Explore the vast range of titles available.

ObjectiveDespite being globally recommended as an effective intervention in tuberculosis (TB) prevention among people living with HIV, isoniazid preventive therapy (IPT) implementation remains suboptimal, especially in sub-Saharan Africa. This study explored the factors influencing the acceptability of IPT among healthcare providers in selected HIV clinics in Nairobi County, Kenya, a high HIV/TB burden country.DesignA qualitative study was conducted using in-depth interviews with healthcare providers in selected HIV clinics. All conversations were audio recorded, transcribed verbatim and analysed using a thematic approach.SettingThe study was conducted in the HIV clinics of three purposefully selected public healthcare facilities in Nairobi County, Kenya between February 2017 and April 2017.ParticipantsEighteen purposefully selected healthcare providers (clinicians, nurses, pharmacists and counsellors) working in the HIV clinics participated in the study.ResultsProvider acceptability of IPT was influenced by factors relating to the organisational context, provider training on IPT and their perception on its efficacy, length and clarity of IPT guidelines and standard operation procedures, as well as structural factors (policy, physical and work environment). Inadequate high-level commitment and support for the IPT programme by programme managers and policy-makers were found to be the major barriers to successful IPT implementation in our study context.ConclusionThis study provides insight into the complexity of factors affecting the IPT implementation in Kenya. Ensuring optimal acceptability of IPT among healthcare providers will require an expanded depth of engagement by policy-makers and IPT programme managers with both providers and patients, as well as on-the-job design specific actions to support providers in implementation. Such high-level commitment and support are consequently essential for quality delivery of the intervention.

Background: Integrated care is increasingly recognised as a key strategy for the management of multimorbidity. However, evidence on the factors associated with the implementation of integrated care models in low- and middle-income countries (LMICs) remains limited. We explored stakeholders' perceptions on existing challenges and recommendations for implementing integrated care at primary health care (PHC) level to tackle cardiometabolic multimorbidity in Kenya. Approach: We conducted a qualitative study using key informant interviews (KIIs) with 16 key stakeholders involved in healthcare delivery, research, and policy on non-communicable diseases (NCDs) in Kenya. All interviews were audio recorded, transcribed verbatim; and the data analysed both inductively and deductively using qualitative data analysis software Nvivo.  The analysis was guided by the Rainbow Model of Integrated Care (RMIC) framework. Data were collected between February and March 2024. Results: Integrated care was perceived mainly from the clinical (holistic care provision), systems (guidelines and standards promoting comprehensive healthcare delivery), and professional (interdisciplinary coordination centred around the healthcare providers) dimensions of the RMIC framework. Key challenges identified included disparity between policy and practice, inadequate resources, donor-driven priorities, limited stakeholder collaboration, limited capacity and human resources, siloed mindset, poor advocacy and limited evidence. Stakeholders recommended developing clear guidelines, enhancing stakeholder engagement, adequate planning and budgeting, improving staff availability and capacity, adequate resources, improving advocacy, evidence, and deliberate configuration of the health system to facilitate integrated care implementation. Conclusion: To address the barriers to facilitate effective integration of cardiometabolic diseases at PHC level in Kenya, there is a need for developing clear guidelines, aligning donor priorities to promote integrated care, engaging stakeholders, improving resource allocation, and building healthcare capacity for implementation.  

