Partners for Health and Development in Africa

Community health worker (CHW) programmes are central to primary healthcare (PHC) in sub-Saharan Africa (SSA). Yet who pays for them, how much, and whether funds favour vertical (single-disease) or horizontal (broader-focus) programmes remains unclear. This study examined trends in donor and government financing for CHW programmes across SSA. We conducted a secondary analysis of publicly available data. Organisation for Economic Co-operation and Development Creditor Reporting System (2002-2022) projects were screened and classified as vertical or horizontal through standard definitions and manual review. Government spending in 37 SSA countries (using WHO Global Health Expenditure Database (2016-2022) was estimated by applying maturity-based allocation percentages to preventive and outpatient curative functions. We described trends, donor composition, vertical-horizontal shares and the annual financing gap against published cost benchmarks. Between 2002 and 2022, global external assistance for CHW programmes totalled US$14.4 billion, SSA receiving 76% (US$11.0 billion). Of donor funds to SSA, 76.4% supported vertical programmes, although these made up fewer than 20% of projects; horizontal programmes received just 14.7%. Annual external assistance rose from ~US$0.28 billion (2016-2019) to ~US$1.83 billion (2020-2022), with over 90% directed to vertical or COVID-19-related efforts. Government spending across 37 SSA countries totalled ~US$1.4 billion (2016-2022). This represented less than 20% of total CHW funding but a greater share directed to horizontal services (54.6%). The annual financing gap remained between US$4.7 billion and US$4.3 billion. CHW financing in SSA is donor-dominant and vertically oriented; domestic allocations are limited but relatively more horizontal. Closing the funding gap will require larger, predictable government budgets for CHWs, better-aligned partner support and stronger expenditure tracking to sustain PHC and advance universal health coverage.

The vaginal microbiome's role in risk, progression, and treatment of female cancers has been widely explored. Yet, there remains a need to develop methods to understand the interaction of microbiome factors with host cells and to characterize their potential therapeutic functions. To address this challenge, we developed a systems biology framework we term the Pharmacobiome for microbiome pharmacology analysis. The Pharmacobiome framework evaluates similarities between microbes, microbial byproducts, and known drugs based on their impact on host transcriptomic cellular signatures. Here, we apply our framework to characterization of the Anti-Gynecologic Cancer Vaginal Pharmacobiome. Using published vaginal microbiome multi-omics data from the Partners PrEP clinical trial, we constructed vaginal epithelial gene signatures associated with each profiled vaginal microbe and metabolite. We compared these microbiome-associated host gene signatures to post-drug perturbation host gene signatures related to 35 FDA-approved anti-cancer drugs from the Library of Integrated Network-based Cellular Signatures database to identify vaginal microbes and metabolites with high statistical and functional similarity to these drugs. We found that select lactobacilli particularly L. crispatus and their metabolites, such as taurine, can regulate host gene expression in ways similar to certain anti-cancer drugs. Additionally, we experimentally tested our model prediction that taurine, a metabolite produced by L. crispatus, kills cancerous breast and endometrial cancer cells. Our study shows that the Pharmacobiome is a robust framework for characterizing the anti-cancer therapeutic potential of vaginal microbiome factors with generalizability to other cancers, microbiomes, and diseases.

The Community-Based Conservation (CBC) approach views local people as interested parties who should actively participate in and control conservation efforts, which contrasts with the conventional 'fortress conservation' common in government-protected areas isolated from human disturbance. The transition from fortress conservation to CBC, however, has not been a smooth journey for many African countries, especially in the sub-Saharan Africa region. This is because, in some cases, local communities do not see themselves as part of the governance structure of these conservancies, which affects the long-term ecological sustainability of the conservancies. Using eight (8) conservancies in the arid and semi-arid counties of Isiolo and Samburu, Kenya, this study used exploratory research to gather data from 24 Focus Group Discussions (FDGs) and forty-eight (48) key informant interviews (KIIs) to assess the influence of communities’ involvement on ecological outcomes of the conservancies. Other secondary sources also supported the primary data sources. Our findings showed that the governance model does influence community support for conservancies, and the benefits that communities receive or expect from the conservancies also have a strong influence on their support for conservation. However, it was established that community conservancies have brought positive changes to the wildlife population trends and habitat health. The study recommends the development of the National Rangelands Resources Management Policy and institutional arrangements to strengthen and safeguard the future of wildlife conservation within those conservancies and to provide clarity on the roles of different stakeholders. The study also recommends further studies on the actual impact of governance on community perception, the value of existing investments in community benefits, and the long-term implications of climate change impacts on conservancy ecosystems.

