University of Nairobi

Despite treatment, many hypertensive patients with coronary heart disease (CHD) have blood pressure (BP) that remains above guideline targets. However, less is known about patients in whom on-treatment BP is below target and major European guidelines differ substantially in their recommendations for such patients. Specifically, 2023 European Society of Hypertension (ESH) guidelines provide a Class 3 recommendation to proactively avoid BP below target whereas 2024 European Society of Cardiology (ESC) guidelines do not. Between 2020 and 2023, adults hospitalised in the previous 6-24 months with incident or recurrent CHD were sampled in 14 countries from all six WHO regions and invited for a standardised interview and examination as part of the International Action on Secondary and Primary Prevention by Intervention to Reduce Events (INTERASPIRE) study. We measured seated BP twice using an automated oscillometric device after 5 min of rest. We defined participants as having BP above target (BP ≥130/80 mm Hg), at target (BP 120-129/70-79 mm Hg) or below target (<120/70 mm Hg); according to both 2023 ESH and 2024 ESC guidelines. Among 4548 participants (21.1% female), the mean age (±SD) was 60.0 (±10.3) years. At a median (IQR) of 1.05 (0.76-1.45) years after index CHD hospitalisation, 10.3% of patients had BP readings within the target range of 120-129/70-79 mm Hg, with 53.9% above target and 35.7% below target. Patients with below-target BP were more likely to have heart failure (13.6% vs 10.0%, p=0.041) and estimated glomerular filtration rate <60 mL/min/1.73 m² (18.9% vs 10.7%, p<0.001), when compared with those at target. They were also statistically more likely to be severely frail (p=0.030). The median number of BP-lowering medications did not differ significantly between the 3 BP target groups. Cumulative dosing of BP-lowering medications in the below-target group was also not more intensive than that in the at-target group. More than one-third of INTERASPIRE patients with CHD presented with BP <120/70 mm Hg, which is below target per current European hypertension guidelines. Further research is needed in this population to resolve discordant guideline recommendations and determine whether de-escalation of BP-lowering therapies is beneficial or even harmful in this setting.

This study presents an exploratory data analysis and visualisation of mental health data in South Sudan, a total of 72,414 reported cases collected between 2020 and 2022 from the National Ministry of Health via the DHIS 2. The Demographic Health Information System 2 (DHIS 2) is a data collection tool that collects data from the health facilities across the country. The mental health statistical analysis covers data for acute stress, depression, psychosis, grief, post-traumatic stress disorder, substance and drug abuse, suicide attempts, other mental health conditions and other significant mental health complaints. The study identifies trends in mental health data needed by the health providers. The detailed data analysis will facilitate data-driven interventions, planning, and monitoring of the mental health programme. The diagnosis of mental health cases was classified using the Diagnostic and Statistical Manual of Mental Disorders (DSM). The exploratory data analysis (EDA) conducted using R statistical software (R Markdown) provides good visualisations and tabulations of the mental health data. Substance &amp; drugs abuse, post-traumatic stress disorders, suicide attempts, grief, depression and acute stress are the common mental problems in South Sudan. The data show that the acute mental health cases are increasing at a rate of 41 per cent annually. The findings are useful for re-programming mental health interventions and increasing public awareness about mental health.

Abstract Background SARS-CoV-2 genomic surveillance data remain limited in most low and middle-income countries (LMICs), resulting in significant gaps in the understanding of variant circulation and evolution. Wastewater-based epidemiology (WBE) presents a non-invasive, cost-effective, and population-representative surveillance approach that can complement clinical testing, particularly in densely populated urban informal settlements with limited healthcare access. This study aimed to pilot wastewater-based genomic surveillance as a multifaceted public health tool in Kenya. Methods A prospective study was conducted using wastewater samples collected from two WHO-validated environmental surveillance sites — Eastleigh A (Kamukunji sub-county) and Mathare (Starehe sub-county) — in Nairobi, Kenya, between December 2022 and October 2023. A total of 272 samples were collected using Moore swabs at a frequency of two to three times per week. Samples were concentrated using Nanotrap® Magnetic Virus Particles, and nucleic acid was extracted using the Qiagen QIAamp Viral RNA Mini Kit. SARS-CoV-2 was detected using RT-PCR (TaqPath™ COVID-19 CE-IVD RT-PCR Kit). Library preparation for whole-genome sequencing was performed using the Illumina COVIDSeq kit, and sequencing was conducted on the Illumina MiSeq platform. Bioinformatic analysis was performed using Terra.bio and RStudio, and phylogenetic analysis included sequences abstracted from GISAID. Results Of 272 samples, 238 (87.5%) tested positive with a cycle threshold (Ct) value of less than 36. Genomic analysis of 181 sequences identified Omicron as the predominant circulating variant, detected in 59% of samples. Other variants included XBB (16%), XBB.2.3(10%), XBB.1.9.X (5%), and additional minor variants. These findings were concordant with clinical sequencing data from Kenya over the same period. Conclusions Wastewater-based genomic surveillance reliably reflected SARS-CoV-2 variant trends observed in clinical data. This approach provides early signals of variant emergence and evolution, offering a cost-effective complement to clinical surveillance in resource-limited settings.

