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Investing in the health workforce to ensure universal access to qualified, skilled and motivated health workers is pertinent in achieving the Sustainable Development Goals (SDGs). The policy thrust in Kenya is to improve the quality of life of the population by investing to improve health service provision and achieving universal health coverage. To realise this, the Ministry of Health undertook a Health Labour Market Analysis with to generate evidence on the relationship between supply, demand and need of the health labour force. In the context of supply, Kenya has a total of 189 932 health workers in 2020 with 66% being in the public sector and 58%, 13% and 7% being nurses, clinical officers and doctors, respectively. The density of doctors, nurses and clinical officers per 10 000 in Kenya in 2020 was 30.14, which represents about 68% of the SDG index threshold of 44.5 doctors, nurses and midwives per 10 000 population. Findings indicates that Kenya needs to align future production in terms of cadre and quantity to the population health needs. Achieving this requires a multisectoral approach to ensure apposite quantity and mix of intakes into training institutions based on the health needs and ability to employ health workers produced.

INTRODUCTION: Globally about 830 women die daily due to complications of pregnancy and child birth out of which 550 occur in Sub-Saharan Africa, with about 8,000 maternal deaths occurring annually in Kenya. 66% of maternal deaths occur within the first week and 85% of maternal deaths occur within two weeks post-delivery. Attendance of postnatal services during this time could significantly reduce morbidity and mortality. We determined effectiveness of short text message (SMS) in reducing failure-to-attend rates (FTA) of postnatal clinic at the largest maternity hospital in Nairobi, Kenya. METHODS: We conducted a hospital-based randomised controlled trial. Women who delivered between March and May 2016 at Pumwani Maternity Hospital were recruited, enrolled and randomised into SMS (intervention) or no SMS (control) arms. Women were masked to which arm they belonged during randomisation but were unmasked during the appointments as the intervention had been sent. The investigators were not masked. Reminders were sent three days prior to and on the morning of the appointment. Relative Risk (RR) at 95% Confidence Interval were calculated to estimate the effectiveness of intervention at two and six-weeks. RESULTS: We enrolled 754 women, with 377 randomly assigned into each arm. There were no differences in socio-demographic characteristics between the study arms at baseline. After two-weeks, women in the intervention arm had an 80% reduction in FTA risk (RR=0.2, 95% CI 0.1–0.3). After six weeks, women in the intervention arm had a 60% reduction in FTA risk (RR=0.4, 95% CI 0.2–0.6). Among participants, 80 (42.1%) women at two-weeks and 30 (41.7%) women at six-weeks cited forgetting appointment as the most common reason for failing to attend postnatal clinic. CONCLUSION: SMS reminders were effective in reducing failure-to-attend clinic appointments. We recommend the use of SMS reminder strategy for postnatal care.

On the last week of May of 2018, a community-based syndromic surveillance system detected mass abortions and deaths of young livestock in northeastern Kenya. Two weeks later, Rift Valley fever (RVF) was confirmed in humans presenting with febrile illness and hemorrhagic syndrome in the same region. A joint animal and human response team carried out an investigation to characterize the outbreak and identify drivers of disease transmission. Here, we describe the outbreak investigation and findings. A total of 106 human cases were identified in the months of May and June 2018: 92% (98) and 8% (8) of these cases occurring in the northern and western regions of Kenya, respectively. Seventy-six (72%) were probable cases, and 30 (28%) were laboratory confirmed by ELISA and/or PCR. Among the confirmed cases, the median age was 27.5 years (interquartile range = 20), and 60% (18) were males. Overall, the case fatality rate was 7% (n = 8). The majority of the confirmed cases, 19 (63%), reported contact with livestock during slaughter and consumption of meat from sick animals. All confirmed cases had fever, 40% (12) presented with hemorrhagic syndrome, and 23% (7) presented with jaundice. Forty-three livestock herds with at least one suspect and/or confirmed animal case were identified. Death of young animals was reported in 93% (40) and abortions in 84% (36) of livestock herds. The outbreak is indicative of the emergence potential of RVF in traditionally high- and low-risk areas and the risk posed by zoonosis to livestock keepers.

