DSpace Collection:

Social relationships, mental health, and stigma: A qualitative study of social networks and HIV disclosure in Western Kenya

2026-08-06T07:01:31Z

Title: Social relationships, mental health, and stigma: A qualitative study of social networks and HIV disclosure in Western Kenya Authors: Obatsa, Sarah; Mburia-Mwalili, Adel; JaureguiIII, Salvador; D. Wagner, Karla; Atwoli, Lukoye; Odhiambo, Francesca; Lewis-Kulzer, Jayne; Goodrich, Suzanne; Wools-Kaloustian, Kara; L. Syvertsen, Jennifer

Reduced efficacy of piperonyl butoxide based long-lastingiInsecticide-treated nets against malaria vectors in western Kenya

2026-08-06T06:50:01Z

Title: Reduced efficacy of piperonyl butoxide based long-lastingiInsecticide-treated nets against malaria vectors in western Kenya Authors: Kahindi, Samuel; Abel, Lucy; Kirwa, Erastus; Amunga, Mark; Kimachas, Emma; Omondi, Evans; Cherono, Millicent; Mangeni, Judith; Obala, Andrew; Markwalter, Christine; Prudhomme O’Meara, Wendy Abstract: Abstract. In response to rising insecticide resistance among malaria vector species, countries are implementing long-lasting insecticide treated nets (LLINs) coformulated with piperonyl butoxide (PBO), which can restore susceptibility to pyrethroid-based nets. In mid-2021, Kenya National Malaria Program rolled out PBO-LLINs in Bungoma County. We evaluated the susceptibility of wild-collected vectors to new versus used PBO-LLINs using the WHO cone bioassays. Results were confirmed with the WHO susceptibility assay. A total of 2,020 female Anopheles were tested, of which 1,480 were wild-collected and 540 were a Kilifi-susceptible strain. Mortality after exposure to new PBO-LLINs was only 68% in the wild-collected mosquitoes and as low as 34% when mosquitoes were exposed to used, 24-month old PBO- LLINs. Anopheles arabiensis was the main vector species that survived exposure. Susceptibility tests confirmed very low mortality after exposure to permethrin with or without PBO. Reduced sensitivity can be attributed partly to the aging of the net but also to very high levels of resistance in the local vector population.

Childhood Acute Lymphoblastic Leukemia survival in Western Kenya: reduction in early deaths and treatment abandonment

2026-08-06T06:36:19Z

Title: Childhood Acute Lymphoblastic Leukemia survival in Western Kenya: reduction in early deaths and treatment abandonment Authors: Olbara, Gilbert; Bogonko, George; Njuguna, Festus; Langat, Sandra; Kipngetich, Martha; Njenga, Dennis; Kaspers4, Gertjan Johannes; Vik, Terry Allen Abstract: Background: An earlier study on children diagnosed with acute lymphoblastic leukemia (ALL) at Moi Teaching and Referral Hospital (MTRH) in Kenya reported a low event-free survival (EFS), excess treatment abandonment, and high induction mortality. Based on these observations, our team focused on implementing strategies to reduce the causes of poor outcomes. Intervention: The interventions were designed to reduce toxic deaths while maintaining the efficacy of treatment. The strategies included are as follows: (1) substituting asparaginase for doxorubicin in induction; (2) enhanced supportive care, increased access of antibiotics and blood products; (3) enhanced social and financial support for all underserved patients at the time of diagnosis. Our study compared childhood outcomes of ALL treatment before and after implementation of these intervention strategies at MTRH. Methods: We retrospectively reviewed the medical charts of 123 children diagnosed with ALL between 2017 and 2020 (cohort 2). Their clinical profiles and treatment data were collected and subsequently compared to that of 136 children diagnosed between 2010 and 2016 (cohort 1) before the implementation of the interventions above. Survival analysis was compared using the Kaplan–Meier method. Results: Three-year EFS estimates improved from 18% to 41% (p = 0.0001). Relapse and progressive disease decreased from 26% to 16% (p = 0.04136), and the abandonment decreased from 24% to 14% (p = 0.03318), respectively. Deaths in induction decreased from 24% to 17% (p = 0.198). Children between 1 and 9 years and those with white blood cell (WBC) count <50 × 109/L had better EFS (50% vs. 26%, p < 0.001 and 50% vs. 24%, p = 0.017, respectively). Conclusions: Use of systematically generated data and application of locally adapted interventions led to a reduction in treatment failure and increased survival. Improved access to asparaginase by working with local suppliers and increased insurance coverage through parental education and philanthropies are strategies that could be adopted by centers in low- and middle-income countries. More efforts are required to improve risk stratification for newly diagnosed ALL patients.

When Concepts Travel In-Between: Knowledge Brokering and DesignJustice in the Hybrid Translation of Competency-Based Education forAfrican Pediatric Training

2026-08-05T12:03:24Z

Title: When Concepts Travel In-Between: Knowledge Brokering and DesignJustice in the Hybrid Translation of Competency-Based Education forAfrican Pediatric Training Authors: Thammasitboon, Satid; Tolea, John; Nguyen, Diane; Kambarami, Rose; Henley, Kirstin gracia; Lubega, Joseph; Schutze, Gordon; Turner, Teri; Ochieng, Powell; Misava, Edward; Marimaa, Reson; Owino, Claudio Abstract: Competency-Based education (CBe) has become the dominant paradigm for structuringmedical training worldwide. Yet its foundational constructs (e.g., entrustable professionalactivities (epas), milestones, and competencies) were conceived within resource-rich,institutionally stable, and culturally specific contexts. Their diffusion across global landscapeshas not been neutral. When such frameworks travel, they carry embedded assumptions,epistemic values, and implicit universalizing authority. This article describes how The east,Central, and Southern africa College of paediatrics and Child Health (eCSapaCH), in partnershipwith the Center for research, innovation, and Scholarship in Health professions education(CriS) at Baylor College of Medicine, reimagined CBe for african pediatric training through aprocess guided by design justice and implemented using knowledge brokering. anchored inHomi Bhabha’s concept of the Third Space and Culture’s In-Between, we argue that thetranslation of CBe into new contexts is not merely a technical or linguistic act but an ethical,dialectical, and generative one. eCSapaCH’s translation process demonstrates that whenframeworks encounter contextual resistance and epistemic contestation, they can bereconstituted into hybrid forms that unsettle universality while deepening both global andlocal understanding. The resulting hybrid framework represents not a replication or simple adaptation of imported theory but a co-created, contextually anchored model for pediatriceducation that emerges from ongoing negotiation under conditions of asymmetrical power.We position this work as an instance of hybrid knowledge production in Bhabha’s ThirdSpace, offering lessons for equitable global partnerships and for the future evolution of CBeas a living, revisable theory.