ObjectiveUnderstanding the facilitators and barriers to managing hypertension and type 2 diabetes (T2D) will inform the design of a contextually appropriate integrated chronic care model in Kenya. We explored the perceived facilitators and barriers to the integrated management of hypertension and T2D in Kenya using the Rainbow Model of Integrated Care.DesignThis was a qualitative study using data from a larger mixed-methods study on the health system response to chronic disease management in Kenya, conducted between July 2019 and February 2020. Data were collected through 44 key informant interviews (KIIs) and eight focus group discussions (FGDs).SettingMultistage sampling procedures were used to select a random sample of 12 study counties in Kenya.ParticipantsThe participants for the KIIs comprised purposively selected healthcare providers, county health managers, policy experts and representatives from non-state organisations. The participants for the FGDs included patients with hypertension and T2D.Outcome measuresPatients’ and providers’ perspectives of the health system facilitators and barriers to the integrated management of hypertension and T2D in Kenya.ResultsThe clinical integration facilitators included patient peer support groups for hypertension and T2D. The major professional integration facilitators included task shifting, continuous medical education and integration of community resource persons. The national referral system, hospital insurance fund and health management information system emerged as the major facilitators for organisational and functional integration. The system integration facilitators included decentralisation of services and multisectoral partnerships. The major barriers comprised vertical healthcare services characterised by service unavailability, unresponsiveness and unaffordability. Others included a shortage of skilled personnel, a lack of interoperable e-health platforms and care integration policy implementation gaps.ConclusionsOur study identified barriers and facilitators that may be harnessed to improve the integrated management of hypertension and T2D. The facilitators should be strengthened, and barriers to care integration redressed.

Background Decentralisation has increasingly been adopted by countries as an important health sector reform aimed at increasing community participation in decision making while enhancing swift response at decentralised levels, to accelerate the attainment of health system goals. Kenya adopted a devolved system of government where health services delivery became a function of the 47 semi-autonomous county governments with planning and budgeting functions practised at both levels of government. This study sought to explore challenges facing health sector planning and budgeting and how they affect immunisation service delivery at the county level. Methods Data were collected through 77 in-depth interviews of senior county department of health officials across 15 counties in Kenya. We applied an inductive thematic approach in analysing the qualitative data using NVIVO software. Findings The study found a lack of alignment between planning and budgeting processes, with planning being more inclusive compared to budgeting. Inadequate capacity in conducting planning and budgeting and political interference were reported to hinder the processes. Limited budget allocations and delayed and untimely disbursement of funds were reported to affect execution of health and immunisation budgets. Low prioritisation of preventive health interventions like immunisation due to their perceived intangibility influenced resource allocation to the programs. Conclusion The findings highlight the need for effective strategies to align planning and budgeting processes, increased technical support to counties to enhance the requisite capacity, and efforts to improve budget execution to improve budget credibility. Counties should plan to increase their funding commitment toward immunisation to ensure sustainability of the program as Kenya transitions from GAVI support.

Introduction: Integrated care is increasingly adopted to address the needs of patients with multimorbidity, but cost-effective configuration of integrated healthcare pathways remains unclear. This study reviewed decision analytic models (DAMs) used in economic evaluations of integrated care interventions for cardiometabolic multimorbidity. Methods: A systematic search of eight electronic databases was conducted to identify peer-reviewed articles published in English until November 2024. Studies using DAMs to evaluate integrated care interventions for patients at risk or having cardiometabolic multimorbidity were included. Data on DAMs characteristics, integrated care models evaluated, and diseases were summarised. The quality of reporting was assessed using Philips (2006) checklist. Results: Sixteen studies met inclusion criteria. Most studies (81%) were cost utility analyses, focused on hypertension and/or diabetes concordant multimorbidity (69%). High-income countries accounted for 69% of the studies. Markov models were used the most (63%), with only three studies employing individual patient simulation (microsimulation) models. Few studies were explicit about data validation and reporting uncertainty. Conclusion: Economic evaluations of integrated care cardiometabolic multimorbidity should adopt microsimulation to better capture patient-level interactions and health outcomes. Better reporting of validation and uncertainty is needed. There is limited application of DAM-based economic evaluations of integrated care in low- and middle-income countries.