Background: Long-lasting insecticidal nets (LLINs) and indoor residual spraying (IRS) are the main malaria vector control measures. Kenya has employed multiple approaches, including free mass net distribution campaigns, for distributing LLINs to the community that resulted in increased household ownership of one or more nets from 44% in 2010 to 63 % in 2015. Migori and Homa Bay Counties are among the malaria endemic counties in Western Kenya that benefitted from three free mass net distribution campaigns between 2012 and 2018.. Widespread pyrethroid resistance among the primary vectors in Western Kenya has necessitated the re-introduction of IRS using an organophosphate insecticide, pirimiphos-methyl (Actellic® 300CS), as part of a strategy to manage insecticide-resistance. Evaluation of the effectiveness of the combined use of non-pyrethroid IRS and LLINs have yielded varied results. We aimed to evaluate malaria indicators before and after the introduction of IRS in a high malaria transmission area compared with an adjacent area where IRS was not introduced until one year later to estimate the effect of the intervention in an area with pyrethroid resistance.Methods: We reviewed records (MoH 405 A, 405 B, and 706) and tallied monthly aggregate of outpatient department (OPD) attendance, suspected malaria cases, those tested for malaria and those testing positive for malaria at two health facilities, one from Nyatike, an intervention sub-county, and one from Suba, a comparison sub-county, both located in Western Kenya, from February 1, 2016, through March 31, 2018. The first round of IRS was conducted in February – March 2017 in Nyatike sub-county and the second round one year later in both Nyatike and Suba sub-counties while the mass distribution of LLINs has been conducted in both locations. We performed a descriptive analysis and estimated the effect of the interventions and temporal changes of malaria indicators using Poisson regression for a period before and after implementation of the first round of IRS.Results: A higher reduction in the intervention area in total OPD, the proportion of OPD visits due to suspected malaria, testing positivity rate and annual malaria incidences except for the total OPD visits among the under 5 children where 59% decrease was observed in the comparison area while 33% decrease was observed in the intervention area (net change -27%, P Conclusions: Our findings demonstrated a reduced malaria burden among population protected by both non-pyrethroid IRS and LLINs implying a possible additional benefit afforded by the combined intervention in malaria endemic zone.

Rapid detection and response to infectious disease outbreaks requires a robust surveillance system with a sufficient number of trained public health workforce personnel. The Frontline Field Epidemiology Training Program (Frontline) is a focused 3-month program targeting local ministries of health to strengthen local disease surveillance and reporting capacities. Limited literature exists on the impact of Frontline graduates on disease surveillance completeness and timeliness reporting. Using routinely collected Ministry of Health data, we mapped the distribution of graduates between 2014 and 2017 across 47 Kenyan counties. Completeness was defined as the proportion of complete reports received from health facilities in a county compared with the total number of health facilities in that county. Timeliness was defined as the proportion of health facilities submitting surveillance reports on time to the county. Using a panel analysis and controlling for county-fixed effects, we evaluated the relationship between the number of Frontline graduates and priority disease reporting of measles. We found that Frontline training was correlated with improved completeness and timeliness of weekly reporting for priority diseases. The number of Frontline graduates increased by 700%, from 57 graduates in 2014 to 456 graduates in 2017. The annual average rates of reporting completeness increased from 0.8% in 2014 to 55.1% in 2017. The annual average timeliness reporting rates increased from 0.1% in 2014 to 40.5% in 2017. These findings demonstrate how global health security implementation progress in workforce development may influence surveillance and disease reporting.

BACKGROUND In 2014, Kenya’s Field Epidemiology and Laboratory Training Program (FELTP) initiated a 3-month field-based frontline training, Field Epidemiology Training Program (FETP-F), for local public health workers. OBJECTIVE This study aimed to measure the effect of FETP-F on participant workplace practices regarding quality and consistency of public health data, critical interaction with public health data, and improvements in on-time reporting (OTR). METHODS Between February and April 2017, FELTP conducted a mixed methods evaluation via online survey to examine outcomes achieved among all 215 graduates from 2014 and 2015. Data quality assessment (DQA) and data consistency assessment (DCA) scores, OTR percentages, and ratings of the training experience were the quantitative measures tracked from baseline and then at 6-month intervals up to 18 months postcompletion of the training. The qualitative component consisted of semistructured face-to-face interviews and observations. Quantitative data were analyzed using descriptive statistics and one-way analysis of variance (ANOVA). Qualitative data were transcribed and analyzed to identify key themes and dimensions. RESULTS In total, 103 (47%) graduates responded to the survey. Quantitative analyses showed that the training significantly increased the mean DQA and OTR scores but there was a nonsignificant increase in mean DCA scores. Qualitative analyses found that 68% of respondents acquired new skills, 83% applied those skills to their day-to-day work, and 91% improved work methods. CONCLUSIONS FETP-F improved overall data quality and OTR at the agency level but had minimal impact on data consistency between local, county, and national public health agencies. Participants reported that they acquired practical skills that improved data collation and analysis and OTR.

