Use of mobile technology to identify behavioral mechanisms linked to mental health outcomes in Kenya: protocol for development and validation of a predictive model

Objective:This study proposes to identify and validate weighted sensor stream signatures that predict near-term risk of a major depressive episode and future mood among healthcare workers in Kenya. Approach: The study will deploy a mobile application (app) platform and use novel data science analytic approaches (Artificial Intelligence and Machine Learning) to identifying predictors of mental health disorders among 500 randomly sampled healthcare workers from five healthcare facilities in Nairobi, Kenya. Expectation: This study will lay the basis for creating agile and scalable systems for rapid diagnostics that could inform precise interventions for mitigating depression and ensure a healthy, resilient healthcare workforce to develop sustainable economic growth in Kenya, East Africa, and ultimately neighboring countries in sub-Saharan Africa. This protocol paper provides an opportunity to share the planned study implementation methods and approaches. Conclusion: A mobile technology platform that is scalable and can be used to understand and improve mental health outcomes is of critical importanc

Mental Health during COVID-19 Pandemic among Caregivers of Young Children in Kenya’s Urban Informal Settlements. A Cross-Sectional Telephone Survey

The emergence of COVID-19 has profoundly affected mental health, especially among highly vulnerable populations. This study describes mental health issues among caregivers of young children and pregnant women in three urban informal settlements in Kenya during the first pandemic year, and factors associated with poor mental health. A cross-sectional telephone survey was administered to 845 participants. Survey instruments included the Patient Health Questionnaire-9, General Anxiety Disorder-7 scale, COVID-19 Anxiety Scale, and questions on the perceived COVID-19 effects on caregiver wellbeing and livelihood. Data were analyzed using descriptive statistics, and univariate and multivariate analysis. Caregivers perceived COVID-19 as a threatening condition (94.54%), affecting employment and income activities (\u3e80%). Caregivers experienced discrimination (15.27%) and violence (12.6%) during the pandemic. Levels of depression (34%), general anxiety (20%), and COVID-19 related anxiety (14%) were highly prevalent. There were significant associations between mental health outcomes and economic and socio-demographic factors, violence and discrimination experiences, residency, and perceptions of COVID-19 as a threatening condition. Caregivers high burden of mental health problems highlights the urgent need to provide accessible mental health support. Innovative and multi-sectoral approaches will be required to maximize reach to underserved communities in informal settlements and tackle the root causes of mental health problems in this population

Health seeking behaviors and childcare patterns in an informal settlement of Nairobi, Kenya: a cross-sectional study

Children in urban informal settlements experience high risks for poor health and development. Understanding health seeking behaviors and childcare patterns of caregivers in urban informal settlements is important for devising effective interventions. This study describes household characteristics and aspects of nurturing care among caregivers of children aged 0–2 years in Dagoretti informal settlement, Nairobi-Kenya. In this cross sectional study, data were collected on household socio-demographic characteristics, antenatal care and child delivery practices, infant and young child feeding practices, activities that promote play, learning and school readiness, and on childcare and protection practices. Descriptive statistics of proportions and means were used to summarize the data. The study covers a total of 458 Kenyan and 118 immigrant households. Caregivers from immigrant households, with low education and from the younger age-group (less than 20 years) were vulnerable to sub-optimal caregiving and health seeking practices, including relatively lower rates of age-appropriate breastfeeding and poor dietary diversity. Seventy-five percent of expectant mothers attended less than four antenatal care visits. Households surveyed had limited possession of children’s books (2% with three or more books), limited access to play materials (43% had two or more play materials), and low paternal involvement in child stimulation and early learning activities (14%). One-third and half of the children were left with inadequate care and disciplined using both violent and non-violent methods, respectively. Our findings highlight the urgent need for contextually appropriate and integrated interventions anchored in the WHO’s nurturing care framework. These interventions can benefit from extensive involvement of caregivers, facility and community-based healthcare workers, policy makers, and other relevant stakeholders

Stakeholders’ perspectives of enablers and barriers to successfully implementing an integrated early childhood development program in an informal urban settlement in Kenya

