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Background: Approximately 15 million babies are born prematurely every year worldwide. Sub-Saharan Africa (SSA) and Asia account for more than half of the global preterm deliveries. Prominent healthcare structural and socio-economic factors in SSA, for example poverty and weak health systems, amplify vulnerabilities for mothers and premature babies; often leading to poor outcomes. Post-discharge mortality rates are high, and readmission is common. For mothers of premature babies, the transition home from hospital is marked by challenges and uncertainties. This study explored the post-discharge experiences of mothers of premature babies with the aim of identifying their needs and suggests strategies to strengthen and support their discharge preparation to care for their premature baby at home, and to and reduce mortality and readmission rates., Methods: Narrative interviews were conducted face-to-face in English or Swahili with 34 mothers of premature babies recruited from two public hospitals and a social support group in Nairobi, Kenya between August-November 2021. Interviews were audio and video-recorded and transcribed for analysis. After transcription, the interviews were translated, where applicable, and thematic analysis was undertaken., Results: For mothers of premature babies, discharge from neonatal care and the transition home is a complex process marked with mixed emotions; many reported feeling unprepared and facing stigma while in hospital and in their communities. Mothers described the emotional challenges of discharge from the neonatal unit and their information and support needs. Minimal involvement in their baby's care while in the neonatal unit appeared to contribute to the mothers' lack of confidence in caring for their babies independently post-discharge when they no longer had the support of the clinical and nursing staff. Insufficient information provided on discharge hindered a smooth transition to home, highlighting the need for information to support mothers' confidence after discharge. Stigma relating to beliefs around preterm births was experienced by some of the mothers in the community and within some health clinics., Conclusions: To support transitions home, strengthening the timing and adequacy of information provided to mothers at discharge from the neonatal unit in low-income settings in SSA and Asia - such as Kenya-is essential. Introducing strategies to build and assess mothers' competencies with skills such as breastfeeding and identifying signs of deterioration before discharge could support their smooth transition home. Targeted engagement interventions at the community level could demystify and address stigma and knowledge gaps about premature deliveries at the community and social levels more broadly and within the health system., Competing Interests: Declarations. Ethics approval and consent to participate: The study was conducted in compliance to the Helsinki Declaration. Ethical approval was granted by the Scientific Ethical Review Committee of the Kenya Medical Research Institute (Protocol no. KEMRI/SERU/CGMR-C/244/4180) and Cambridge Psychology Research Ethics Committee (PRE. 2021.052). In addition, permission to conduct the study was obtained from the National Commission for Science and Technology (NACOSTI) and from Nairobi County Government as well as each hospital’s research department and the hospital medical superintendent and the neonatal unit in-charges. Consent for publication: All interviewees completed informed consent prior to data collection. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Introduction: The COVID-19 pandemic had devastating health and socioeconomic effects, partly due to policy decisions to mitigate them. Little evidence exists of approaches that guided decisions in settings with limited pre-pandemic modelling capacity. We thus sought to identify knowledge translation mechanisms, enabling factors and structures needed to effectively translate modelled evidence into policy decisions., Methods: We used convergent mixed methods in a participatory action approach, with quantitative data from a survey and qualitative data from a scoping review, in-depth interviews and workshop notes. Participants included researchers and policy actors involved in COVID-19 evidence generation and decision-making. They were mostly from lower- and middle-income countries (LMICs) in Africa, Southeast Asia and Latin America. Quantitative and qualitative data integration occurred during data analysis through triangulation and during reporting in a narrative synthesis., Results: We engaged 147 researchers and 57 policy actors from 28 countries. We found that the strategies required to use modelled evidence effectively include capacity building of modelling expertise and communication, improved data infrastructure, sustained funding and dedicated knowledge translation platforms. The common knowledge translation mechanisms used during the pandemic included policy briefs, face-to-face debriefings and dashboards. Some enabling factors for knowledge translation comprised solid relationships and open communication between researchers and policymakers, credibility of researchers, co-production of policy questions and embedding researchers in policymaking spaces. Barriers included competition among modellers, negative attitude of policymakers towards research, political influences and demand for quick outputs., Conclusion: We provide a contextualised understanding of knowledge translation for LMICs during the COVID-19 pandemic. Furthermore, we share key lessons on how knowledge translation from mathematical modelling complements the broader learning agenda related to pandemic preparedness and long-term investments in evidence-to-policy translation. Our findings led to the co-development of a knowledge translation framework useful in various settings to guide decision-making, especially for public health emergencies., Competing Interests: Competing interests: No conflicts other than the The Bill and Melinda Gates Foundation paid for travel expenses to attend working session during which the framework was developed., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.)

