Penda Health

Abstract We conducted a retrospective evaluation of an electronic medical record-embedded large language model (LLM) clinical decision support system deployed across 16 primary care clinics in Kenya, between July-September 2024. A panel of trained physicians reviewed 1,469 records. Hallucinations were uncommon (50/1,469; 3.4%), most often involving mis-expanded acronyms or drug names. Clinical management guidance aligned with local guidelines in almost all cases (approximately 100%). Despite this, clinicians did not modify documentation in 62% of encounters. Safety assessments identified actively harmful recommendations from the LLM in 7.8% of encounters, with 67 such recommendations appearing in the final documentation. Conversely, risk present in the clinician’s initial notes was fully mitigated in 118 encounters (8.0% overall; 12.1% of amended cases). Overall, the tool showed strong potential to support quality improvement, but the asymmetric adoption of harmful versus beneficial outputs underscore the need for usability optimization, local guardrails, and prospective trials to confirm patient-level benefit.

Overproduction of free radicals in excess of antioxidants leads to oxidativestress which can cause harm to the body. Conventional antioxidants havedrawbacks and are believed to be carcinogenic. The present study seeked toconfirm folklore use and validate the antioxidant potentials of Grewiatembensis and Xerophyta spekei which have beenwidely used in the Mbeere community as medicinal plants. Antioxidant propertieswere determined through scavenging effects of diphenyl-1-picrylhydrazyl (DPPH)and hydrogen peroxide radicals as well as iron chelating effects. The dataobtained was assayed in comparison to the standards (Ascorbic acid and EDTA).Ascorbic acid had a significantly greater DPPH radical scavenging property withan inhibitory concentration (IC50) value of 20.54 ± 2.24 µg/mL incomparison to the plant extracts, which had IC50 values of33.00 ± 1.47 µg/mL, 69.66 ± 1.01 µg/mL and 86.88 ± 2.64 µg/mL for X.spekei, G. tembensis leaf and G. tembensis stembark extracts, respectively. EDTA demonstrated a significantly greater ironchelating effect having a significantly lesser IC50 value of25.05 ± 0.79 µg/mL as opposed to 43.56 ± 0.46 µg/mL, 89.78 ± 0.55 µg/mL, and120.70 ± 0.71 µg/mL for X. spekei, G. tembensis leaf, andG. tembensis stem bark extracts respectively. Additionally,ascorbic acid also exhibited stronger hydrogen peroxide radical scavengingeffect than the studied extracts. Generally, X. spekei extracthad higher antioxidant activities as compared to both the leaf and stem barkextracts of G. tembensis. The phytochemical screeningdemonstrated the presence of secondary metabolites associated with antioxidantproperties. The present study therefore, recommends ethno medicinal andtherapeutic use of G. tembensis and X. spekeiin the treatment and management of oxidative stress related infections.

Welcome to Annals of Global Health,Annals of Global Health is a peer-reviewed, fully open access, online journal dedicated to publishing high quality articles dedicated to all aspects of global health. The journal's mission is to advance global health, promote research, and foster the prevention and treatment of disease worldwide. Its goals are to improve the health and well-being of all people, advance health equity, and promote wise stewardship of the earth's environment. The latest journal impact factor is 3.64.Annals of Global Health is supported by the Program for Global Public Health and the Common Good at Boston College. It was founded in 1934 by the Icahn School of Medicine at Mount Sinai as the Mount Sinai Journal of Medicine. It is a partner journal of the Consortium of Universities for Global Health. Authors of articles accepted for publication in Annals of Global Health will be asked to pay an Article Publication Charge (APC) to cover publication costs. This charge can normally be sourced from your funder or institution. We are committed to supporting authors from all countries to publish their work in Annals of Global Health regardless of national income level, and to achieve this goal, we waive the Article Publication Charge for manuscripts where all authors are from low-income or lower-middle-income countries (as defined by the World Bank). From time to time, Annals of Global Health publishes Special Collections, a series of articles organized around a common theme in global health. Recent Special Collections have included “Strengthening Women’s Leadership in Global Health”, “Decolonizing Global Health Education”, and “Capacity Building for Global Health Leadership Training”. Global health workers interested in developing a Special Collection are strongly encouraged to contact the Managing Editor in advance to discuss the project.

Mid-level care providers serve as the backbone of primary care in many parts of sub-Saharan Africa. Despite this, research suggests that the quality and consistency of this care is uneven. This study assessed the degree to which a set of four simple, low-cost interventions could improve adherence to a set of clinical quality measures (CQMs) associated with four common health conditions seen in a resource-constrained primary care setting. A quasi-experimental, longitudinal study was carried out in three primary care clinics in Nairobi, Kenya from August 2014 to January, 2015. Mid-level clinical officers (COs) at each clinic participated in four interventions aimed at improving CQM adherence. A group of temporary COs acted as a control group. Clinical encounter data were abstracted from eligible medical charts and assessed for CQM adherence. Mixed-effects logistic regression models were then fitted to these data to determine whether adherence to CQMs improved over time, and if this adherence differed by provider type and other characteristics. Adherence to CQMs increased from 41.4% to 77.1% for COs that took part in the intervention, and dropped slightly from 26.5% to 21.8% for temporary COs over the 6-month study period. This difference was statistically different between treatment groups and suggests that environmental interventions alone cannot change behaviour. Adherence also varied significantly by health condition, but did not vary by provider gender, age or clinic site. This study demonstrates the potential for low-tech, low-cost interventions to improve the quality of care delivered by mid-level care providers in resource-constrained settings. Given the widespread utilization of mid-level care providers across sub-Saharan Africa, multicomponent interventions such as this one, that consist of simple educational modules and clinic-based feedback sessions, could lead to substantial improvements in the quality of primary care in these settings.