Integrated early childhood development (ECD) programs boost child health and developmental outcomes. However, the factors contributing to the successful implementation of such programs in informal urban settlements are not well researched. We conducted 14 focus group discussions and 13 key informant interviews with 125 caregivers of children under the age of 5 years and stakeholders, exploring their views on enablers and barriers to implementing an integrated ECD program in an informal settlement in Kenya. Strategic engagement, capacity building, transparency, fair compensation of ECD workforce, communication skills, and the need to tailor ECD programs to local realities were discussed. An equity-focused implementation approach for integrated ECD programs is timely

Leaving No One Behind: A Photovoice Case Study on Vulnerability and Wellbeing of Children Heading Households in Two Informal Settlements in Nairobi

Children heading households (CHH) in urban informal settlements face specific vulnerabilities shaped by limitations on their opportunities and capabilities within the context of urban inequities, which affect their wellbeing. We implemented photovoice research with CHHs to explore the intersections between their vulnerabilities and the social and environmental context of Nairobi’s informal settlements. We enrolled and trained four CHHs living in two urban informal settlements—Korogocho and Viwandani—to utilise smartphones to take photos that reflected their experiences of marginalisation and what can be done to address their vulnerabilities. Further, we conducted in-depth interviews with eight more CHHs. We applied White’s wellbeing framework to analyse data. We observed intersections between the different dimensions of wellbeing, which caused the CHHs tremendous stress that affected their mental health, social interactions, school performance and attendance. Key experiences of marginalisation were lack of adequate food and nutrition, hazardous living conditions and stigma from peers due to the limited livelihood opportunities available to them. Despite the hardships, we documented resilience among CHH. Policy action is required to take action to intervene in the generational transfer of poverty, both to improve the life chances of CHHs who have inherited their parents’ marginalisation, and to prevent further transfer of vulnerabilities to their children. This calls for investing in CHHs’ capacity for sustaining livelihoods to support their current and future independence and wellbeing

Clonal expansion of community-associated meticillin-resistant Staphylococcus aureus (MRSA) in people who inject drugs (PWID)::Prevalence, risk factors and molecular epidemiology, Bristol, United Kingdom, 2012 to 2017

Background: In 2015, Bristol (South West England) experienced a large increase in cases of meticillin-resistant Staphylococcus aureus (MRSA) infection in people who inject drugs (PWID). Aim: We aimed to characterise and estimate the prevalence of MRSA colonisation among PWID in Bristol and test evidence of a clonal outbreak. Methods: PWID recruited through an unlinked-anonymous community survey during 2016 completed behavioural questionnaires and were screened for MRSA. Univariable logistic regression examined associations with MRSA colonisation. Whole-genome sequencing used lineage-matched MRSA isolates, comparing PWID (screening and retrospective bacteraemia samples from 2012-2017) with non-PWID (Bristol screening) in Bristol and national reference laboratory database samples. Results: The MRSA colonisation prevalence was 8.7% (13/149) and was associated with frequently injecting in public places (odds ratio (OR): 5.5; 95% confidence interval (CI):1.34–22.70), recent healthcare contact (OR: 4.3; 95% CI: 1.34–13.80) and injecting in groups of three or more (OR: 15.8; 95% CI: 2.51–99.28). People reporting any one of: injecting in public places, injection site skin and soft tissue infection or hospital contact accounted for 12/13 MRSA positive cases (sensitivity 92.3%; specificity 51.5%). Phylogenetic analysis identified a dominant clade associated with infection and colonisation among PWID in Bristol belonging to ST5-SCCmecIVg. Conclusions: MRSA colonisation in Bristol PWID is substantially elevated compared with general population estimates and there is evidence of clonal expansion, community-based transmission and increased infection risk related to the colonising strain. Targeted interventions, including community screening and suppression therapy, education and basic infection control are needed to reduce MRSA infections in PWID