Purpose: The purpose of the study was to examine the influence of strategic change on organizational growth at Beta Healthcare International Limited in Kenya. Methodology: The study was anchored on Agency Theory, Stewardship Theory, and Stakeholder theory to explain leadership accountability, managerial behavior, and stakeholder engagement during strategic transformation. An exploratory research design using a qualitative approach was adopted. Data was collected through in-depth interviews with seven purposively selected employees drawn from different functional areas of Beta Healthcare International Limited. The data were analyzed using thematic analysis with the support of NVivo software to identify patterns and themes related to digitization, organizational restructuring, communication processes, and training initiatives. Findings: The findings revealed that strategic change initiatives, particularly digitization and organizational restructuring, positively influenced operational efficiency, decision-making processes, and overall strategic alignment within the organization. However, the implementation of these initiatives faced several challenges, including inadequate internal communication, employee resistance to change, and unequal access to training opportunities. The results further demonstrated that effective training and capacity building initiatives significantly enhance employee adaptability and successful implementation of strategic change. Contribution to Theory, Policy and Practice: The study contributes to theory by demonstrating the continued relevance of Agency, Stewardship and Stakeholder perspectives in understanding the dynamics of strategic change implementation. Practically, the findings highlight the need for organizations to integrate digital transformation, structural alignment and human capital development to achieve sustainable growth. The study recommends strengthening internal communication systems, implementing inclusive and continuous employee training programs and adopting structured change management practices to enhance employee participation and reduce resistance to change. These measures are critical for improving organizational agility, competitiveness and long-term performance in healthcare sector.

Cassava brown streak disease (CBSD), caused by cassava brown streak virus (CBSV; Ipomovirus brunusmanihotis) and Ugandan cassava brown streak virus (UCBSV; Ipomovirus manihotis) (family Potyviridae, genus Ipomovirus), is increasingly becoming a threat to cassava production in several parts of Africa, especially in Eastern, Central and Southern Africa. In Kenya, the disease continues to wreak havoc on cassava production leading to a significant reduction in crop yields and economic losses of up to USD 1 billion. Variation in virus populations make the control of CBSD challenging as virus genomic variation can affect the accuracy of diagnostic tests, lead to resistance breaking isolates and jeopardize strategies of breeding for resistance. CBSV and UCBSV populations obtained from cassava fields in Kenya were characterized. In total, 44 new complete sequences of CBSV and UCBSV were assembled and 40 sequences successfully submitted to GenBank. Single Nucleotide Polymorphism (SNP) analysis revealed that the cylindrical inclusion protein (CI) is the most stable region across the genome of CBSV and UCBSV. In contrast, protein 1 (PI) and the coat protein (CP) were the most hypervariable regions. Phylogenetic analysis showed three major geographical groupings for both UCBSV and CBSV isolates, suggesting a continued spread of the viruses through human-mediated movement of infected planting materials. The data obtained in this study can support the development of disease management strategies through improved molecular diagnostic tests and targets for breeding for resistance against CBSD.

ABSTRACT Administrative accountability is widely recognized as a central feature of effective penal systems and their rehabilitative function. Globally, stronger accountability structures have been associated with better inmate outcomes, aligning with Sustainable Development Goal 16 on peace, justice, and strong institutions. In Kenya, however, the implementation of rehabilitation policies continues to be constrained by weak accountability mechanisms within prison administration. This literature review examines how administrative practices shape inmate rehabilitation in Nairobi-based prisons, drawing on studies published between 2015 and, 2024. Guided by New Public Management (NPM) theory, the review explores the roles of performance measurement, decentralization, transparency, and stakeholder involvement in shaping service delivery. The findings suggest that although policy frameworks exist, accountability mechanisms remain poorly institutionalized. This results in limited program monitoring, inefficiencies in service provision, and weak reintegration outcomes for inmates. The review also identifies a notable gap in Kenya-specific empirical research on administrative accountability in prisons. It argues that reforms should focus on strengthening localized autonomy, establishing clear and consistent performance evaluation systems, and promoting evidence-based implementation. Addressing these weaknesses is necessary if Kenya’s correctional institutions are to meet their rehabilitative mandate in practice.

Ecological filters govern how hemiparasites express functional traits, shaping species persistence and ecosystem dynamics in drylands. We investigated how host identity, elevation, and disturbance influence morphological plasticity in Osyris lanceolata, a facultative hemiparasite of conservation concern in Uganda’s semi-arid Karamoja rangelands. Despite broad host availability, O. lanceolata consistently associated with a core group of woody hosts including Rhus natalensis, Euclea racemosa, and Maytenus senegalensis, reflecting deterministic host-driven trait outcomes (Sørensen greater than 0.70). Elevation, coppicing, and spatial arrangement caused pronounced plasticity in stem number, stem diameter, and leaf area, with trade-offs observed between height and thickness under disturbance. These predictable shifts, influenced by both hosts and the environment, reveal mechanisms of hemiparasite adaptation that support nutrient cycling and dryland community dynamics. Considering host specificity, morphological plasticity, and responses to disturbance, O. lanceolata provides a model for understanding functional ecology in hemiparasitic plants. The findings offer guidance for sustaining O. lanceolata populations and their host networks to maintain resilient dryland ecosystems.