Background In 2014, Kenya’s field epidemiology and laboratory training program (FELTP) initiated a 3-month-long field-based frontline training (FETP-F) for local public health workers.Methods Between February and April 2017, FELTP conducted a mixed-methods evaluation to examine outcomes achieved among 2014 and 2015 graduates of the trainings. Data quality assessment (DQA) and data consistency assessment (DCA) scores, on-time-reporting (OTR) percentages, and ratings of the training experience were the quantitative measures tracked from baseline and then at 6-month intervals up to 18 months post-completion of the training. The qualitative component consisted of semi-structured face-to-face interviews and observations. Quantitative data were analyzed using one-way analysis of variance (ANOVA). Qualitative data were transcribed and analyzed to identify key themes and dimensions.Results One hundred and three graduates were included. For the qualitative component, we reached saturation after 19 onsite interviews and observation exercises. ANOVA showed that the trainings had small but significant impacts on mean DQA and OTR scores. Results showed an insignificant increase in mean DCA scores. Qualitative analyses showed that 68% of respondents acquired new skills, 83% applied those skills to their day-to-day work, and 91% improved work methods.Conclusion The findings show that FETP-F is effective in improving work methods, facilitating behavior change, and improving key public health competencies.

Dadaab Refugee camp in Garissa County, Kenya, hosts nearly 340,000 refugees in five subcamps (Dagahaley, Hagadera, Ifo, Ifo2, and Kambioos) (1). On November 18 and 19, 2015, during an ongoing national cholera outbreak (2), two camp residents were evaluated for acute watery diarrhea (three or more stools in ≤24 hours); Vibrio cholerae serogroup O1 serotype Ogawa was isolated from stool specimens collected from both patients. Within 1 week of the report of index cases, an additional 45 cases of acute watery diarrhea were reported. The United Nations High Commissioner for Refugees and their health-sector partners coordinated the cholera response, community outreach and water, sanitation, and hygiene (WASH) activities; Médecins Sans Frontiéres and the International Rescue Committee were involved in management of cholera treatment centers; CDC performed laboratory confirmation of cases and undertook GIS mapping and postoutbreak response assessment; and the Garissa County Government and the Kenya Ministry of Health conducted a case-control study. To prevent future cholera outbreaks, improvements to WASH and enhanced disease surveillance systems in Dadaab camp and the surrounding area are needed.

Globally, >80% of diabetes-related deaths occur in low- and middle-income countries. In 2014, the International Diabetes Federation ranked Kenya 31st in Africa in terms of diabetes with an estimated prevalence of 460 cases per 10,000 population. This study characterizes the prevalence and associated co-morbidities of diabetes in five rural and semi-urban counties in Kenya. We conducted a descriptive cross-sectional review of diabetes registry data in five selected rural and semi-urban hospitals between 2010 and 2015. Patients with clinical or laboratory diagnosis of diabetes were included in the study. Demographic and epidemiologic data were abstracted, entered into MS-Excel 2007, and descriptive and correlation statistics were calculated using Epi-Info 7. We identified 1548 cases (59% female) across the 5 sites, with a mean age of 58 ± 13.5 years. We calculated diabetes prevalence measures of 310, 30, 20, and 4 per 10,000 in Isiolo, Othaya, Mukurweini, Thika, and Meru, respectively. Type 2 diabetes comprised 98% of cases from Othaya and Mukurweini, 96% from both Isiolo and Meru counties, and 94% from Thika. The most common co-morbidity was hypertension, with 80% affected from Othaya and Mukurweini, 52% in Thika, and 34% in Isiolo County. The correlation between age, gender, and presence of a co-morbidity and diabetes varied across counties. Diabetes and its complications are prevalent in rural and semi-urban areas of Kenya and women seem to be more affected by the disease, indicating an increasing population who are at risk for type 2 diabetes and associated complications.

Background Globally, under-nutrition accounts for >3 million deaths annually among children 5,000 Kenya shillings (AOR=4.6; 95% CI: 1.2-17.8) being independently associated. Conclusion Proper pre-natal care, child feeding practices and deworming programs should be enhanced to reduce pediatric malnutrition.

