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Background The recognition of the unintended impact of COVID-19 mitigation measures to the availability of sexual and reproductive health (SRH) services led to the initiation of mitigation and health systems support mechanisms within public health facilities by the Ministry of Health (MoH) in Kenya to maintain pre-Covid-19 levels of SRH service provision. These recovery mechanisms however concentrated on policy and infrastructural elements of service provision with limited attention given to the psychosocial impacts of COVID-19 on health care workers (HCWs). This paper examines the psychosocial impact of COVID-19 on front line family planning (FP) and sexually transmitted infections (STI) management HCWs and their coping mechanisms with a view to suggesting ways in which HCWs can be supported during future pandemics. Methodology This paper employs a mixed methods approach with quantitative methodology analyzing data on the preparedness of the health sector to maintain service provision levels and qualitative data examining the mental and psychosocial states of HCWs who provide FP and STI health care services within Kenyan public health facilities. Results Our main finding was that the psychosocial wellbeing of HCWs was majorly neglected in the government response mechanisms for the pandemic leading to burnout and depression, as well as HCWs absconding their duties in the initial stages of the pandemic, and avoidance of testing and disclosure of status as the pandemic progressed. Some of these mechanisms undermined the mitigation measures by the government and put patients and colleagues at risk of infection by HCWs whose COVID-19 status remained unknown. Conclusions We recommend that future responses include mechanisms that address the psychosocial wellbeing of HCWs as a core element of the response for effective management of pandemics. In the case of new and unprecedented pandemics such as COVID-19, it is important that HCWs are provided with accurate and timely information about the pandemic as well as to what is expected of their conduct in service delivery and in the promotion of a culture of risk reduction. Plain English Summary This study employed quantitative and qualitative research methodologies to examine the effect of COVID-19 on the healthcare workers (HCWs) psychosocial health and their coping mechanisms. HCWs are critical in the management of epidemics since they are involved in outbreak control and the treatment of patients. Maintaining their physical and psychosocial health is crucial for the success of the infection prevention and control (IPC) mechanisms during an epidemic. The COVID-19 outbreak led to the initiation of measures such as the use of IPC materials, social distancing and delimitation of patient numbers by HCWs. There was however little attention given to the psychosocial well-being of health care workers with very few measures adopted to support healthcare workers mental health. The increasing cases of COVID-19, heavy workloads, shortages of personnel protective equipment, information overload and contradictions and a lack of public support from a suspicious populace caused immense mental stress to HCWs. In the absence of a collective government mental health intervention, HCWs adopted coping mechanisms such as refusing to test for COVID-19 and hiding their COVID-19 status to avoid stigma and ostracization by the community. These and other defense mechanisms put both patients and colleagues at risk of infection. This study recommends that during pandemics special attention be given to the psychosocial health of HCWs through provision of counselling services and timely and accurate information alongside other support measures if the epidemic control mechanisms are to be successful.

This article examines collaboration in transnational medical research from the viewpoint of African scientists working in partnerships with northern counterparts. It draws on ethnographic fieldwork in an HIV laboratory of an East African state university, with additional data from interviews with scientists working in related research institutions. Collaboration is today the preferred framework for the mechanisms by which northern institutions support research in the south. The concept signals a shift away from the legacy of unequal (post-) colonial power relations, although, amid persisting inequalities, the rhetorical emphasis on equality might actually hinder critical engagement with conflicts of interest and injustice. To collaborate, African scientists engage various strategies: They establish a qualified but flexible, non-permanent workforce, diversify collaborators and research areas, source complementary funding to assemble infrastructures, and maintain prospective research populations to attract transnational clinical trials. Through this labor of collaboration, they sustain their institutions under prevailing conditions of scarcity.

IntroductionKenya reported its first COVID-19 case on 13 March 2020. Pandemic-driven health system changes followed and unforeseen societal, economic and health effects reported. This protocol aims to describe the methods used to identify the gender equality and health equity gaps and possible disproportional health and socioeconomic impacts experienced by paid and unpaid (community health volunteer) female healthcare providers in Kilifi and Mombasa Counties, Kenya during the COVID-19 pandemic.Methods and analysisParticipatory mixed methods framed by gender analysis and human-centred design will be used. Research implementation will follow four of the five phases of the human-centred design approach. Community research advisory groups and local advisory boards will be established to ensure integration and the sustainability of participatory research design.Ethics and disseminationEthical approval was obtained from the Institutional Scientific and Ethics Review Committee at the Aga Khan University and the University of Manitoba.This study will generate evidence on root cultural, structural, socioeconomic and political factors that perpetuate gender inequities and female disadvantage in the paid and unpaid health sectors. It will also identify evidence-based policy options for future safeguarding of the unpaid and paid female health workforce during emergency preparedness, response and recovery periods.

