Moi University

This study examined challenges affecting competency- based education implementation in senior secondary schools in Bungoma County, Kenya and proposed mitigation strategies. A descriptive survey design was used with 244 Grade 10 teachers sampled from 24 public schools. Data were collected using structured questionnaires with established reliability and analyzed using descriptive statistics, Findings revealed key challenges including inadequate ICT infrastructure, insufficient teacher training, financial constraints, and negative stakeholder attitudes. Teachers also reported difficulties in curriculum planning and assessment practices. Suggested mitigation strategies included enhanced teacher in-service training, improved resource allocation, policy support, and stakeholder sensitization. The study concludes that strengthening institutional support mechanisms is essential for effective implementation of competency based education in Kenya.

BackgroundProstate cancer (PCa) is a leading cause of cancer-related morbidity and mortality among men globally. The prevalence is disproportionate among men of African descent and more specifically, in East Africa, where it is characterized by aggressive tumour biology and poor survival outcomes. Despite its high burden, the risk factors underlying its disproportionate prevalence remain understudied in this population. This study investigated lifestyle risk and protective factors among prostate cancer (PCa) patients, including demographic, dietary, lifestyle, and family cancer history, at Muhimbili National Hospital (MNH) and Ocean Road Cancer Institute (ORCI) in Dar es Salaam, Tanzania.MethodsThis case-control study compared PCa patients with non-PCa controls. Data on sociodemographic, lifestyle, diet, and family history were collected using a standardized questionnaire. Multivariate logistic regression identified significant risk and protective factors for PCa from each of these factors. Several statistical approaches were used to rank a Tanzanian urban population’s significant risk or protective factors.ResultsRanking of broad classes of factors revealed that diet, lifestyle, sociodemographic, family, and patient history of cancer and other disease factor groups, in order of importance, were associated with PCa in men. However, the single best model explaining the odds of being PCa had intake of red meat, coffee, alcohol, tomato, and marital status as independent variables. Specifically, increased intake of red meat (AOR = 5.248), and alcohol (AOR = 2.189) were associated with a high PCa incidence while increased intake of soya (AOR = 0.248), coffee (AOR = 0.603), tomato (AOR = 0.188), and not being married (AOR = 0.147) were associated with lower incidence of PCa in the Tanzanian urban population.ConclusionThe findings suggest that dietary and lifestyle factors have a significant association with PCa incidence in a Tanzanian population compared to sociodemographic, family cancer history, and exposure to infectious and other lifestyle diseases. We recommend further research, including prospective studies or randomized controlled trials with large sample sizes, to confirm these findings, as they suggest health initiatives for the prevention of PCa among high-risk populations, such as urban male populations.

Reciprocal innovation, a model of sustained, multidirectional exchange in which health strategies are adapted, revisited, and refined across contexts, offers a compelling framework to rethink how implementation science can support global health equity by enabling dynamic, multidirectional learning across different contexts. Drawing on the EXTRA-CVD trial, a nurse-led cardiovascular disease prevention intervention designed to extend the HIV treatment cascade in United States (U.S.) HIV clinics, which adapted strategies informed by implementation research in Kenya and the U.S. Veterans Affairs health system, this perspective examines how reciprocal innovation can begin to emerge within existing research structures, as well as where opportunities for deeper exchange remain limited. We identify four operational domains of reciprocal innovation: care delivery strategies, end-user engagement, research methodologies, and research leadership and partnership. Across these domains, we describe how cross-context learning shaped intervention adaptation and site-level implementation in EXTRA-CVD, as well as missed opportunities where more intentional feedback, shared leadership, and methodological exchange could have strengthened multidirectional learning. Taken together, this work highlights both the potential and the practical challenges of reciprocal innovation in implementation research, emphasizing its role in moving beyond unidirectional knowledge transfer toward iterative, context-responsive learning. By embedding structures for iterative feedback, equity-centered governance, and multidirectional learning systems within research and implementation systems, future global partnerships can foster more inclusive, responsive, and sustainable health interventions.

ABSTRACT Introduction Low dietary diversity has been identified as a predictor of depression outcomes in high-income countries, while evidence is scarce from low-income settings where poor nutrition and depression often co-occur. In this study, we estimate the relationship between dietary diversity and depression among adults in rural western Kenya. Method We conducted a cross-sectional analysis of 311 participants enrolled in the Bridging Income Generation through Group Integrated Care program. We assessed depressive symptoms using the 20-item Centre for Epidemiologic Studies for Depression Scale (CES-D), and measured dietary diversity as the number of five food groups consumed in previous 24-hours using a validated dietary diversity scale. We used linear regression to estimate the association between high dietary diversity (consumption of all the five food groups) and continuous depression scores, adjusting for key covariates. We tested for effect measure modification by wealth status. We conducted a secondary analysis using quantile regression to explore variation across depression scores distributions. Results Higher dietary diversity was associated with fewer depressive symptoms [adjusted β (95% CI): -3.49 (-6.62, -0.38)]. The association was stronger among individuals with low wealth backgrounds [adjusted β (95% CI): -6.00 (-10.46, -1.42)] relative to those with high wealth backgrounds [adjusted β (95% CI): -0.53 (-4.76, 3.68); Wald p-value for interaction term =0.0003]. The effect sizes for the association were larger at higher quantiles, notably at 75th [adjusted β (95% CI): -4.00 (-10.13, 2.13)] and 90th [adjusted β (95% CI): -1.59 (-7.43, 4.25)] compared to those at lower quantiles for 10 th [adjusted β (95% CI): -0.59 (-2.46, 1.28) and 25 th [adjusted β (95% CI): -0.82 (-4.14, 2.50), though wide confidence intervals limited the precision of effect estimates. Conclusion In rural western Kenya, higher dietary diversity was associated with lower depression symptoms, particularly among participants from lower wealth backgrounds, and particularly among those with scores consistent with more severe depression symptoms. These findings suggest that improving dietary diversity may offer mental health benefit to the most socioeconomically disadvantaged individuals and could be a promising strategy to reduce depression in resource poor settings. Future work could leverage longitudinal and experimental studies for improved inference and should investigate mechanisms through which dietary diversity may influence depression.