BackgroundCholera affects 1.3-4 million people globally and causes 21000-143,000 deaths annually. Nairobi County in Kenya reported cholera cases since April 2017. We investigated to identify associated factors and institute control measures.MethodsWe reviewed the line-list of patients admitted at the Kenyatta National referral Hospital, Nairobi and performed descriptive epidemiology. We carried out a frequency-matched case control study, using facility-based cases and community controls. We defined a case as acute onset of watery diarrhoea of at least >3 stools/24hours with or without vomiting in person of any age, admitted in Kenyatta National Hospital as from July 1st, 2017. We calculated odds ratios and their respective 95% confidence intervals. We also took water samples at water reservoirs, distribution and consumer points, and made observation on hygiene and sanitation conditions in the community.ResultsWe reviewed 71 line-listed cases; median age 30 years (range 2-86 years); 45 (63%) were male. First case was admitted on 14thApril 2017. Culture was performed on 44 cases, 30 (68%) was positive forVibrio cholerae, biotype El-Tor, serotype Ogawa. There were 2 deaths (case fatality ratio 2.8%). Age-group ≥25 years was most affected. Drinking unchlorinated water (aOR 14.57, 95% CI 4.44-47.83), eating in public places (aOR 9.45, 95% CI 3.07-29.12) sourcing water from non-Nairobi city water company source (aOR 4.92, 95% CI 1.56-15.52) and having drank untreated water in the previous week before the outbreak (aOR 3.21, 95% CI 1.12-9.24) were independently associated with being a case in the outbreak. Out of 28 water samples, 4 (14%) had >180 coliforms/100mls; all were at consumer points.ConclusionPoor water quality and sanitation were responsible for this outbreak. We recommended adequate, clean water supply to unplanned settlements in Nairobi County, as well education of residents on water treatment at the household level.Author summaryCholera, a disease causing outbreaks in areas with low standards of hygiene and sanitation has afflicted humans for millennia. It is caused by a bacterium,Vibrio Cholerae, transmitted mainly through water contaminated by faecal matter. The resultant disease is acute watery diarrhoea, which causes death rapidly due to dehydration and shock. Virtually brought under control in the developed world due to improvements in hygiene, the disease still ravages many communities in low and middle income countries, as well as regions affected by conflict or natural disasters. In outbreak situations, rapid response in water treatment, sanitation improvement and setting up of cholera treatment centres for rehydration therapy reduces impact and saves lives. Long-term control can only be achieved through sustainable improvements in sanitation and standards of living. Case control studies in outbreak situations provide quick, actionable information to public health specialists during outbreak response. This study provides a cholera outbreak investigation in an urban informal settlement setting; the approach reported here can guide in outbreak investigations and response in similar settings globally.

Background Globally, under-nutrition accounts for >3 million deaths annually among children 5,000 Kenya shillings (AOR=4.6; 95% CI: 1.2-17.8) being independently associated. Conclusion Proper pre-natal care, child feeding practices and deworming programs should be enhanced to reduce pediatric malnutrition.

Introduction:in 2015, a cholera outbreak was confirmed in Nairobi county, Kenya, which we investigated to identify risk factors for infection and recommend control measures. Methods:we analyzed national cholera surveillance data to describe epidemiological patterns and carried out a case-control study to find reasons for the Nairobi county outbreak. Suspected cholera cases were Nairobi residents aged >2 years with acute watery diarrhea (>4 stools/≤12 hours) and illness onset 1-14 May 2015. Confirmed cases hadVibrio choleraeisolated from stool. Case-patients were frequency-matched to persons without diarrhea (1:2 by age group, residence), interviewed using standardized questionaires. Logistic regression identified factors associated with case status. Household water was analyzed for fecal coliforms andEscherichia coli. Results:during December 2014-June 2015, 4,218 cholera cases including 282 (6.7%) confirmed cases and 79 deaths (case-fatality rate [CFR] 1.9%) were reported from 14 of 47 Kenyan counties. Nairobi county reported 781 (19.0 %) cases (attack rate, 18/100,000 persons), including 607 (78%) hospitalisations, 20 deaths (CFR 2.6%) and 55 laboratory-confirmed cases (7.0%). Seven (70%) of 10 water samples from communal water points had coliforms; one hadEscherichia coli. Factors associated with cholera in Nairobi were drinking untreated water (adjusted odds ratio [aOR] 6.5, 95% confidence interval [CI] 2.3-18.8), lacking health education (aOR 2.4, CI 1.1-7.9) and eating food outside home (aOR 2.4, 95% CI 1.2-5.7). Conclusion:we recommend safe water, health education, avoiding eating foods prepared outside home and improved sanitation in Nairobi county. Adherence to these practices could have prevented this protacted cholera outbreak.

Medical students have limited exposure to field epidemiology, even though will assume public health roles after graduation. We established a 10-week elective in field epidemiology during medical school. Students attended one-week didactic sessions on epidemiology, and nine weeks in field placement sites. We administered pre- and post-tests to evaluate the training. We enrolled 34 students in 2011 and 2012. In 2011, we enrolled five of 24 applicants from a class of 280 medical students. In 2012, we enrolled 18 of 81 applicants from a class of 360 students; plus 11 who participated in the didactic sessions only. Among the 34 students who completed the didactic sessions, 74% were male, and their median age was 24years (range: 22–26). The median pre-test score was 64% (range: 47–88%) and the median post-test score was 82% (range: 72–100%). Successful completion of the field projects was 100%. Six (30%) students were not aware of public health as a career option before this elective, 56% rated the field experience as outstanding, and 100% reported it increased their understanding of epidemiology. Implementing an elective in field epidemiology within the medical training is a highly acceptable strategy to increase awareness for public health among medical students.