There is a decreased life span of 10 - 15 years in persons with psychiatric illnesses in contrast with the public population; hence interventions on first onset may improve some end results. This article explores the psychiatric morbidity among youth patients of age group 18 - 35 years. The study implemented a cross-sectional descriptive design. The study was carried out at Nakuru County Referral and Teaching Hospital in Kenya: 385 youth patients were sampled for this study using simple random sampling. There were more female (55.3%) participants compared to male (44.7%). Marital status and employment status were found to have a statistically significant association with psychiatric morbidity. The singles (p = .024) had an OR (4.771) higher chance of having a psychiatric morbidity as compared to the married. On the other hand, those who were widow/widower (p = .016) had an OR (5.650) times of developing a mental illness compared to the married. In conclusion, the prevalence of psychiatric morbidity among youth outpatients of the age bracket 18 - 35 years at Nakuru County Referral and Teaching Hospital stands at 46.5%. Marital status and employment status were noted to have a statistically significant link with psychiatric morbidity. Regular psychological assessments should be conducted as part of treatment evaluations for patients to get other more interventions necessary for them, bettering their health outcome broadly.

Clinicians, NGOs, funders and academics (among others) in global health are accustomed to discussion of the "low-resource setting". Commonly, the resources implicit in this term are physical (equipment, drugs) and infrastructural (electricity, water and sanitation) in nature. Human resources are well recognised as scarce in this context too, and the focus in most "workforce" research is on the number, distribution and/or training of healthcare workers. In this article, we make the case for closer examination of "social resource" as necessary to patient safety and distinct from simple enumeration of available/trained personnel. We use the clinical specialty of anaesthesia as a case study, identifying the different ways in which social resource is necessary to enable safe practice for anaesthesia providers, and the potential challenges to accessing social resource relevant in the low- and middle-income context. Finally, we suggest ways in which social resource for anaesthesia professionals in LMICs might be meaningfully investigated, with a view to improving its priority and access for safe anaesthesia care worldwide.

The injectable contraceptive, depot medroxyprogesterone acetate (DMPA), is associated with compromised cervical mucosal barriers. High-resolution spatial transcriptomics is applied here to reveal the spatial localization of these altered molecular markers. Ectocervical tissue samples from Kenyan sex workers using DMPA, or non-hormonal contraceptives, underwent spatial transcriptomics and gene set enrichment analyses. Integrated systemic estradiol levels and bulk tissue gene expression data from a larger cohort enhanced the study’s scope. Unsupervised clustering unveiled four epithelial and seven submucosal layers, showcasing spatially restricted and diverse functional epithelial responses, and a less structured submucosal spatial ordering. DMPA associated with mucosal-wide immunoglobulin gene upregulation, verified by CD20+ B-cell immunostaining, and upregulated immune markers adjacent to the basal membrane. Downregulated genes represented spatially restricted disrupted epithelial barrier integrity and submucosal extracellular matrix dysfunction. The transcriptional profile was associated with markers of estrogen regulation. Collectively, our findings reveal estrogen-modulated distinct ectocervical transcriptional profiles associated with DMPA usage. While upregulation of immunoglobulin genes occurs throughout the mucosa, activation of innate immune responses and dysregulation of barrier integrity markers are spatially restricted. These results extend previous analyses using bulk transcriptomics and provide insights into the molecular landscape influenced by DMPA, shedding light on contraceptive effects and health implications.

Objective: The general objective of this study is to establish the influence of Transformational Leadership on Performance of Deposit Taking SACCOs in Nairobi city County, Kenya and more specifically establish the role of Employee Commitment in the relationship between transformational leadership and performance of the SACCOs. Theoretical Framework: The main concepts and theories that underpin the research and chosen to anchor the variables of the study include: Transformational leadership theory, Self-determination theory and Contingency theory. Method: The research philosophy embraced by this study was positivism. The research design used was descriptive research design and Census Survey was conducted on the forty (40) deposit taking Savings and Credit Cooperative Societies (SACCOs) in Nairobi City County, Kenya (SASRA, 2016). The study relied on primary data which was collected using structured questionnaires with close-ended questions. Results and Discussion: The results obtained from this study reveal that transformational leadership has a significant influence on performance of DTSACCOs which is in line with transformational leadrship theory that transformational leaders are able to articulate organizational goals and objectives in a bid to achieve the set objectives in organzations. At the same note, employee commitment was found to have a significant mediationg influence in the relationship between transformational leadrship and organzational performance. The limitations of this study is that data was collected from at a snap short (one point in time) and hence lmiting comparison. Research Implications: These results further reveal that organizations ought to provide a challenge to the goals, the feedback mechanism provided by management, and the opportunity to participate in decision-making by eemployees as it will raise their levels of commitment. The SACCOs’ management need to embrace strategies that enhance the employees’ level of commitment by making them achieve their needs since this contributes to employees feeling competent and confidence, which results in increased employee commitment and greater performance. In addition SASRA needs to come up with policies and programs that enhance employee commitment and encourage leaders to embrace the commitments of employees towards achieving the organizations performance. Originality/Value: The study contributes to literature by contributing to operationalization and conceptualization of the variables whch a long way to providing insight for scholars and researchers. These research also provide input regarding leadership practices and Employee engagement in the said SACCOs to improve Performance. The study also enriches the body of knowledge in relation to leadership, employee commitment and performance. Finally, the study shall contribute into policy by guiding SASRA in coming up with regulations that promote employee engagement and raise their commitment.