Background: Maternal and neonatal outcomes in, Kakamega County is characterized by a maternal mortality rate of 316 per 100,000 live births and a neonatal mortality rate of 19 per 1,000 live births. In 2018, approximately 70,000 births occurred in the county, with 35% at home, 28% in primary care facilities, and 37% in hospitals. A maternal and child health service delivery redesign (SDR) that aims to reorganize maternal and newborn health services is being implemented in Kakamega County in Kenya to improve the progress of these indicators. Research has shown that women's ability to make decisions (voice, agency, and autonomy) is critical for gender equality, empowerment and an important determinant of access and utilization. As part of the Kakamega SDR process evaluation, this study sought to understand women's processes of decision-making in seeking maternal health care and how these affect women's ability to access and use antenatal, delivery, and post-natal services., Methods: We adapted the International Centre for Research on Women (ICRW) conceptual framework for reproductive empowerment to focus on the interrelated concepts of "female autonomy", and "women's agency" with the latter incorporating 'voice', 'choice' and 'power'. Our adaptation did not consider the influence of sexual relationships and leadership on SRH decision-making. We conducted key informant interviews, in-depth interviews, small group interviews and focus group discussions with pregnant women attending Antenatal clinics, women who had delivered, women attending post-natal clinics, and men in Kakamega County. A thematic analysis approach was used to analyze the data in NVivo 12., Results: The results revealed notable findings across three dimensions of agency. Women with previous birthing experiences, high self-esteem, and support from their social networks exhibited greater agency. Additionally, positive previous birthing experiences were associated with increased confidence in making reproductive health choices. Women who had control over financial resources and experienced respectful communication with their partners exhibited higher levels of agency within their households. Distance relational agency demonstrated the impact of health system factors and socio-cultural norms on women's agency and autonomy. Finally, women who faced barriers such as long waiting times or limited staff availability experienced reduced agency in seeking healthcare., Conclusions: Individual agency, immediate relational agency, and distance relational agency all play crucial roles in shaping women's decision-making power and control over their utilization of maternal health services. This study offers valuable insights that can guide the ongoing implementation of an innovative service delivery redesign model, emphasizing the critical need for developing context-specific strategies to promote women's voices for sustained use., (© 2024. The Author(s).)

Adolescent sexual and reproductive health (ASRH) services are key to improving the health of adolescents. This study aimed to establish the effectiveness of an intervention that combined activities in health facilities and communities in Kenya to increase utilisation of ASRH services. A quasi-experimental evaluation design was used to assess the effectiveness of the intervention. Using a stratified cluster sampling approach, two cross-sectional household surveys targeting girls aged 15-19 were conducted at baseline (September 2019) and endline (December 2020) in intervention and comparison. We combined the difference-in-difference approach to analyse the net change in outcomes between intervention and comparison arms of the study at baseline and endline and coarsened exact matching for variables that were significantly different to address the imbalance. There were a total of 1011 participants in the intervention arm and 880 in the comparison arm. Descriptive results showed a net increase of 12.7% in intervention sites in the knowledge of misconceptions about sex, pregnancy, and contraception, compared to 10.4% in the control site. In the multivariate regression analysis, two outcomes remained significant: decreases in adolescents' discomfort when seeking ASRH services because of either fear of parents (aPR = 0.58, 95% CI = 0.42-0.79, P  = 0.001) or a lack of support from their partner (aPR = 0.25, 95% CI = 0.08-0.82, P  = 0.023). The intervention combining a facility and community approach was not effective in increasing the use of ASRH information and services. Possible reasons for this are explored.

Health system strengthening remains elusive and challenging. Health systems in many countries in sub-Saharan Africa are frequently characterised as weak, with inadequate management and accountability mechanisms, and poor human and financial resources. Putting patients and staff at the heart of health systems is an essential step towards strengthening them. As one of the three pillars of quality in health care, understanding patient experiences is key to moving towards people-centred care. Yet patient experiences are not a singular concept. Patient narratives can convey individual experiences of illness and health care, which complement and augment epidemiological and public health evidence. These narratives, gathered with rigorous, interview-based research and shared with digital tools (audio and video), can generate persuasive evidence. This evidence has important potential for influencing policy and practice, and for supporting people-centred care, but has not been tested systematically in low-income countries. In the Kenyan context of newborn health, work under way is generating evidence to show the transformative potential of patient narratives., Competing Interests: Declaration of interests ME is part of WHO Technical Working Groups (in an unpaid role) and an Advisory Group for the Wellcome Trust for a trial of oxygen therapy in African hospitals. All other authors declare no competing interests., (Copyright © 2023 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

Rift Valley fever virus (RVFV) is a zoonotic arbovirus that has profound impact on domestic ruminants and can also be transmitted to humans via infected animal secretions. Urban areas in endemic regions across Africa have susceptible animal and human hosts, dense vector distributions, and source livestock (often from high risk locations to meet the demand for animal protein). Yet, there has never been a documented urban outbreak of RVF. To understand the likely risk of RVFV introduction to urban communities from their perspective and guide future initiatives, we conducted focus group discussions with slaughterhouse workers, slaughterhouse animal product traders, and livestock owners in Kisumu City and Ukunda Town in Kenya. For added perspective and data triangulation, in-depth interviews were conducted one-on-one with meat inspector veterinarians from selected slaughterhouses. A theoretical framework relevant to introduction, transmission, and potential persistence of RVF in urban areas is presented here. Urban livestock were primarily mentioned as business opportunities, but also had personal sentiment. In addition to slaughtering risks, perceived risk factors included consumption of fresh milk. High risk groups' knowledge and experience with RVFV and other zoonotic diseases impacted their consideration of personal risk, with consensus towards lower risk in the urban setting compared to rural areas as determination of health risk was said to primarily rely on hygiene practices rather than the slaughtering process. Groups relied heavily on veterinarians to confirm animal health and meat safety, yet veterinarians reported difficulty in accessing RVFV diagnostics. We also identified vulnerable public health regulations including corruption in meat certification outside of the slaughterhouse system, and blood collected during slaughter being used for food and medicine, which could provide a means for direct RVFV community transmission. These factors, when compounded by diverse urban vector breeding habitats and dense human and animal populations, could create suitable conditions for RVFV to arrive an urban center via a viremic imported animal, transmit to locally owned animals and humans, and potentially adapt to secondary vectors and persist in the urban setting. This explorative qualitative study proposes risk pathways and provides initial insight towards determining how urban areas could adapt control measures and plan future initiatives to better understand urban RVF potential., Competing Interests: All authors declare no competing interests., (Copyright: © 2023 Gerken et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)