Background Cholera globally affects 1.3–4.0 million people and causes 21 000–143 000 deaths annually. In June 2017, a cluster of diarrhoeal illness occurred among participants of an international scientific conference at a hotel in Nairobi, Kenya. Culture confirmed Vibrio cholerae, serotype Ogawa. We investigated to assess magnitude, identify likely exposures and suggest control measures. Methods We carried out a retrospective cohort study utilizing a structured questionnaire administered by telephone, email and internet-based survey. We calculated food-specific attack rates, risk ratios and in a nested-case control analysis, performed logistic regression to identify exposures independently associated with the outbreak. Results We interviewed 249 out of 456 conference attendees (response rate=54.6%). Mean age of respondents was 37.8 years, ±8.3 years, 131 (52.6%) were male. Of all the respondents, 137 (55.0%) were cases. Median incubation time was 35 (11–59) hours. Eating chicken (adjusted OR 2.49, 95% CI, 1.22–5.06) and having eaten lunch on Tuesday (adjusted OR 2.34, 95% CI 1.09–5.05) were independently associated with illness; drinking soda was protective (adjusted OR 0.17, 95% CI 0.07–0.42). Conclusion Point source outbreak, associated with chicken eaten at lunch on Tuesday 20th June 2017 occurred. We recommend better collaboration between the food and health sectors in food-borne outbreak investigations.

BackgroundCutaneous Leishmaniasis is a neglected tropical disease caused by a protozoan and transmitted by sand-fly bite. Following reports of a possible outbreak of cutaneous leishmaniasis in 2016, we conducted a review of hospital records and a follow up case control study to determine the magnitude of the disease, characterize the cases and identify factors associated with the disease in Gilgil, a peri-urban settlement in Central Kenya.MethodsWe reviewed hospital records, conducted active case search in the community and carried out a case-control study. Medical officers in the study team made clinical diagnosis of cutaneous leishmaniasis cases based on presence of a typical skin ulcer. We enrolled 58 cases matched by age and residence to 116 controls in a case control study. We administered structured questionnaires and recorded environmental observations around homes of cases and controls. Simple proportions, means and medians were calculated for categorical data and continuous data respectively. Logistic regression models were constructed for individual, indoor and outdoor factors associated with the outbreak.ResultsWe identified 255 suspected cases and one death; Females constituted 56% (142/255), median age of the cases was 7 years (IQR 14). Cases were clustered around Gitare (28.6%, 73/255) and Kambi-Turkana (14%, 36/255) with seasonal peaks between June-November. Among individual factors, staying outside the residence in the evening after sunset (OR 4.1, CI 1.2-16.2) and occupation involving visiting forests (OR 4.56, CI 2.04-10.22) had significant associations with disease. Sharing residence with a cutaneous leishmaniasis patient (OR 14.4, CI 3.8-79.3), a house with alternative roofing materials (OR 7.9, CI 1.9-45.7) and residing in a house with cracked walls (OR 2.3, CI 1.0-4.9) were significant among indoor factors while sighting rock hyraxes near residence (OR 5.3, CI 2.2-12.7), residing near a forest (OR 7.8, CI 2.8-26.4) and living close to a neighbour with cutaneous leishmaniasis (OR 6.8, CI 2.8-16.0) had increased likelihood of disease. Having a cultivated crop farm surrounding the residence (OR 0.1, CI 0.0-0.4) was protective.Conclusions/SignificanceThis study reveals the large burden of cutaneous leishmaniasis in Gilgil. There is strong evidence for both indoor and outdoor patterns of disease transmission. Occupations and activities that involve visiting forests or residing near forests and sharing a house or neighbourhood with a person with CL were identified as significant exposures of the disease. The role of environmental factors and wild mammals in disease transmission should be investigated furtherAuthor summaryLeishmaniasis is a group of diseases caused by a protozoa (Leishmania) and affects humans and other mammals following the bite of an infected sand-fly. Cutaneous form of the disease (cutaneous leishmaniasis) is considered a neglected tropical disease mainly affecting the poor destabilized or migrant populations in rural areas. Recently, the disease has expanded its geographical range and invaded previously non-endemic areas including areas surrounding large urban centres that are experiencing human population influx leading to multiple localised disease outbreaks. In this paper, we report findings of a study we conducted to determine the burden and factors promoting the spread of cutaneous leishmaniasis in a peri-urban settlement in Kenya. Our results indicate a high burden of cutaneous leishmaniasis in this area and an association of the disease with several groups of factors at individual, indoor and outdoor environments. Many cases of cutaneous leishmaniasis were linked to activities that involved visiting the forested areas around homes, underpinning the significance of human activity in forests in these areas in spread of the disease.

