http://41.89.205.12/handle/123456789/173 2026-08-08T13:38:49Z http://41.89.205.12/handle/123456789/2885 Repositioning Public Health Officers in Kenya’s Devolved Health System: A Policy Analysis to Strengthen Primary Health Care and Advance Universal Health Coverage Okedi, William Nyabola Health systems in low- and middle-income countries are prioritizing primary health care (PHC) to advance universal health coverage (UHC) and health security. In Kenya, devolution has restructured governance and service delivery, creating both opportunities and coordination challenges. Within this context, Public Health Officers (PHOs)—key to environmental health, disease prevention, and health promotion—remain insufficiently defined and underutilized. This study examines the policy and institutional factors shaping the positioning of PHOs in Kenya’s devolved health system Health systems in low- and middle-income countries are prioritizing primary health care (PHC) to advance universal health coverage (UHC) and health security. In Kenya, devolution has restructured governance and service delivery, creating both opportunities and coordination challenges. Within this context, Public Health Officers (PHOs)—key to environmental health, disease prevention, and health promotion—remain insufficiently defined and underutilized. This study examines the policy and institutional factors shaping the positioning of PHOs in Kenya’s devolved health system 2026-01-01T00:00:00Z http://41.89.205.12/handle/123456789/2879 Socio-Cultural Determinants, Parental Attitudes, and Gender Roles in Gendered ICT Access in Rural Kenyan Secondary Schools Ogolla, Nichanor Achola; Ombok, Caroline Atieno The integration of Information and Communication Technology (ICT) into education has transformed teaching and learning globally. However, unequal access to digital technologies continues to reinforce educational disparities, particularly among girls in rural communities. This study examined how socio-cultural determinants, parental attitudes, and traditional gender roles shape gendered access to and use of ICT in rural public mixed day secondary schools in Siaya County, Kenya. Guided by Digital Divide Theory and Gender Socialization Theory, the study employed a convergent mixed-methods design involving students, teachers, parents, school administrators, and education officers. Quantitative data were collected through questionnaires, while qualitative data were obtained through interviews, focus group discussions, observations, and document analysis. The findings revealed significant gender disparities in access to digital devices, internet connectivity, and digital learning opportunities. Girls reported greater parental restrictions, heavier domestic workloads, and stronger social monitoring regarding technology use compared to boys. Cultural beliefs associating technology with masculinity further discouraged girls’ participation in ICT-related activities and STEM subjects. School-level practices, including unequal encouragement and limited female technological role models, reinforced these disparities. The study concludes that the digital gender divide in rural Kenya is not solely a technological challenge but a socially reproduced system of inequality shaped by intersecting cultural, institutional, and household dynamics. The paper recommends gender-responsive ICT policies, community sensitization programs, equitable school-based digital initiatives, and targeted mentorship programs to promote inclusive digital participation among girls in rural schools. The integration of Information and Communication Technology (ICT) into education has transformed teaching and learning globally. However, unequal access to digital technologies continues to reinforce educational disparities, particularly among girls in rural communities. This study examined how socio-cultural determinants, parental attitudes, and traditional gender roles shape gendered access to and use of ICT in rural public mixed day secondary schools in Siaya County, Kenya. Guided by Digital Divide Theory and Gender Socialization Theory, the study employed a convergent mixed-methods design involving students, teachers, parents, school administrators, and education officers. Quantitative data were collected through questionnaires, while qualitative data were obtained through interviews, focus group discussions, observations, and document analysis. The findings revealed significant gender disparities in access to digital devices, internet connectivity, and digital learning opportunities. Girls reported greater parental restrictions, heavier domestic workloads, and stronger social monitoring regarding technology use compared to boys. Cultural beliefs associating technology with masculinity further discouraged girls’ participation in ICT-related activities and STEM subjects. School-level practices, including unequal encouragement and limited female technological role models, reinforced these disparities. The study concludes that the digital gender divide in rural Kenya is not solely a technological challenge but a socially reproduced system of inequality shaped by intersecting cultural, institutional, and household dynamics. The paper recommends gender-responsive ICT policies, community sensitization programs, equitable school-based digital initiatives, and targeted mentorship programs to promote inclusive digital participation among girls in rural schools. 