BackgroundThe cervicovaginal epithelial barrier is crucial for defending the female reproductive tract against sexually transmitted infections. Hormones, specifically estradiol and progesterone, along with their respective receptor expressions, play an important role in modulating this barrier. However, the influence of estradiol and progesterone on gene and protein expression in the ectocervical mucosa of naturally cycling women is not well understood.MethodsMucosal and blood samples were collected from Kenyan female sex workers at high risk of sexually transmitted infections. All samples were obtained at two time points, separated by two weeks, aiming for the follicular and luteal phases of the menstrual cycle. Ectocervical tissue biopsies were analyzed by RNA-sequencing and in situ immunofluorescence staining, cervicovaginal lavage samples (CVL) were evaluated using protein profiling, and plasma samples were analyzed for hormone levels.ResultsUnsupervised clustering of RNA-sequencing data was performed using Weighted gene co-expression network analysis (WGCNA). In the follicular phase, estradiol levels positively correlated with a gene module representing epithelial structure and function, and negatively correlated with a gene module representing cell cycle regulation. These correlations were confirmed using regression analysis including adjustment for bacterial vaginosis status. Using WGCNA, no gene module correlated with progesterone levels in the follicular phase. In the luteal phase, no gene module correlated with either estradiol or progesterone levels. Protein profiling on CVL revealed that higher levels of estradiol during the follicular phase correlated with increased expression of epithelial barrier integrity markers, including DSG1. This contrasted to the limited correlations of protein expression with estradiol levels in the luteal phase. In situ imaging analysis confirmed that higher estradiol levels during the follicular phase correlated with increased DSG1 expression.ConclusionWe demonstrate that estradiol levels positively correlate with specific markers of ectocervical epithelial structure and function, particularly DSG1, during the follicular phase of the menstrual cycle. Neither progesterone levels during the follicular phase nor estradiol and progesterone levels during the luteal phase correlated with any specific sets of gene markers. These findings align with the expression of estradiol and progesterone receptors in the ectocervical epithelium during these menstrual phases.

SMART DAPPER is an implementation science study responding to mental health treatment gaps for depression and trauma-related disorders in Sub-Saharan Africa (SSA). We report on patient experiences in a study using a Sequential, Multiple Assignment Randomized Trial (SMART) design to test first and second line non-specialist treatment using psychotherapy (Interpersonal Psychotherapy [IPT] or medication (fluoxetine [FLX]), integrated within public sector primary care in western Kenya. An embedded qualitative study conducted in-depth interviews (n = 17) and three (n = 3) focus group discussions with participants (May to October 2021). Audio-recorded interviews were transcribed and translated into English; we deductively and inductively analyzed transcripts guided by grounded theoretical approaches and content analysis. We drew on the health belief model and socio-ecological framework to present findings, including perceived severity (motivations for taking part in the intervention), impacts of the intervention at the individual, interpersonal, and community and health systems levels as well as barriers and facilitators. Participants discussed family and marital conflict, loss of a child, loss of income or a job, and traumatic events such as a death or illness. Impacts at the individual level included reduced headaches, improved appetite and weight management, increased energy, improved sleep, better self-efficacy, and improved concentration, which was reported to lead to increased economic opportunities. At the interpersonal level, participants noted a reduction in conflict, better conflict management and resolution, increased harmony with family and community members, and improved relationships with their partners and children. Perceived challenges included balancing the intervention with livelihoods, preference for traditional medicines, actual or anticipated side effects with medication (FLX), mental health stigma, major life events, and perceived inadequate counseling and challenges with providers. The findings demonstrate the potential of the SMART DAPPER intervention for depression and trauma-related disorder treatments and underscore the challenges and barriers that must be addressed when scaling similar interventions. Trial registration: ClinicalTrials.gov identifier: NCT03466346.