Introduction The burden of chronic kidney disease (CKD) is increasing worldwide. Few studies in low and low-middle income countries have estimated the prevalence of CKD. We aimed to estimate prevalence and factors associated with CKD among medical inpatients at the largest referral hospital in Kenya. Methods We conducted a cross-sectional study among medical inpatients at the Kenyatta National Hospital. We used systematic sampling and collected demographic information, behavioural risk factors, medical history, underlying conditions, laboratory and imaging workup using a structured questionnaire. We estimated glomerular filtration rate (GFR) in ml/min/1.73m2 classified into 5 stages; G1 (≥ 90), G2 (60-89), G3a (45-59), G3b (30-44), G4 (15-29) and G5 (

PURPOSE In 2017, the Kenya Ministry of Health launched the National Cancer Control Strategy 2017 to 2022. A scoping review of oncology research in Kenya was conducted to understand the scope of—and gaps in—existing research and inform the development of the national cancer research agenda. METHODS We searched PubMed/MEDLINE, Embase, Scopus, and Global Health databases using controlled vocabulary and keywords to identify oncology research with a study site in Kenya, published in English, from 2007 to 2017. Fifteen journals and additional gray literature sources were hand searched. Screening of titles, abstracts, and full text was completed by pairs of 2 reviewers, with a third reviewer reconciling discrepancies. From included studies, data were extracted and coded using Google Forms. Microsoft Excel was used for descriptive statistics. RESULTS Of the 284 included articles, a majority were analytic observational studies (66.9%). The top 5 cancers studied were cervical cancer (n = 106; 35.9%), breast cancer (n = 25; 11.9%), Burkitt lymphoma (n = 23; 8.5%), esophageal cancer (n = 15; 5.1%), and pediatric cancers (n = 12; 4.1%). Primary focus areas were early detection, diagnosis, and prognosis and cancer control, survivorship, and outcomes research. Kenyatta National Hospital, Moi Teaching and Referral Hospital, and University of Nairobi were most often cited as research host institutions. One hundred twenty-three unique funding sources were reported, with the most prevalent study funding sources by region being North America (48%), Europe (28.8%), and Middle East/Africa (17.6%). The US National Institutes of Health was cited as the leading funding source of cancer research in Kenya. CONCLUSION This scoping review provides an overview of the published literature on cancer research conducted in Kenya. It highlights cancer research by cancer type, location, and focus area. It also focuses attention on research gaps, as well as the need for rigorous, well-conducted population-based studies, longitudinal studies, and randomized controlled trials aligned with the cancer burden in Kenya.

BACKGROUND:Cholera remains a public health problem in Kenya despite increased efforts to create awareness. Assessment of knowledge, attitude and practice (KAP) in the community is essential for the planning and implementation of preventive measures. We assessed cholera KAP in a community in Isiolo County, Kenya. METHODS:This cross-sectional study involved a mixed-methods approach utilizing a questionnaire survey and focus group discussions (FGDs). Using multistage sampling with household as the secondary sampling unit, interviewers administered structured questionnaires to one respondent aged ≥18 years old per household. We created knowledge score by allotting one point for each correct response, considered any total score ≥ median score as high knowledge score, calculated descriptive statistics and used multivariate logistic regression to examine factors associated with high knowledge score. In FGDs, we randomly selected the participants aged ≥18 years and had lived in Isiolo for >1 year, conducted the FGDs using an interview guide and used content analysis to identify salient emerging themes. RESULTS:We interviewed 428 participants (median age = 30 years; Q1 = 25, Q3 = 38) comprising 372 (86.9%) females. Of the 425/428 (99.3%) who had heard about cholera, 311/425 (73.2%) knew that it is communicable. Although 273/428 (63.8%) respondents knew the importance of treating drinking water, only 216/421 (51.3%) treated drinking water. Those with good defecation practice were 209/428 (48.8%). Respondents with high knowledge score were 227/428 (53.0%). Positive attitude (aOR = 2.88, 95% C.I = 1.34-6.20), treating drinking water (aOR = 2.21, 95% C.I = 1.47-3.33), age

