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This protocol lays the groundwork for a community-centered investigation into the intersection between climate change and violence against women and girls. Providing a standardized framework, this paper will enable researchers to collect and analyze data on severe weather patterns and their potential impact on violence within communities. The interlinkage between violence and climate is an emerging field of research. There is a need for a comprehensive understanding of the intersection of these two issues focusing on the manifestations of violence, specific vulnerabilities, and coping strategies. This protocol outlines a qualitative research approach employed in Kilifi County, Kenya. The study will include key informant interviews with community leaders and policymakers, along with focus group discussions with women, adolescent girls, and men. Community engagement is a crucial component of this work as it will ensure that the research is conducted ethically and respectfully and ensure that the findings are relevant and applicable to the community being studied. This study will contribute to a deeper understanding of the complex dynamics between violence against women and girls and climate change, informing policies, interventions, and advocacy efforts and elevating the voices of women and girls to promote gender equity in the face of climate change challenges. [ABSTRACT FROM AUTHOR]

Equitable partnerships across borders, sectors and communities are integral in creating shared understanding, novel solutions and sustainable development. Sustainable development goal (SDG) 17: Partnerships for goals, focuses on strengthening global partnerships. This highlights the importance of partnership as a tool to support the achievement of all SDGs. Partnerships are particularly vital to creating sustainable and appropriate services to support people who experience communication or swallowing disability and their families, in under-served communities, where services and expert personnel may be limited and where innovative strategies are required for working with families and communities to improve service accessibility. To reflect on key principles underpinning the creation of a speech–language pathologists' (SLPs') community of practice, designed to support SLPs from high-, low- and middle-income countries to develop equitable partnerships, aimed at supporting people who experience communication or swallowing disability their families. We draw on the authors' experiences of building partnerships to enhance participation for people who experience communication or swallowing disability. We discuss the need for global partnerships and challenges with current funding mechanisms. We use the principles of the speech–language pathology community of practice and concepts from the Partnership Accelerator 2030 Agenda to frame reflections and recommendations. This commentary paper focuses on partnerships for the goals (SDG 17). [ABSTRACT FROM AUTHOR]

Minority World countries have often been involved in supporting services for people with communication disability (PWCD) in Majority World countries. In East Africa, this support has historically involved speech-language pathologists (SLPs) from Minority World countries providing therapy; later evolving to include partnerships between Majority and Minority World organisations providing education, training, and support—sometimes with the aim of increasing service sustainability. Our objective is to provide an overview of how partnerships for the goals (SDG 17) has been realised for speech-language pathology services in three East African countries (Uganda, Kenya, and Rwanda). For SLPs, we consider training and education, research opportunities, and the development of the profession. For PWCD, we consider the equity of services. We identify key challenges and successes of UK/East African partnerships, identifying steps for improvement for robust speech-language pathology partnerships. We suggest three key approaches for better-designed partnerships: (1) Improve accessibility, by expanding services to rural areas and coordinating fee setting. (2) Ensure local stakeholders and professionals are included in meaningful and agreed ways. (3) Ensure partnerships complement existing services and are culturally appropriate. These approaches support related goals to achieve better services for PWCD. This commentary paper focuses on good health and well-being (SDG 3); quality education (SDG 4); decent work and economic growth (SDG 8); industry, innovation, and infrastructure (SDG 9); reduced inequalities (SDG 10); partnerships for the goals (SDG 17). [ABSTRACT FROM AUTHOR]

Financial technology tools have been utilised to create readily available mobile loan platforms for urban-based, daily-wage earners in Kenya. From a financial lending perspective, this development signals greater inclusion and equality in formal bank financing systems. In this paper, however, we examine mobile loans and their repayment from the perspective of women who sell sex in Nairobi, drawing upon the qualitative findings of two community-based studies conducted in close collaboration with sex worker-led organisations serving the sexual health needs of their peers. Our findings suggest that mobile loans may undermine the financial security strategies and economic independence of sex workers, leaving these women in more precarious economic circumstances, which have been shown in other instances to have effects on sexual risk taking and vulnerability to HIV infection. [ABSTRACT FROM AUTHOR]