ObjectiveThe burden of non-communicable diseases is rising in low-and-middle-income countries, with diet being a key risk factor. This study aimed to assess the patterns, socioeconomic inequalities and determinants of eating healthy in Kenya. The study is the first in Kenya to use a healthy diet index to assess dietary patterns.Design and methodsWe analysed cross-sectional data from the 2015/16 Kenya Integrated Household Budget Survey. The study’s outcome variable was a continuous healthy diet index (HDI) constructed using principal component analysis from nine WHO/Food and Agriculture Organization (FAO) healthy diet recommendations. The HDI score and WHO/FAO healthy diet recommendations met were summarised for Kenyan households. Using the concentration index, we examined the socioeconomic disparities in healthy eating. In addition, multivariable linear regression was used to determine factors that influence healthy eating in Kenya.ResultsA total of 21 512 households in Kenya were included, of which 60% were rural and about two-thirds headed by males. The HDI score ranged between −1.13 and 1.70, with a higher value indicating healthier eating. Overall, the average HDI score was 0.24 (95% CI: 0.24 to 0.25), interpreted as moderate. We identified key determinants including socioeconomic status and urban–rural residency differences. Healthy eating was concentrated among higher socioeconomic households, regardless of gender or location. Higher socioeconomic status (β=0.28, 95% CI 0.26 to 0.30), rural residence (β=0.18, 95% CI 0.15 to 0.20), household head being in union (β=0.04, 95% CI 0.02 to 0.06) or employed (β=0.05, 95% CI 0.02 to 0.08) were significantly associated with increased HDI scores, whereas male-headed households and lack of education were associated with significant decreases in HDI scores on average.ConclusionsMost Kenyan households do not meet all the healthy dietary recommendations, and socioeconomic inequalities exist in eating healthy. Targeted interventions that promote healthy eating based on key determinants in Kenya are required.

Introduction Adequate nutrition is essential for proper growth, development, and disease prevention during the first 1000 days of life. Introducing solid, semi-solid, or liquid foods in addition to breast milk, also known as complementary feeding (CF), earlier or later than the recommended 6 months, is associated with poor nutritional outcomes in children under the age of two. Given the limited evidence, this study aimed to determine the factors associated with timely complementary feeding in children aged 6–23 months. Methods We used data from the first round of Kenya’s 2017 Performance Monitoring for Action (PMA) survey. The dependent variable, timely CF, was defined as “the introduction of other feeds apart from breast milk at 6 months.” Frequencies, percentages, and 95% confidence intervals were used to describe the sample characteristics and prevalence of timely CF. Univariable and multivariable logistic regression analyses were performed to examine the determinants of timely complementary feeding. Results Of the 3,084 mothers included in the study, most were married (82.1%), aged 20–34 years (78.8%), and unemployed (75.5%). The overall weighted prevalence of timely CF was 51.7% (95% CI 47.6, 55.9), with a higher prevalence among the richest (66.6%), urban residents (60.6%), and mothers with a tertiary education (61.1%). After adjusting for other covariates, mothers aged 20–34 years had lower odds of practicing timely complementary feeding than those aged 35–49 years (aOR = 0.72, 95% CI: 0.52–0.99). Similarly, children from wealthier households were more likely to receive timely complementary feeding, with the odds increasing across wealth quintiles from the poorer (aOR = 1.69, 95% CI: 1.30–2.19) to the richest (aOR = 3.32, 95% CI: 1.97–5.60). Conclusion Timely complementary feeding remains suboptimal in Kenya despite strong policy frameworks, indicating implementation gaps and the need for targeted interventions to address socioeconomic and regional disparities.