Background Cutaneous leishmaniasis is a neglected disease known to cause significant morbidity among the poor. We investigated a suspected outbreak to determine the magnitude of cases, characterize the cases and identify risk factors of cutaneous leishmaniasis in Gilgil, a peri-urban settlement in Central Kenya. Methods Hospital records for the period 2010-2016 were reviewed and additional cases were identified through active case search. Clinical diagnosis of cutaneous leishmaniasis was made based on presence of ulcerative, nodular or papular skin lesion. The study enrolled 58 cases matched by age and neighbourhood to 116 controls in a case control study. Data was collected using structured questionnaires and simple proportions, means and medians were computed, and logistic regression models were constructed for analysis of individual, indoor and outdoor risk factors. Results Of the 255 suspected cases of cutaneous leishmaniasis identified, females constituted 56% (142/255) and the median age was 7 years (IQR 7-21). Cases occurred in clusters and up to 43% of cases originated from Gitare (73/255) and Kambi-Turkana (36/255) villages. A continuous transmission pattern was depicted throughout the period under review. Individual risk factors included staying outside the residence in the evening after sunset (OR 4.1, CI 1.2-16.2) and visiting forests (OR 4.56, CI 2.04-10.22). Sharing residence with a case (OR 14.4, CI 3.8-79.3), residing in a thatched house (OR 7.9, CI 1.9-45.7) and cracked walls (OR 2.3, CI 1.0-4.9) were identified among indoor factors while sighting rock hyraxes near residence (OR 5.3, CI 2.2-12.7), residing near a forest (OR 7.8, CI 2.8-26.4) and having a close neighbour with cutaneous leishmaniasis (OR 6.8, CI 2.8-16.0) were identified among outdoor factors. Conclusions We identify a large burden of cutaneous leishmaniasis in Gilgil with evidence of individual, indoor and outdoor factors of disease spread. The role of environmental factors and rodents in disease transmission should be investigated further.

Objective Brucellosis is one of the top five priority zoonosis in Kenya because of the socio-economic burden of the disease, especially among traditional, livestock keeping communities. We conducted a 1 year, hospital based, unmatched case–control study to determine risk factors for brucellosis among Maasai pastoralists of Kajiado County in 2016. A case was defined by a clinical criteria; fever or history of fever and two clinical signs suggestive of brucellosis and a positive competitive enzyme-linked immunosorbent assay test (c-ELISA). A control was defined as patients visiting the study facility with negative c-ELISA. Unconditional logistic regression was used to study association between exposure variables and brucellosis using odds ratios (OR) and 95% confidence intervals (CI). Results Forty-three cases and 86 controls were recruited from a population of 4792 individuals in 801 households. The mean age for the cases was 48.7 years while that of the controls was 37.6 years. The dominant gender for both cases (62.7%) and controls (58.1%) groups was female. Regular consumption of un-boiled raw milk and assisting animals in delivery were significantly associated with brucellosis by OR 7.7 (95% CI 1.5–40.1) and OR 3.7 (95% CI 1.1–13.5), respectively.

Road traffic crashes (RTC) cause significant premature morbidity, mortality and disability globally. The burden is estimated to be higher in low and middle income countries, where surveillance is inadequate and data incomplete. We aimed to describe the burden of fatal RTC in Kenya to inform improvement in road traffic injury surveillance in the country. We used publicly available data from the National Transport and Safety Authority (NTSA). The NTSA is the organization mandated to collect road crash data and implement road safety policies in Kenya. Data collected daily for 2017 was combined into a single dataset, cleaned using Microsoft Excel, and analyzed using Epi Info software, version 7.1. We generated descriptive statistics and compared the overall fatalities in 2017 with 2016. We used mid-year estimated population for 2016 and 2017 to calculate mortality ratios. Total fatalities in 2017 were 2893; 36% were pedestrians, 27% vehicular passengers, 11% drivers, 17% motorcyclists, 7% pillion passengers and 2% pedal cyclists. Of these, 938 (32.4%) had at least one demographic detail recorded. Mean age of victims was 35.7 years (±16.7 years), 68.3% (308 out of 451 with age recorded) were aged 40 years and below, while 87.0% (773/889) were male. Nairobi, Kiambu and Machakos Counties had the highest proportion of fatalities with 15.8%, 8.1% and 6.0% respectively. The mortality ratio for 2017 was 5.8 per 1 00 000 compared to 6.1 per 1 00 000 population in 2016 (p=0.85). The monthly distribution of fatalities had three peaks; March, July-August and December. Most fatalities were recorded between 1800 hours and 0100 hours. Burden of RTC fatalities remains unchanged in Kenya despite efforts by NTSA to address the problem, especially among young males. A comprehensive RTC surveillance system with better data completeness is necessary to effectively monitor public health impact of RTC in Kenya and institute measures.