Since the 1990s, researchers have used community-based participatory approaches to achieve outcomes relevant to local communities, to build collaborative and sustainable research infrastructures, and to address disparities in knowledge production. Notwithstanding these strengths, communities and researchers have questioned its success in addressing power imbalances inherent in collaborative research encounters. In this methodological paper, we describe a novel community-based program science approach to guide an interdisciplinary research project on HIV self-testing among men who have sex with men in three Kenyan counties. Drawing on ethnographic field notes, we detail how community researchers and their academic and programmatic partners collaborated through all phases of the research process, including research design and data collection. Importantly, community researchers also played an integral role in data analysis and dissemination, going well beyond the conventional role of 'community engagement' in global health research. We also present findings from qualitative interviews conducted by community researchers with their peers to inform the rollout of HIV self-testing kits in their respective county-contexts. Our approach highlights that engaging community directly in evidence production allows research findings – owned and generated by communities on their own behalf – to be fed more swiftly and effectively into community-led program delivery. [ABSTRACT FROM AUTHOR]

Background: The changing diabetes in children (CDiC) project is a public‐private partnership implemented by Novo Nordisk, to improve access to diabetes care for children with type 1 diabetes. This paper outlines the findings from an evaluation of CDiC in Bangladesh and Kenya, assessing whether CDiC has achieved its objectives in each of six core program components. Research design and methods: The Rapid Assessment Protocol for Insulin Access (RAPIA) framework was used to analyze the path of insulin provision and the healthcare infrastructure in place for diagnosis and treatment of diabetes. The RAPIA facilitates a mixed‐methods approach to multiple levels of data collection and systems analysis. Information is collected through questionnaires, in‐depth interviews and focus group discussions, site visits, and document reviews, engaging a wide range of stakeholders (N = 127). All transcripts were analyzed thematically. Results: The CDiC scheme provides a stable supply of free insulin to children in implementing facilities in Kenya and Bangladesh, and offers a comprehensive package of pediatric diabetes care. However, some elements of the CDiC program were not functioning as originally intended. Transitions away from donor funding and toward government ownership are a particular concern, as patients may incur additional treatment costs, while services offered may be reduced. Additionally, despite subsidized treatment costs, indirect costs remain a substantial barrier to care. Conclusion: Public‐private partnerships such as the CDiC program can improve access to life‐saving medicines. However, our analysis found several limitations, including concerns over the sustainability of the project in both countries. Any program reliant on external funding and delivered in a high‐turnover staffing environment will be vulnerable to sustainability concerns. [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]

Objective: Antimicrobial resistance (AMR) is a global health crisis that threatens to undermine the achievement of Sustainable Development Goal 3, which calls for promoting the health and well-being of all people. AMR prevention and healthcare innovation are essential to Kenya's healthcare system. This study examined the incorporation of transformative elements in interventions that facilitate the implementation of Antimicrobial Stewardship (AMS) in Kenya's decentralised healthcare system. Materials and Methods: The authors conducted a systematic review of technical documents to identify six transformative elements of AMR interventions: directionality, societal goals, impact on the healthcare system, learning versus reflection, conflict resolution and consensus building, and inclusiveness. Results: Kenya's healthcare regulations are strategically in line with its constitution, national development goals, and international commitments. A multidisciplinary approach is guaranteed by the coordination of initiatives across ministries, research institutes, academia, and civil society through several inter-agency committees. The development of healthcare networks and the integration of traditional medicine into conventional healthcare are two factors that support innovative practices. Conclusion: Kenya's healthcare system has made significant progress in implementing AMR prevention and healthcare innovation policies and programs. Active stakeholder participation, particularly from marginalized communities, promotes inclusivity and system-wide impact. However, challenges remain, including resource allocation, policy coordination, and innovation barriers. Continuous learning, reflection, and adaptation are essential for successful AMR stewardship and dispute resolution caused by restrictive regulations. [ABSTRACT FROM AUTHOR]

