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How do national identities matter in global health? Our paper addresses this question through a study of Kenya's vaccine diplomacy during the Covid-19 pandemic. It combines critical perspectives, challenging the neglect of African agency in international relations (IR), with constructivist approaches highlighting the importance of discourse in the exercise of agency. The insight that identity is an important resource in the realization of foreign policy goals is confirmed by our review of interventions by senior Kenyan leaders, as well as ministries and official bodies, concerned with vaccine procurement during the pandemic. Moreover, this material shows that identity is not pre-given, but rather performed in discourse, being adapted and renewed in speeches, briefings, policy documents, and so on. Identities are plural, not singular, drawing on historic and cultural resources proper to individual states. This allows us to link the range of identities performed during the Covid-19 pandemic to earlier moments in Kenya's diplomatic history, noting the continued pertinence of its image, variously, as 'an island of stability', 'a good global health citizen', 'a member of the pan-African community of states', and 'an active contributor to IR'. [ABSTRACT FROM AUTHOR]

Although the refugee phenomenon is not new and refugee camps are rarely temporary, in most cases, the procedures implemented within refugee camps have failed to apply principles of sustainability to ensure refugees' dignity and improve their quality of life, thereby helping them become independent and self-reliant. This improvement, in turn, may help them return to their homes in the future or may, at least, reduce the high cost and negative coping strategies associated with refugee camps and instead increase refugees' social integration within the host community. This paper discusses the procedures applied in both the Zaatari refugee camp in Jordan and the Dadaab Refugee Complex in Kenya and provides evidence regarding the extent to which they meet the United Nations 2030 Agenda for Sustainable Development without leaving refugees behind. Furthermore, this paper shows how sustainable development goals (SDGs) are interconnected in a refugee camp setting. This study concludes that refugee camps not only failed to align with 2030 agenda but failed to ensure refugees' basic rights where a more inclusive and sustainable approach is required to improve the refugees' quality of life and to help them live in dignity and reach self-reliance that can benefit both refugees and their host communities. [ABSTRACT FROM AUTHOR]

Community engagement is crucial for controlling disease outbreak and mitigating natural and industrial disasters. The COVID-19 pandemic has reconfirmed the need to elevate community engagement to build equity, trust and sustained action in future health promotion preparedness strategies. Using the health promotion strategy of strengthening community action enhances the opportunity for better outcomes. There is, therefore, a need to improve our understanding of community engagement practices during crises, scale-up good community engagement initiatives, and improve and sustain people-centered approaches to emergency responses. This paper presents five case studies from the United States, Singapore, Sierra Leone, Kenya and South Africa that demonstrate the potential strengths that can be nurtured to build resilience in local communities to help mitigate the impact of disasters and emergencies. The case studies highlight the importance of co-developing relevant education and communication strategies, amplifying the role of community leaders, empowering community members to achieve shared goals, assessing and adapting to changing contexts, pre-planning and readiness for future emergencies and acknowledgement of historic context. [ABSTRACT FROM AUTHOR]

Background This paper presents a descriptive analysis of the perceptions of Kenyan midwifery educators regarding the early impact of coronavirus disease 2019 (COVID-19) on the continuity of midwifery education. Methods A cross-sectional online survey was conducted among 51 midwifery/clinical medicine educators from 35 diploma training colleges from all eight regions of Kenya. Educators' concerns and satisfaction regarding the delivery of training during the early phases of the pandemic were expressed as proportions on a three-point Likert scale. Results Of the educators, 76% were extremely concerned about face-to-face teaching during the pandemic; 96% of educators had started delivering virtual teaching (VT), with only 41% being extremely confident in facilitating VT; and 97% were unsatisfied with the measures in place in their institutions to continue face-to-face teaching. Conclusion To minimise the impact of COVID-19 on midwifery education in Kenya, capacity building for VT and mitigation measures for safe in-person training are urgently needed. [ABSTRACT FROM AUTHOR]