Pandemic mitigation measures can have a negative impact on access and provision of essential healthcare services including sexual and reproductive health (SRH) services. This rapid review looked at the literature on the impact of COVID-19 mitigation measures on SRH and gender-based violence (GBV) on women in low- and middle-income countries (LMIC) using WHO rapid review guidance. We looked at relevant literature published in the English language from January 2020 to October 2021 from LMICs using WHO rapid review methods. A total of 114 articles were obtained from PubMed, Google Scholar and grey literature of which 20 met the eligible criteria. Our review found that there was an overall reduction in; (a) uptake of services as shown by lower antenatal, postnatal and family planning clinic attendance, (b) service delivery as shown by reduced health facility deliveries, and post abortion care services and (c) reproductive health outcomes as shown by an increase in incidence of GBV especially intimate partner violence. COVID-19 mitigation measures negatively impact SRH of women in LMICs. Findings from this review could inform policy makers in the health sector to recognise the potential adverse effects of COVID-19 responses on SRH in the country, and therefore implement mitigation measures.

Maternal immunization is a critical strategy to prevent both maternal and infant morbidity and mortality from several infectious diseases. When the first COVID-19 vaccines became available during the pandemic, there was mixed messaging and confusion amongst the broader public and among those associated with health care systems about the recommendations for COVID-19 vaccinations in pregnancy in many countries. A multi-country, mixed-methods study is being undertaken to describe how vaccine decision-making occurs amongst pregnant and postpartum women, with a focus on COVID-19 vaccines. The study is being conducted in Brazil, Ghana, Kenya, and Pakistan. In each country, participants are being recruited from either 2 or 3 maternity hospitals and/or clinics that represent a diverse population in terms of socio-economic and urban/rural status. Data collection includes cross-sectional surveys in pregnant women and semi-structured in-depth interviews with both pregnant and postpartum women. The instruments were designed to identify attitudinal, behavioral, and social correlates of vaccine uptake during and after pregnancy, including the decision-making process related to COVID-19 vaccines, and constructs such as risk perception, self-efficacy, vaccine intentions, and social norms. The aim is to recruit 400 participants for the survey and 50 for the interviews in each country. Qualitative data will be analyzed using a grounded theory approach. Quantitative data will be analyzed using descriptive statistics, latent variable analysis, and prediction modelling. Both the quantitative and qualitative data will be used to explore differences in attitudes and behaviors around maternal immunization across pregnancy trimesters and the postpartum period among and within countries. Each country has planned dissemination activities to share the study findings with relevant stakeholders in the communities from which the data is collected and to conduct country-specific secondary analyses.

Background Apnoea of prematurity (AOP) is a common condition among preterm infants. Methylxanthines, such as caffeine and aminophylline/theophylline, can help prevent and treat AOP. Due to its physiological benefits and fewer side effects, caffeine citrate is recommended for the prevention and treatment of AOP. However, caffeine citrate is not available in most resource-constrained settings (RCS) due to its high cost. Challenges in RCS using caffeine citrate to prevent AOP include identifying eligible preterm infants where gestational age is not always known and the capability for continuous monitoring of vital signs to readily identify apnoea. We aim to develop an evidence-based care bundle that includes caffeine citrate to prevent and manage AOP in tertiary healthcare facilities in Kenya. Methods This protocol details a prospective mixed-methods clinical feasibility study on using caffeine citrate to manage apnoea of prematurity in a single facility tertiary-care newborn unit (NBU) in Nairobi, Kenya. This study will include a 4-month formative research phase followed by the development of an AOP clinical-care-bundle prototype over 2 months. In the subsequent 4 months, implementation and improvement of the clinical-care-bundle prototype will be undertaken. The baseline data will provide contextualised insights on care practices within the NBU that will inform the development of a context-sensitive AOP clinical-care-bundle prototype. The clinical care bundle will be tested and refined further during an implementation phase of the quality improvement initiative using a PDSA framework underpinned by quantitative and qualitative clinical audits and stakeholders’ engagement. The quantitative component will include all neonates born at gestation age < 34 weeks and any neonate prescribed aminophylline or caffeine citrate admitted to the NBU during the study period. Discussion There is a need to develop evidence-based and context-sensitive clinical practice guidelines to standardise and improve the management of AOP in RCS. Concerns requiring resolution in implementing such guidelines include diagnosis of apnoea, optimal timing, dosing and administration of caffeine citrate, standardisation of monitoring devices and alarm limits, and discharge protocols. We aim to provide a feasible standardised clinical care bundle for managing AOP in low and middle-income settings.