Aim: We explore how nurses navigate competing work demands in resource‐constrained settings and how this shapes the enactment of nursing roles. Design: An exploratory‐descriptive qualitative study. Methods: Using individual in‐depth interviews and small group interviews, we interviewed 47 purposively selected nurses and nurse managers. We also conducted 57 hours of non‐participant structured observations of nursing work in three public hospitals. Results: Three major themes arose: (i) Rationalization of prioritization decisions, where nurses described prioritizing technical nursing tasks over routine bedside care, coming up with their own 'working standards' of care and nurses informally delegating tasks to cope with work demands. (ii) Bundling of tasks describes how nurses were sometimes engaged in tasks seen to be out of their scope of work or sometimes being used to fill for other professional shortages. (iii) Pursuit of professional ideals describes how the reality of how nursing was practised was seen to be in contrast with nurses' quest for professionalism. [ABSTRACT FROM AUTHOR]

Background: Given the high burden of adverse sexual and reproductive health outcomes (SRH) and low levels of school attendance among adolescent girls in Kenya, this study sought to elucidate the association between school attendance and SRH outcomes among adolescent girls in Homa Bay and Narok counties. Methods: This study uses baseline quantitative data from the mixed-methods evaluation of the In Their Hands (ITH) program which occurred between September to October 2018 in Homa Bay and Narok counties. In total, 1840 adolescent girls aged 15–19 years participated in the baseline survey, of which 1810 were included in the present analysis. Multivariable logistic regression models were used to assess the association between school attendance (in- versus out-of-school) and ever having sex, condom use during last sex, and ever pregnant, controlling for age, orphan status, income generation, religion, county, relationship status, and correct SRH knowledge. Results: Across the 1810 participants included in our study, 61.3% were in-school and 38.7% were out-of-school. Compared to adolescent girls who were in-school, those out-of-school were more likely (AOR 5.74 95% CI 3.94, 8.46) to report ever having sex, less likely (AOR: 0.21, 95% CI 0.16, 0.31) to have used a condom during their last sexual intercourse, and more likely (AOR: 6.98, 95% CI 5.04, 9.74) to have ever been pregnant. Conclusions: School attendance plays an integral role in adolescent girls' SRH outcomes, and it is imperative that policy actors coordinate with the government and community to develop and implement initiatives that support adolescent girls' school attendance and education. Plain Language Summary: Adolescent girls in Kenya experience poor sexual and reproductive health outcomes (SRH) and have low levels of educational attainment. In this study, we aimed to examine if school attendance was associated with sexual and reproductive health outcomes among adolescent girls aged 15 to 19 years in Homa Bay and Narok counties in Kenya. The study used data from the evaluation of the In Their Hands (ITH) program which occurred between September to October 2018. A total of 1840 adolescent girls years participated in the baseline survey, of which 1810 were included in this study. We found that compared to adolescent girls in-school, those who were out-of-school were significantly more likely to report ever having sex, less likely to have used a condom during their last intercourse, and more likely to have ever been pregnant. This study found that attending school plays an important protective role in the SRH of adolescent girls. Therefore, it is important to develop and implement initiatives to support adolescent girls' school attendance, and ultimately their education attainment. [ABSTRACT FROM AUTHOR]

Medical internship is a key period for doctors' individual career planning and also a transition period for the broader labour market. We aimed to understand the complex set of factors influencing the career intentions and decisions of junior doctors, post-internship in Kenya and Uganda. We conducted semi-structured interviews with 54 junior medical officers and 14 consultants to understand doctors' internship experiences and subsequent employment experiences. We analysed the data using a mix of a direct content approach, informed by an internship experience and career intentions framework developed primarily from high-income country literature, alongside a more inductive thematic analysis. Echoing the internship experience and career intentions framework, we found that clinical exposure during internship, work–life balance, aspects of workplace culture such as relationships with consultants and other team members, and concerns over future job security and professional development all influenced Kenyan and Ugandan doctors' career preferences. Additionally, we added a new category to the framework to reflect our finding that interns might want to 'fill a health system gap' when they choose their future careers, based on what they witness as interns. However, often career intentions did not match career and employment decisions due to specific contextual factors, most importantly a shortage of job opportunities. We have shown how internship experiences shape medical doctors' career intentions in Kenya and Uganda and highlighted the importance of job availability and context in influencing doctors' career choices. [ABSTRACT FROM AUTHOR]