Background From December 2014 to September 2016, a cholera outbreak in Kenya, the largest since 2010, caused 16,840 reported cases and 256 deaths. The outbreak affected 30 of Kenya’s 47 counties and occurred shortly after the decentralization of many healthcare services to the county level. This mixed-methods study, conducted June–July 2015, assessed cholera preparedness in Homa Bay, Nairobi, and Mombasa counties and explored clinic- and community-based health care workers’ (HCW) experiences during outbreak response. Methods Counties were selected based on cumulative cholera burden and geographic characteristics. We conducted 44 health facility cholera preparedness checklists (according to national guidelines) and 8 focus group discussions (FGDs). Frequencies from preparedness checklists were generated. To determine key themes from FGDs, inductive and deductive codes were applied; MAX software for qualitative data analysis (MAXQDA) was used to identify patterns. Results Some facilities lacked key materials for treating cholera patients, diagnosing cases, and maintaining infection control. Overall, 82% (36/44) of health facilities had oral rehydration salts, 65% (28/43) had IV fluids, 27% (12/44) had rectal swabs, 11% (5/44) had Cary-Blair transport media, and 86% (38/44) had gloves. A considerable number of facilities lacked disease reporting forms (34%, 14/41) and cholera treatment guidelines (37%, 16/43). In FDGs, HCWs described confusion regarding roles and reporting during the outbreak, which highlighted issues in coordination and management structures within the health system. Similar to checklist findings, FGD participants described supply challenges affecting laboratory preparedness and infection prevention and control. Perceived successes included community engagement, health education, strong collaboration between clinic and community HCWs, and HCWs’ personal passion to help others. Conclusions The confusion over roles, reporting, and management found in this evaluation highlights a need to adapt, implement, and communicate health strategies at the county level, in order to inform and train HCWs during health system transformations. International, national, and county stakeholders could strengthen preparedness and response for cholera and other public health emergencies in Kenya, and thereby strengthen global health security, through further investment in the existing Integrated Disease Surveillance and Response structure and national cholera prevention and control plan, and the adoption of county-specific cholera control plans.

Background. Lead exposure is linked to intellectual disability and anemia in children. The United States Centers for Disease Control and Prevention (CDC) recommends biomonitoring of blood lead levels (BLLs) in children with BLL ≥5 μg/dL and chelation therapy for those with BLL ≥45 μg/dL.Objectives. This study aimed to determine blood and environmental lead levels and risk factors associated with elevated BLL among children from Owino Uhuru and Bangladesh settlements in Mombasa County, Kenya.Methods. The present study is a population-based, cross-sectional study of children aged 12–59 months randomly selected from households in two neighboring settlements, Owino Uhuru, which has a lead smelter, and Bangladesh settlement (no smelter). Structured questionnaires were administered to parents and 1–3 ml venous blood drawn from each child was tested for lead using a LeadCare ® II portable analyzer. Environmental samples collected from half of the sampled households were tested for lead using graphite furnace atomic absorption spectroscopy.Results: We enrolled 130 children, 65 from each settlement. Fifty-nine (45%) were males and the median age was 39 months (interquartile range (IQR): 30–52 months). BLLs ranged from 1 μg/dL to 31 μg/dL, with 45 (69%) children from Owino Uhuru and 18 (28%) children from Bangladesh settlement with BLLs >5 μg/dL. For Owino Uhuru, the geometric mean BLL in children was 7.4 μg/dL (geometric standard deviation (GSD); 1.9) compared to 3.7 μg/dL (GSD: 1.9) in Bangladesh settlement (pConclusions. Children in Owino Uhuru had significantly higher BLLs compared with children in Bangladesh settlement. Interventions to diminish continued exposure to lead in the settlement should be undertaken. Continued monitoring of levels in children with detectable levels can evaluate whether interventions to reduce exposure are effective.Participant Consent. ObtainedEthics Approval. Scientific approval for the study was obtained from the Ministry of Health, lead poisoning technical working group. Since this investigation was considered a public health response of immediate concern, expedited ethical approval was obtained from the Kenya Medical Research Institute and further approval from the Mombasa County Department of Health Services. The investigation was considered a non-research public health response activity by the CDC.Competing Interests. The authors declare no competing financial interests.

In Kenya, human anthrax cases most often occur linked to animal anthrax. In most cases, human behaviors, especially slaughter and consumption of meat from animal anthrax cases, has been implicated. This case study is based on an anthrax outbreak investigation conducted in an endemic region in Kenya in May 2016.The case study simulates how a mixed methods approach can be used in epidemiologic research.To fully benefit from this case study, participants should have had prior lectures or other instruction in quantitative and qualitative study designs and sampling approachesused in epidemiologic research. The case study is ideally suited for trainees at intermediate or advance level training in field epidemiology who should be able to complete the case study in approximately 3 hours.