After the expansion of the World Health Organization's guidelines on eligibility for the seasonal malaria chemoprevention (SMC), the government of Kenya prepared to implement SMC for a first time in Turkana Central Subcounty in 2024. To inform the design of SMC, we conducted a baseline qualitative and quantitative study. Using stratified cluster sampling, we enrolled 198 households with children of ages 6 months to 5 years and tested all individuals six months and older using a rapid diagnostic test (RDT) and polymerase chain reaction (PCR) for Plasmodium falciparum. We performed 78 key informant interviews; 31 focus group discussions with community health workers, elders, and caretakers of children; and 60 in-depth interviews with caretakers. Prevalence of P. falciparum infection was 21% (9-42%) by RDT and 21% (11-38%) by PCR. Prevalence varied across villages, with the highest positivity of 73% by PCR. Although SMC was perceived positively, the identified challenges included physical access (households far from village centers, pastoralists, children living in the streets), stigma (children living with disabilities, households with members struggling with alcohol use), and acceptability (traditionalists, highly educated households). Despite the high malaria burden in the region, SMC may be a feasible approach to reduce its burden and transmission. However, implementation of SMC should be tailored, combining centralized distribution with door-to-door delivery and outreach to pastoralists and people living in the interior. Using existing grassroots structures, such as pastoralist leadership structures and religious and group leaders, and intensive mobilization will be critical for success of this intervention.

Inclusion of youth (10–24 years) living with HIV (YLWH) in clinical research is critical to addressing their unique vulnerabilities and improving care outcomes. Examining the role of trust and relationship building in research decision-making is critical to designing ethical recruitment and engagement strategies. We conducted in-depth, semi-structured interviews with YLWH (10–24 years, enrolled in HIV care at Academic Model Providing Access to Healthcare (AMPATH) in western Kenya), caregivers (parents and guardians) of YLWH, and other subject matter experts (SMEs). Interviews focused on barriers, facilitators, and strategies to improve participant-researcher trust and relationship building, with a particular focus on recruitment and engagement strategies. Interviews were conducted with 99 participants (53% male): 40 YLWH [median age 17.5, (range 11–24), 50% female], 20 caregivers of enrolled YLWH (70% female), and 39 SMEs (33% female; 46% community leaders, 26% healthcare providers, 15% clinical researchers, 8% social scientists, 3% international research experts, 2% laboratory experts). All groups indicated trust could be built and broken through research processes. YLWH and SMEs viewed participant identification and study recruitment through medical records as a violation of trust, indicating that their HIV status and health information should remain confidential between themselves and their clinical team. All groups preferred recruitment through existing clinician-YLWH relationships, emphasizing the importance of privacy and confidentially; this strategy was viewed as stronger and more ethical. Losses of confidentiality and mistakes in sample collection that require participants to attend additional, unnecessary research visits or provide additional samples were identified by all groups as additional barriers to relationship-building. YLWH and caregivers discussed researcher characteristics that support relationship-building, emphasizing the importance of positive demeanors and non-stigmatizing behaviors by research personnel. YLWH and SMEs discussed operational needs that foster relationship-building, including proper communication about study procedures, reliably reporting results to participants, and receiving future benefits. Trusting participant-researcher relationships plays an important role in YLWH research decision making and greatly influence the development of ethical recruitment strategies. Study participants highlighted more appropriate and ethical recruitment strategies, stemming from strong participant-researcher relationships.

Prenatal exposure to potentially toxic elements (PTEs), including heavy metals and metalloids, poses a significant public health risk in low- and middle-income countries (LMICs), where environmental surveillance is limited. This study assessed maternal and foetal exposure to PTEs in maternal and umbilical cord blood samples (n = 32 each) collected at Ishaka Adventist Hospital, Uganda, an agricultural region with known environmental contamination. Concentrations of arsenic (As), lead (Pb), chromium (Cr), nickel (Ni), copper (Cu), iron (Fe), and zinc (Zn) were quantified using Microwave Plasma Atomic Emission Spectroscopy; cadmium was undetected. Maternal samples had significantly higher mean concentrations than cord blood (p < 0.05), suggesting partial placental filtration. Nonetheless, maternal–foetal transfer ratios ranged from 10% (Zn) to 50.51% (Pb), indicating foetal exposure. Weighted Risk Score modelling revealed substantial maternal and foetal risks, primarily due to exposure to elevated levels of multiple metals (Pb, Ni, Cr and As). Spearman correlation and multivariate parsimonious regression analyses revealed significant associations between maternal and cord blood PTE concentrations and reported health issues. Notably, hypertension, respiratory allergies, gastrointestinal upsets, and gestational diabetes were correlated (singly or in combination) with higher maternal blood metal(loid) levels, passive smoking, geophagia, repeated use of mosquito coils, and use of biomass fuel (firewood), identifying these as potential environmental sources. Stratified Mann–Whitney and Kruskal–Wallis tests showed significantly higher Cr and Pb among mothers reporting geophagia, and significantly lower birth weight (LBW) among infants of older mothers and those practising geophagy. Similarly, cord blood metal(loid) levels were associated with LBW. Findings highlight substantial in utero exposure to a mixture of toxicants, with potential implications for adverse birth outcomes and long-term health effects, underscoring urgent maternal-child health interventions and environmental regulation in LMICs settings.