Global health researchers often discount mutual learning and benefit to address shared health challenges across high and low- and middle-income settings. Drawing from a 30-year partnership called AMPATH that started between Indiana University in the US and Moi University in Kenya, we describe an innovative approach and program for mutual learning and benefit coined 'reciprocal innovation.' Reciprocal innovation harnesses a bidirectional, co-constituted, and iterative exchange of ideas, resources, and innovations to address shared health challenges across diverse global settings. The success of AMPATH in Kenya, particularly in HIV/AIDS and community health, resulted in several innovations being 'brought back' to the US. To promote the bidirectional flow of learning and innovations, the Indiana CTSI reciprocal innovation program hosts annual meetings of multinational researchers and practitioners to identify shared health challenges, supports pilot grants for projects with reciprocal exchange and benefit, and produces educational and training materials for investigators. The transformative power of global health to address systemic health inequities embraces equitable and reciprocal partnerships with mutual benefit across countries and communities of academics, practitioners, and policymakers. Leveraging a long-standing partnership, the Indiana CTSI has built a reciprocal innovation program with promise to redefine global health for shared wellbeing at a global scale. [ABSTRACT FROM AUTHOR]

Urban refugees often face tremendous adversities during displacement that exacerbate mental health and psychosocial outcomes. Given the lack of research on how extended displacement affects mental health in urban refugee youth, this study examines the differential effects of country of birth on trauma exposure and psychosocial factors that influence mental health experiences among Somali refugee youth in urban Kenya (n = 303). Findings reveals that childhood trauma and impeded social functioning predicted mental health outcomes. Being born in Kenya was a significant predictor of poor mental health despite there being no significant difference in trauma exposures and psychosocial factors between Somali-born and Kenya-born youth. This difference can be attributed to prolonged displacement, disrupted development of cultural identity, and discrimination experienced in the host country. Given the widely devastating effects of childhood trauma and community violence, mental health interventions need to be two-prolonged: addressing and preventing intergenerational trauma sequelae through family-based interventions; and community-level programs and advocacy for safety and protection for the displaced. Our findings also emphasize that future interventions for urban refugee communities should be inclusive to all community members, considering shared vulnerability to community violence as well as intergenerational transmission of traumas through childhood adversities and lacking support. [ABSTRACT FROM AUTHOR]

Sexual and gender-based violence (SGBV) leads to severe sequelae for individuals and communities. Lack of cross-sector coordination inhibits effective medical–legal support and justice for survivors. Multisectoral trainings for health, legal, and law enforcement professionals on survivor-centered SGBV care were conducted in Kenya during 2012–2018. Evaluation utilized objective structured clinical examinations, standardized patients, knowledge assessments, and interviews. A total of 446 professionals participated in 18 trainings. Mean knowledge scores increased from 75.6% to 84.7% (p <.001). Thirty interviews revealed improved survivor confidentiality, increased specialized hospital care, more comprehensive forensic care, and greater cross-sector collaboration. Participants reported survivors feeling more comfortable pursuing legal action and increased perpetrator convictions. [ABSTRACT FROM AUTHOR]

Research with survivors of gender-based violence in low- and middle-income countries is important to improve understanding of experiences of violence and the policies that can help combat it. But this research also implies risks for survivors, such as re-traumatization, safety concerns, and feelings of exploitation. These risks are magnified if research is undertaken by researchers from high-income countries, whose positionality produces power inequalities affecting both participants and research partners. This article describes the ethical challenges of international gender-based violence research from the perspective of Kenyan researchers and organizations and identifies recommendations about how to prevent them. [ABSTRACT FROM AUTHOR]