ObjectiveTo determine the prevalence of health insurance and associated factors among households in urban slum settings in Nairobi, Kenya.DesignThe data for this study are from a cross-sectional survey of adults aged 18 years or older from randomly selected households in Viwandani slums (Nairobi, Kenya). Respondents participated in the Lown scholars’ study conducted between June and July 2018.SettingThe Lown scholars’ survey was nested in the Nairobi Urban Health and Demographic Surveillance System in Viwandani slums in Nairobi, Kenya.ParticipantsA total of 300 randomly sampled households participated in the survey. The study respondents comprised of either the household head, their spouses or credible adult household members.Primary outcome measureThe primary outcome of this study was enrolment in a health insurance programme. The households were classified into two groups: those having at least one member covered by health insurance and those without any health insurance cover.ResultsThe prevalence of health insurance in the sample was 43%. Being unemployed (adjusted OR (aOR) 0.17; p<0.05; 95% CI 0.06 to 0.47) and seeking care from a public health facility (aOR 0.50; p<0.05; 95% CI 0.28 to 0.89) was significantly associated with lower odds of having a health insurance cover. The odds of having a health insurance cover were significantly lower among respondents who perceived their health status as good (aOR 0.62; p<0.05; 95% CI 1.17 to 5.66) and those who were unsatisfied with the cost of seeking primary care (aOR 0.34; p<0.05; 95% CI 0.17 to 0.69).ConclusionsHealth insurance coverage in Viwandani slums in Nairobi, Kenya, is low. As universal health coverage becomes the growing focus of Kenya’s ‘Big Four Agenda’ for socioeconomic transformation, integrating enabling and need factors in the design of the national health insurance package may scale-up social health protection.

Sugar-sweetened beverages (SSBs) are major sources of free sugars in diet and have been linked to obesity, chronic diseases, and increased risk of premature deaths. Evidence suggests that the health impacts of SSBs may be greater among females than males; however, there is limited evidence on SSB consumption among women, especially in low-and middle-income countries. Therefore, we aimed to determine the prevalence and factors associated with SSB consumption among women aged 10-49 years in Kenya using secondary data from the first and second rounds of Kenya's Performance Monitoring for Action (PMA) nutrition surveys. We stratified the analysis by residence (rural vs. urban), and used univariable and multivariable logistic regression to assess the determinants of SSB consumption. The prevalence of SSB consumption among women was 52.4% (95% CI 47.9, 56.8). The prevalence of SSB consumption was higher in urban than rural areas (53.2% vs. 51.7%) and was high among women aged 20-29 years (54.1%), women in union (52.9%), women with tertiary level of education (59.1%), and women from the richest households (52.4%). Urban women had 1.29 times higher odds of SSB consumption compared to rural women. Moreover, education level was significantly associated with SSB consumption, with higher education linked to increased odds of consumption. Overall, more than half of women aged 10-49 years reported consuming SSBs. These findings underscore the need for targeted policy interventions to reduce SSB consumption, especially among urban residents and individuals with higher socioeconomic status.

Gavi, the Vaccine Alliance, defined a transition roadmap for countries receiving funding support based on their income status projections. According to the latest projections, Kenya will complete their transition from vaccine funding in 2029. While eligible countries are kept informed and supported for a smooth transition process, the extent to which countries understand the significant implications of a complete end of GAVI support on immunization service delivery varies. Furthermore, whereas studies have been conducted to assess national preparedness for transition, there is a paucity of data on the understanding of subnational authorities of this process. In this study, we explored the perspectives of county-level stakeholders on Kenya's preparedness for GAVI transition. using purposive sampling, 77 senior county officials from 15 counties were selected for in-depth interviews. Data were collected using a semi-structured interview guide, transcribed, and thematically analysed. Ethical approval for the study was granted by Moi University Institutional Ethics and Research Committee. findings reveal a consensus among respondents that both national and county governments are not fully prepared for the end of the Gavi Alliance. Concerns were highlighted around a lack of knowledge about vaccine costs, post-transition funding sources, and potential disruptions in immunization services. Respondents advocated for a phased transition, continued donor support, clear funding allocation, and legislative measures to ensure financial sustainability. Moreover, advocacy and awareness efforts, capacity building, and a robust legal framework were emphasized as essential for a smooth transition. after the end of the financial support provided by Gavi Alliance, Kenya's immunization bill is expected to be significant. This study underscores the importance of effectively engaging the subnational (county) level authorities. Successful transition from Gavi's support requires a strategy that promotes awareness and improves communication regarding the expected impact of the impending transition from Gavi on sustainable immunization financing in Kenya.