duplication and inefficiency. Two case studies from AMREF in Kenya demonstrate how the principles of aid effectiveness can be applied to increase the impact of HIV/AIDS interventions. Rendre l'aide efficace au niveau communautaire : l'expérience d'AMREF L'utilisation efficace de l'aide apportée par les bailleurs de fonds est cruciale pour atteindre le sixième Objectif du Millénaire pour le développement - inverser l'épidémie du VIH/sida d'ici à 2015. La Déclaration de Paris de 2005 a identifié cinq principes clés pour l'efficacité de l'aide : l'appropriation, l'alignement, l'harmonisation, la redevabilité mutuelle et la gestion en vue de résultats. Comme les organisations de la société civile jouent un rôle crucial dans la mise en œuvre des interventions en matière de VIH/sida, il est important qu'elles adhèrent à ces principes. Cependant, souvent, elles échouent à mettre en œuvre des interventions conformes aux principes, ce qui aboutit à des doublons et à l'inefficacité. Deux études de cas d'AMREF au Kenya démontrent la manière dont les principes de l'efficacité de l'aide peuvent être appliqués pour accroître l'impact des interventions de lutte contre le VIH/sida. Tornando a Ajuda Efetiva no Âmbito da Comunidade: A experiência da AMREF O uso efetivo da ajuda dos doadores é crucial para se alcançar o sexto Objetivo de Desenvolvimento do Milênio - reverter a epidemia do HIV/AIDS até 2015. A Declaração de Paris de 2005 identificou cinco princípios-chave para a efetividade da ajuda: apropriação, alinhamento, harmonização, responsabilidade mútua e gerenciamento para resultados. Como as organizações da sociedade civil desempenham um papel crucial na implementação de intervenções relativas ao HIV/AIDS, é importante que elas tenham adesão a estes princípios. Frequentemente, porém, elas falham na implementação das intervenções de acordo com os princípios, levando à duplicação e ineficiência. Dois estudos de caso da AMREF no Quênia mostram como os princípios da efetividade da ajuda podem ser aplicados para aumentar o impacto das intervenções relativas ao HIV/AIDS. Una ayuda más eficiente a nivel comunitario: la experiencia AMREF Para alcanzar los Objetivos de Desarrollo del Milenio y conseguir que la epidemia del VIH/SIDA retroceda para el 2015, es de vital importancia que la ayuda de los donantes se utilice con más eficiencia. La Declaración de París de 2005 enunció cinco principios clave para que la ayuda sea eficaz: apropiación, alineación, armonización, rendición de cuentas mutua y gestión basada en los resultados. Debido a que las organizaciones de la sociedad civil desempeñan un papel fundamental en la lucha contra el VIH/SIDA, es necesario que éstas respeten los cinco principios. Sin embargo, a menudo éstos no se aplican en la práctica ocasionando duplicidades y falta de eficiencia. Dos estudios de caso de AMREF (siglas en inglés de la Fundación Africana de Medicina e Investigación) en Kenia muestran cómo estos principios de eficacia en la ayuda son útiles para aumentar el impacto de la lucha contra el VIH/SIDA.

Effective use of donor aid is critical in achieving the sixth Millennium Development Goal –reversing the HIV/AIDS epidemic by 2015. The Paris Declaration of 2005 identified five key principles for aid effectiveness: ownership, alignment, harmonisation, mutual accountability and managing for results. As civil society organisations play a critical role in implementing HIV/AIDS interventions, it is important that they adhere to these principles. Often, however, they fail to implement interventions conforming with the principles, leading to duplication and inefficiency. Two case studies from AMREF in Kenya demonstrate how the principles of aid effectiveness can be applied to increase the impact of HIV/AIDS interventions.Rendre l'aide efficace au niveau communautaire : l'expérience d'AMREFL'utilisation efficace de l'aide apportée par les bailleurs de fonds est cruciale pour atteindre le sixième Objectif du Millénaire pour le développement – inverser l'épidémie du VIH/sida d'ici à 2015. La Déclaration de Paris de 2005 a identifié cinq principes clés pour l'efficacité de l'aide : l'appropriation, l'alignement, l'harmonisation, la redevabilité mutuelle et la gestion en vue de résultats. Comme les organisations de la société civile jouent un rôle crucial dans la mise en œuvre des interventions en matière de VIH/sida, il est important qu'elles adhèrent à ces principes. Cependant, souvent, elles échouent à mettre en œuvre des interventions conformes aux principes, ce qui aboutit à des doublons et à l'inefficacité. Deux études de cas d'AMREF au Kenya démontrent la manière dont les principes de l'efficacité de l'aide peuvent être appliqués pour accroître l'impact des interventions de lutte contre le VIH/sida.Tornando a Ajuda Efetiva no Âmbito da Comunidade: A experiência da AMREFO uso efetivo da ajuda dos doadores é crucial para se alcançar o sexto Objetivo de Desenvolvimento do Milênio – reverter a epidemia do HIV/AIDS até 2015. A Declaração de Paris de 2005 identificou cinco princípios-chave para a efetividade da ajuda: apropriação, alinhamento, harmonização, responsabilidade mútua e gerenciamento para resultados. Como as organizações da sociedade civil desempenham um papel crucial na implementação de intervenções relativas ao HIV/AIDS, é importante que elas tenham adesão a estes princípios. Frequentemente, porém, elas falham na implementação das intervenções de acordo com os princípios, levando à duplicação e ineficiência. Dois estudos de caso da AMREF no Quênia mostram como os princípios da efetividade da ajuda podem ser aplicados para aumentar o impacto das intervenções relativas ao HIV/AIDS.Una ayuda más eficiente a nivel comunitario: la experiencia AMREFPara alcanzar los Objetivos de Desarrollo del Milenio y conseguir que la epidemia del VIH/SIDA retroceda para el 2015, es de vital importancia que la ayuda de los donantes se utilice con más eficiencia. La Declaración de París de 2005 enunció cinco principios clave para que la ayuda sea eficaz: apropiación, alineación, armonización, rendición de cuentas mutua y gestión basada en los resultados. Debido a que las organizaciones de la sociedad civil desempeñan un papel fundamental en la lucha contra el VIH/SIDA, es necesario que éstas respeten los cinco principios. Sin embargo, a menudo éstos no se aplican en la práctica ocasionando duplicidades y falta de eficiencia. Dos estudios de caso de AMREF (siglas en inglés de la Fundación Africana de Medicina e Investigación) en Kenia muestran cómo estos principios de eficacia en la ayuda son útiles para aumentar el impacto de la lucha contra el VIH/SIDA.