Background: Within intensive care settings such as neonatal intensive care units, effective intra- and interprofessional teamwork has been linked to a significant reduction of errors and overall improvement in the quality of care. In Kenya, previous studies suggest that coordination of care among healthcare teams providing newborn care is poor. Initiatives aimed at improving intra- and interprofessional teamwork in healthcare settings largely draw on studies conducted in high-income countries, with those from resource-constrained low and middle countries, particularly in the context of newborn care lacking. In this study, we explored the nature of intra- and interprofessional teamwork among health care providers in newborn units (NBUs) of three hospitals in Kenya, and the professional and contextual dynamics that shaped their interactions.Methods: This exploratory qualitative study was conducted in three hospitals in Nairobi and Muranga Counties in Kenya. We adopted an ethnographic approach, utilizing both in-depth interviews (17) and non-participant observation of routine care provision in NBUs (250 observation hours). The study participants included: nurses, nursing students, doctors, and trainee doctors. All the data were thematically coded in NVIVO 12.Results: The nature of intra- and interprofessional teamwork among healthcare providers in the study newborn units is primarily shaped by broader contextual factors and varying institutional contexts. As a result, several team types emerged, loosely categorized as the 'core' team which involves providers physically present in the unit most times during the work shift; the emergency team and the temporary ad-hoc teams which involved the 'core' team, support staff students and mothers. The emergence of these team types influenced relationships among providers. Overall, institutionalized routines and rituals shaped team relations and overall functioning.Conclusions: Poor coordination and the sub-optimal nature of intra-and interprofessional teamwork in NBUs are attributed to broader contextual challenges that include low staff to patient ratios and institutionalized routines and rituals that influenced team norming, relationships, and team leadership. Therefore, mechanisms to improve coordination and collaboration among healthcare teams in these settings need to consider contextual dynamics including institutional cultures while also targeting improvement of team-level processes including leadership development and widening spaces for more interaction and better communication. [ABSTRACT FROM AUTHOR]

The dearth of child and adolescent mental health services (CAMHS) is a global problem. Integrating CAMHS in primary care has been offered as a solution. We sampled integrated care perspectives from colleagues around the world. Our findings include various models of integrated care namely: the stepped care model in Australia; shared care in the United Kingdom (UK) and Spain; school-based collaborative care in Qatar, Singapore and the state of Texas in the US; collaborative care in Canada, Brazil, US, and Uruguay; coordinated care in the US; and, developing collaborative care models in low-resource settings, like Kenya and Micronesia. These findings provide insights into training initiatives necessary to build CAMHS workforce capacity using integrated care models, each with the ultimate goal of improving access to care. Despite variations and progress in implementing integrated care models internationally, common challenges exist: funding within complex healthcare systems, limited training mechanisms, and geopolitical/policy issues. Supportive healthcare policy, robust training initiatives, ongoing quality improvement and measurement of outcomes across programs would provide data-driven support for the expansion of integrated care and ensure its sustainability. [ABSTRACT FROM AUTHOR]

Despite improvements in educational opportunities, policy changes, and pay raises in the nursing and midwifery professions in East Africa, poor working conditions, few professional development opportunities, and a general lack of respect for these professions predominate. These issues contribute to a low quality of care among a population with a high burden of communicable diseases. Health professional associations may help to address these challenges by providing a voice for nurses and midwives. This study evaluated the impact of a 5-year programme focused on strengthening nurses' and midwives' professional associations in East Africa. This study used a mixed methods design. Quantitative, cross-sectional descriptive data were captured via surveys (n = 1,266) distributed to association members. In-depth interviews (n = 65) were used to obtain qualitative data and complement the survey responses. Quantitative and qualitative data collection occurred concurrently. The results were compared to assess the impact of the programme across Uganda, Kenya, and Tanzania. The programme successfully built capacity in four of five organisational capacity areas: resource mobilisation, financial management, strategy, and monitoring and evaluation. Marketing and communications, the fifth targeted area, did not show improvement. Capacity in both research and service delivery was also improved, despite the programme not providing training in these areas. In addition, collaboration among associations and their members was improved. These results support existing evidence on the impact of capacity building among professional nursing associations and coincide with the World Health Organization's objectives for nursing. Future capacity building programmes should consider replicating the successful activities from this programme and investigate ways to reach more rural branches and provide tailored content. This study contributes to a small but growing body of knowledge that supports capacity building among the African health workforce. [ABSTRACT FROM AUTHOR]

This study examined reflective practice by teachers in a fragile community in Kenya. Without formal qualifications, teachers grappled with engineering teaching until they become critically reflective practitioners. We used qualitative data from weekly critical friends meetings, teacher journals, peer observations, messaging app conversations, and semi-structured interviews. Analysis entailed inductive coding to identify two themes: reflective practice enabled teachers to collaborate and develop identities. Implications suggest reflective practice is an effective tool for untrained teachers in Kenya to make meaning, build identities, and actualize their teaching and learning to meet growing demand for teacher preparation under recent curricular reforms. [ABSTRACT FROM AUTHOR]