Background Kawasaki disease (kDa) is a childhood vasculitides that affects small and medium-sized arteries. It is self-limiting but when left untreated can cause coronary artery aneurysms in about 25% of children1. The diagnosis is clinical and is made with the criteria of fever for at least five days, and at least four out of five other clinical signs: bilateral non-exudative conjunctivitis, oral mucous membrane changes, peripheral extremity changes, polymorphous rash, and cervical lymphadenopathy. Incomplete kDa is diagnosed with fever for at least five days and at least 2–3 of the principal signs, with suggestive lab investigations and lack of an alternative diagnosis1. kDa is named after Dr Tomisaku Kawasaki who first described it in 1967 in Japan2. The highest incidence of kDa continues to be reported among Asian children, with an incidence rate of 264.8 per 100 000 population aged 0–4 years as per Japan's latest nationwide survey3. In Africa, the true incidence is unknown but several case reports have been published. A 2016 paper by Gorrab et al.4 found that the annualized incidence rate of kDa in the Maghreb children living in Quebec (18.49/year/100 000 children under 5 years of age) was 4–12 times higher than reported in their countries of origin- Tunisia, Morocco, and Algeria (0.95, 4.52, and 3.15, respectively) suggesting a likelihood of under-diagnosis. This case series sought to highlight the characteristics, presentation, and management of patients diagnosed with kDa in a tertiary hospital in Kenya. Methods This was a retrospective cross-sectional study carried out by reviewing the charts of all the patients with a discharge diagnosis of kDa from January 2013 to December 2017 at the Aga Khan University Hospital, Nairobi. Their demographics, presentation, diagnostic work-up, and management are reported. Analysis was done by descriptive statistics using the Microsoft Excel 2016 Application. Results A total of 15 cases were identified and the patient characteristics and presentation are as tabulated below: Characteristic.  n (%).  Age (mean+/-SD, range, years)   2+/-1.5 (0.3-5.7)  Sex—Males   8 (53.3)  Duration of fever at diagnosis (mean +/-SD, range, days)   6.8+/-3.4 (2-13)  Incomplete KD   7 (46.7)  Clinical Features: Fever   15 (100)  Oral Changes   15 (100)  Extremity changes   12 (80)  Cervical lymphadenopathy   9 (60)  Non-exudative conjunctivitis   8 (53.3)  Characteristic.  n (%).  Age (mean+/-SD, range, years)   2+/-1.5 (0.3-5.7)  Sex—Males   8 (53.3)  Duration of fever at diagnosis (mean +/-SD, range, days)   6.8+/-3.4 (2-13)  Incomplete KD   7 (46.7)  Clinical Features: Fever   15 (100)  Oral Changes   15 (100)  Extremity changes   12 (80)  Cervical lymphadenopathy   9 (60)  Non-exudative conjunctivitis   8 (53.3)  Open in new tab Characteristic.  n (%).  Age (mean+/-SD, range, years)   2+/-1.5 (0.3-5.7)  Sex—Males   8 (53.3)  Duration of fever at diagnosis (mean +/-SD, range, days)   6.8+/-3.4 (2-13)  Incomplete KD   7 (46.7)  Clinical Features: Fever   15 (100)  Oral Changes   15 (100)  Extremity changes   12 (80)  Cervical lymphadenopathy   9 (60)  Non-exudative conjunctivitis   8 (53.3)  Characteristic.  n (%).  Age (mean+/-SD, range, years)   2+/-1.5 (0.3-5.7)  Sex—Males   8 (53.3)  Duration of fever at diagnosis (mean +/-SD, range, days)   6.8+/-3.4 (2-13)  Incomplete KD   7 (46.7)  Clinical Features: Fever   15 (100)  Oral Changes   15 (100)  Extremity changes   12 (80)  Cervical lymphadenopathy   9 (60)  Non-exudative conjunctivitis   8 (53.3)  Open in new tab In addition to elevated inflammatory markers (C reactive protein and/or Erythrocyte Sedimentation Rate), a significant number of the patients also had sterile pyuria (9/9), hypoalbuminemia (8/10), thrombocytosis (8/15), and anaemia (11/15). Nine out of eleven had negative blood cultures. Fourteen out of the fifteen patients had echocardiograms done during admission. Only one patient was found to have abnormal findings of bilaterally dilated coronaries arteries. Five patients had at least one documented repeat echocardiogram. Fourteen patients received Intravenous Immunoglobulin (IVIG), with 13 of them responding to treatment. No adverse effects were reported after treatment. One patient did not improve and needed a second dose of IVIG and intravenous methylprednisone (30 mg/kg). Fourteen patients received aspirin but dosing varied from high (80–90 mg/kg/day) to moderate (30–50 mg/kg/day) to low dose (3 mg/kg/day). One patient on high-dose aspirin was noted to have developed symptoms consistent with aspirin-induced bronchospasm and was changed to low dose. Conclusion This case series highlights the presence of kDa in the Kenyan pediatric population with patient characteristics similar to what is reported globally. Diagnosis was made after a mean of about 7 days, possibly due to low awareness of the disease among healthcare professionals. Management with IVIG in most cases was successful but more guidance is needed around the use of steroids and the dosing of aspirin. [ABSTRACT FROM AUTHOR]