Kenya's Experience: Factors Enabling and Impeding the COVID-19 Response.

This case study describes the country-level response to the COVID-19 pandemic in Kenya between February 2020 and May 2021. We organize the presentation of COVID-19 response strategies across the five stages of (a) engagement, (b) assessment, (c) planning, (d) action/implementation, and (e) evaluation. We describe the participatory monitoring and evaluation (M&E) process implemented in collaboration with the WHO Regional Office for Africa Monitoring and Evaluation Team. The M&E system was used to organize and make sense of emerging data regarding specific response activities and changing COVID incidence. We share the results of that collaborative sensemaking, with particular attention to our analysis of the factors that facilitated and those that impeded our pandemic response. We conclude with lessons learned and practical implications from Kenya's experience to help guide future country-level responses to rapidly changing public health crises.

Contribution of community champions to accelerate the uptake of COVID-19 vaccination in Rukwa region, Tanzania, February - October 2022.

Introduction: Tanzania is among the African countries which started COVID-19 vaccination late (August 2021) compared to other countries in the African continent. By mid-March 2022, overall vaccine uptake was 13% of the targeted population, which was very low compared to other countries. We describe the contribution of champions in the Rukwa region that led to an increase in vaccine coverage rate in Tanzania. Methods: a community-based campaign was conducted using community champions from July 15th to August 31st, 2022. A baseline assessment was conducted focusing on the key drivers, barriers, and enablers for COVID-19 vaccine uptake in the region. A working session to develop IEC materials and messages tailored to addressing the issues raised in the community to be used in the campaign in the region was conducted, followed by the campaign's launch. Community engagement and sensitizations, which contributed to the rise of vaccinated people, were based on house-to-house visits, village meetings, and visiting community gatherings such as marketplaces, places of worship, and sports areas, which were done by champions alongside vaccinators. Results: the campaign contributed to the increase of vaccination coverage because, before the start of the campaign, the vaccination coverage was 10% as of July 14th, 2022. After the campaign, which started on July 15th to August 31st, 2022, the coverage increased by 12%. During the post-evaluation exercise after the campaign, the coverage keeps increased and reached 94% by October 2022. The coverage kept increasing even after the intervention's end due to the campaign's positive effect. Conclusion: the community still needs correct information to avoid misinformation and hesitancy, especially when introducing new disease response mechanisms such as vaccines. The community champions who are based in the community play a critical role in addressing community concerns and contribute to the effectiveness of the implementation; hence sustainability is crucial.

Perceptions on Adherence to Dietary Prescriptions for Adults with Chronic Kidney Disease on Hemodialysis: A Qualitative Study.

Diet is one of the modifiable lifestyle factors in management of kidney disease. We explored perceptions on adherence to dietary prescriptions for adults with chronic kidney disease on hemodialysis. This was a qualitative descriptive study. Participants were purposively selected at renal clinics/dialysis units at national referral hospitals in Kenya. Data were collected using in-depth interviews, note-taking and voice-recording. The data were managed and analyzed thematically in NVIV0-12 computer software. Study participants were 52 patients and 40 family caregivers (42 males and 50 females) aged 20 to 69 years. Six sub-themes emerged in this study: "perceived health benefits"; "ease in implementing prescribed diets"; "cost of prescribed renal diets"; "nutrition information and messages"; "transition to new diets" and "fear of complications/severity of disease". Both patients and caregivers acknowledged the health benefits of adherence to diet prescriptions. However, there are mixed messages to the patients and caregivers who have challenges with management and acceptability of the prescriptions. Most of them make un-informed dietary decisions that lead to consumption of unhealthy foods with negative outcomes such as metabolic waste accumulation in the patients' bodies negating the effects of dialysis and undermining the efforts of healthcare system in management of patients with chronic kidney disease.

Beliefs about Supporting Mothers to Exclusively Breastfeed for 6 Months: An Elicitation Study of Health Professionals Working in Maternal-Child Health Clinics in Nairobi, Kenya.

BACKGROUND: Exclusive breastfeeding rates remain low in Kenya and determinants influencing mothers' practice are documented. Little is known about factors underlying health professionals' intention to support mothers to continue exclusive breastfeeding. Effective behavior modification requires designing interventions at multiple levels of influence, informed by theory-based research to identify relevant determinants. OBJECTIVES: To identify salient beliefs held by health professionals about support of mothers to exclusively breastfeed for 6 months and to explore definitions of the term support. METHODS: This qualitative study was conducted in 6 public health facilities in Nairobi, Kenya. We used open-ended questions based on the reasoned action approach to elicit salient consequences, referents, and circumstances perceived by 15 health professionals about support for mothers to exclusively breastfeed for 6 months. RESULTS: The most frequently mentioned consequences were healthier babies (87%) and reduced childhood ailments (67%). The main disadvantage was human immunodeficiency virus transmission through breast milk (33%). Colleagues (80%) and managers (67%) were perceived as approving referents, whereas some mothers/couples (40%) and the breast milk substitute industry (20%) were perceived as disapproving. Facilitating circumstances included lighter workload, better training, and more time. Definitions of support were varied and included giving information and demonstrating positioning and attachment techniques. CONCLUSIONS: Overall, health professionals perceived positive consequences toward supporting exclusive breastfeeding continuation and identified a number of approving referents. However, they reported challenging circumstances in the work environment, which managers need to address to help health professionals provide the support needed by Kenyan mothers to continue exclusive breastfeeding.