Health, wellbeing and nutrition: Domain report

The escalation of global political, economic and ecological crises and associated price surges has contributed to interdependent forms of malnutrition – undernutrition, overweight and obesity – with enduring societal consequences. This study investigates the factors influencing the adoption of healthy diets in five African cities – Bukavu, DRC, Freetown, Sierra Leone, Kampala, Uganda, Lilongwe, Malawi and Nairobi, Kenya. It explores the engagement of policymakers, consumers, private actors and further stakeholders in food and health systems. Across all cities, rising food insecurity and the prevalence of non-communicable diseases (NCDs) linked to unhealthy dietary patterns, notably around consumption of ultra-processed foods, are observed. Despite urban residents generally experiencing lower food insecurity than rural counterparts, people with low incomes, particularly those living in informal settlements, remain vulnerable. Additional axes of vulnerability that intersect with low incomes are gender, age, disability and migrant/refugee status. Socioeconomic drivers that exacerbate food and nutrition insecurity include the high cost of nutritious diets, inadequate market, road, water and sanitation infrastructures, and the proliferation of unhealthy processed foods. Policy responses predominantly prioritise food quantity over quality, overlooking the importance of healthy diets. Additionally, profit-driven dynamics, within food and healthcare systems, and inconsistent resident knowledge of healthy, balanced diets, perpetuate the cycle of ill-health driven by poor nutrition, while informal food vendors, vital for low-income urbanites, face neglect or harassment. However, city governments possess avenues for intervention, such as awareness campaigns, social security mechanisms, and social and technical infrastructure support for water and sanitation, markets and street vendors. Primary healthcare services and community health workers play crucial roles in addressing malnutrition, youth development and adolescent health. Multisectoral collaboration is advocated for broadening the impact of strategic interventions from neighbourhood to city level. Reform efforts necessitate broad coalitions, encompassing governments, civil society and the private sector

The role of transformational leadership on millennials’ dedication in level five private hospitals in Kenya

The primary intent of this study is to establish the role of transformational governance on millennials’ dedication to level - 5 private hospitals in Kenya. A mixed methods study was applied using a cross-sectional exploratory survey design with quantitative and qualitative approaches. The sample comprised millennials and their leaders working in level - 5 private hospitals. The sample size was 415 respondents. Five-level multi-stage cluster sampling and purposeful sampling were used. The study findings indicated that individualized consideration and intellectual stimulation influenced millennial dedication. This study has provided actionable insights into leading millennials to safeguard millennial engagement in Kenyan healthcare. Furthermore, to be dedicated, millennials require close monitoring and support. The millennials’ values differ from those of other generations, and they prefer challenges when they get bored with routine work. However, there are two categories of millennials; the older millennials are more responsible and resilient than the younger millennials, who are not dedicated

Effects of crude kerosene on testosterone levels, aggression and toxicity in rat

The use of crude kerosene as a dietary supplement in boarding schools has been a common practice in east Africa and other countries for many years, with the belief of it reducing the sex drive (libido) at the pubertal stage. There is however no scientific basis for this belief. The present study aimed at using a rat animal model to investigate the effects of crude kerosene on serum testosterone levels, aggression and its possible toxic effects. Fifteen male albino rats of approximately similar age and average weights were put into three groups of five animals each; the control group (placebo), low kerosene dose (10 μl/day) group and high kerosene dose (300 μl/day) group. ELISA was used to determine the serum testosterone levels. During treatment, changes in aggression were observed and noted. Liver toxicity was determined using enzyme assays, total protein and albumin while renal toxicity was monitored using serum creatinine levels. A full hemogram was conducted to determine hematological effects. Various tissue biopsies were obtained and examined using histopathological techniques for evidence of toxicity. Contrary to the common belief, our findings showed an overall increase of serum testosterone levels of up to 66% in the low dose and 75% in the high dose groups, with an increasing trend by the end of the study. The high dose group showed significantly increased levels of white blood cells (WBC) (p = 0.036), red blood cells (RBC) (p = 0.025), hematocrit (HCT) (p = 0.03), red cell distribution width (p = 0.028) and platelets (p = 0.017). The histological results of the stomach indicated chronic gastritis