Maternal immunization is a critical strategy to prevent both maternal and infant morbidity and mortality from several infectious diseases. When the first COVID-19 vaccines became available during the pandemic, there was mixed messaging and confusion amongst the broader public and among those associated with health care systems about the recommendations for COVID-19 vaccinations in pregnancy in many countries. A multi-country, mixed-methods study is being undertaken to describe how vaccine decision-making occurs amongst pregnant and postpartum women, with a focus on COVID-19 vaccines. The study is being conducted in Brazil, Ghana, Kenya, and Pakistan. In each country, participants are being recruited from either 2 or 3 maternity hospitals and/or clinics that represent a diverse population in terms of socio-economic and urban/rural status. Data collection includes cross-sectional surveys in pregnant women and semi-structured in-depth interviews with both pregnant and postpartum women. The instruments were designed to identify attitudinal, behavioral, and social correlates of vaccine uptake during and after pregnancy, including the decision-making process related to COVID-19 vaccines, and constructs such as risk perception, self-efficacy, vaccine intentions, and social norms. The aim is to recruit 400 participants for the survey and 50 for the interviews in each country. Qualitative data will be analyzed using a grounded theory approach. Quantitative data will be analyzed using descriptive statistics, latent variable analysis, and prediction modelling. Both the quantitative and qualitative data will be used to explore differences in attitudes and behaviors around maternal immunization across pregnancy trimesters and the postpartum period among and within countries. Each country has planned dissemination activities to share the study findings with relevant stakeholders in the communities from which the data is collected and to conduct country-specific secondary analyses.

The ‘Africanization’ of science after decolonization was replete with dreams. Claims to Africa’s place in the high-modern world, expectations of national technological and economic progress, and individual dreams of scientific discovery, professional development and fulfilled careers drove scientific work and lives. The term Africanization, coined by the colonizers, reproduced colonial notions of race but also stimulated the imagination of mid-twentieth-century African scientists, who hotly debated and enthusiastically embraced it. Half a century later, some dreams have failed, but many more remain unfulfilled. This article examines two reunions of Tanzanian and European science workers – in Amani in 2015 and in Cambridge in 2013 – who had worked together in the decades after Tanzania’s independence at Amani Hill Research Station, then one of Africa’s foremost laboratories for research on malaria and other tropical diseases. It explores ideas of good science and experiences of social differentiation, divergent dreams and persistent tensions – and the role of joking in remembering these. L’« africanisation » de la science après la décolonisation était remplie de rêves. Des revendications à la place de l’Afrique dans le monde de la haute modernité, des attentes de progrès technologiques et économiques nationaux et des rêves individuels de découverte scientifique, de développement professionnel et de carrière épanouie stimulaient le travail et la vie des scientifiques. Le terme « africanisation », inventé par les colonisateurs, reproduisait les notions coloniales de race mais aussi stimulait l’imagination des scientifiques africains de la moitié du vingtième siècle, qui en débattirent âprement et l’adoptèrent avec enthousiasme. Un demi-siècle plus tard, certains rêves ont échoué, mais bien d’autres encore demeurent inassouvis. Cet article examine deux réunions de travailleurs scientifiques tanzaniens et européens (à Amani en 2015 et à Cambridge en 2013) qui avaient travaillé ensemble pendant des décennies, après l’indépendance de la Tanzanie, à la station de recherche d’Amani Hill qui était à l’époque l’un des principaux laboratoires de recherche sur le paludisme et autres maladies tropicales. Il explore l’idée de bonne science et les expériences de différenciation sociale, de rêves divergents et de tensions persistantes, ainsi que le rôle de la plaisanterie dans le souvenir de ces expériences.

Pregnant women are at increased risk of severe manifestations of COVID-19, resulting in ICU admission, mechanical ventilation, and death compared to non-pregnant women. COVID-19 vaccines were approved for use in pregnant women in early 2022 by the World Health Organization, but permissive policies toward vaccine women differed by country. As education has been associated with vaccine uptake, this study sought to examine the association between socio-economic or educational status and vaccination behaviors, including reasons for vaccination or non-vaccination among pregnant women seeking health care services in Nairobi, Kenya. This study administered a survey to pregnant women at the two referral hospitals in Nairobi: Aga Khan University Hospital (AKUH) and Pumwani Maternity Hospital (PMH). A total of 400 women took the survey. Pregnant women with college level education were more likely to have been vaccinated for COVID-19 compared to pregnant women without a college education. Women registered or visiting for pregnancy and delivery care from AKUH Kenya were also more likely to be vaccinated compared to women receiving care from PMH. Despite this difference in COVID-19 vaccine uptake, women from both the hospitals had similar reasons for receiving or refusing a COVID-19 vaccine. a Our findings align with previous studies that have showed that education status correlates positively with COVID-19 vaccination among pregnant women. To improve maternal vaccination acceptance, education status can be used as a way to segment audiences to inform messaging and other demand generation efforts.