2026-06-12T00:00:00Z http://41.89.205.12/handle/123456789/2863 Barriers and Pathways to Healthcare Access Among Women Survivors of Gender Based Violence in Turkana County, Kenya Mukii, Rose Betty; Okedi, Dr. William; Keraka, Prof. Margaret Gender-based violence is a pervasive public health and human rights issue. In Kenya, over 40% of women have experienced physical mistreatment and 14% sexual assault. In Turkana County, the GBV rate stood at 42% in 2024, higher than the national average of 34%. The study aimed to determine the barriers and pathways to healthcare access among women survivors of GBV in Turkana County. Specifically, it sought to identify types of GBV experienced by survivors seeking care, assess barriers faced in accessing healthcare services, and examine steps taken by survivors in seeking care. A cross-sectional descriptive mixed-methods study was conducted at Lodwar County Referral Hospital and Kakuma Sub-County Hospital. Purposive sampling targeted 73 women GBV survivors attending the facilities. Client exit interviews provided quantitative data and a Focus Group Discussion generated qualitative data. Data were analyzed using R software; findings presented in tables, graphs, and narratives. The study found that 97% of respondents experienced physical, psychological, or sexual harm due to GBV. Major barriers included patriarchal cultural norms (99%), corruption and associated costs (96%), lack of formal referral networks (90%), financial constraints (67%), and fear of stigma or intensified abuse (62%). While 80.8% first sought care at healthcare facilities, only 49.3% did so immediately. Single survivors had 87% lower odds (OR=0.127, p=0.012) and Muslim survivors 90% lower odds (OR=0.102, p=0.010) of seeking immediate help. The model explained 23% of the variance in immediate help-seeking behavior. Qualitative data highlighted community leaders and village elders as initial contact points in many cases. The study concluded that GBV is highly prevalent in Turkana County. Survivors face significant sociocultural, economic, and systemic barriers that delay or prevent timely healthcare access. It therefore recommends; provision of free GBV services, anti-corruption measures, strengthened referral networks, stigma reduction, family engagement, and targeted interventions for single and Muslim survivors. Gender-based violence is a pervasive public health and human rights issue. In Kenya, over 40% of women have experienced physical mistreatment and 14% sexual assault. In Turkana County, the GBV rate stood at 42% in 2024, higher than the national average of 34%. The study aimed to determine the barriers and pathways to healthcare access among women survivors of GBV in Turkana County. Specifically, it sought to identify types of GBV experienced by survivors seeking care, assess barriers faced in accessing healthcare services, and examine steps taken by survivors in seeking care. A cross-sectional descriptive mixed-methods study was conducted at Lodwar County Referral Hospital and Kakuma Sub-County Hospital. Purposive sampling targeted 73 women GBV survivors attending the facilities. Client exit interviews provided quantitative data and a Focus Group Discussion generated qualitative data. Data were analyzed using R software; findings presented in tables, graphs, and narratives. The study found that 97% of respondents experienced physical, psychological, or sexual harm due to GBV. Major barriers included patriarchal cultural norms (99%), corruption and associated costs (96%), lack of formal referral networks (90%), financial constraints (67%), and fear of stigma or intensified abuse (62%). While 80.8% first sought care at healthcare facilities, only 49.3% did so immediately. Single survivors had 87% lower odds (OR=0.127, p=0.012) and Muslim survivors 90% lower odds (OR=0.102, p=0.010) of seeking immediate help. The model explained 23% of the variance in immediate help-seeking behavior. Qualitative data highlighted community leaders and village elders as initial contact points in many cases. The study concluded that GBV is highly prevalent in Turkana County. Survivors face significant sociocultural, economic, and systemic barriers that delay or prevent timely healthcare access. It therefore recommends; provision of free GBV services, anti-corruption measures, strengthened referral networks, stigma reduction, family engagement, and targeted interventions for single and Muslim survivors. 2026-06-01T00:00:00Z http://41.89.205.12/handle/123456789/2862 Caught between infection and deficiency: Abonyo, Collins; Kiboi, Nathan; Shaviya, Nathan Anaemia remains a pervasive complication among people living with HIV (PLWHIV), with multifactorial origins that include poor antiretroviral therapy (ART) adherence, immune dysfunction, and iron dysregulation. This study investigated the interplay between nutritional status, immune markers, and iron biomarkers in contributing to anaemia and iron deficiency anaemia (IDA) in HIVinfected adults in Western Kenya. A cross-sectional study was conducted at Busia County Referral Hospital among 163 adults comprising HIV-infected ART-adherent (n = 47), ART-naive (n = 23), non-adherent (n = 42), and healthy control (n = 51) participants. Demographic, clinical, immunologic, and biochemical data were collected through interviews, physical measurements, and laboratory analyses. Iron indices (ferritin, serum iron, and transferrin), haemoglobin concentration, CD4+ T cell counts, HIV viral load, and body mass index (BMI) were measured using standardized protocols. Group comparisons were performed using Kruskal-Wallis and chi-square tests. Binary logistic regression was used to assess predictors of IDA. The highest prevalence of anaemia (61.9%) and iron deficiency anaemia (65.4%) was observed among non-adherent individuals, followed by ART-naïve (52.2% and 50.0%) and adherent participants (36.2% and 17.6%). Haemoglobin concentrations and iron levels were significantly lower (P < 0.0001), while transferrin levels were elevated (P < 0.0001) in ART non-adherent and naïve groups compared to controls. CD4+ T cell counts were markedly suppressed, and viral loads elevated in these groups, underscoring immune compromise. Logistic regression identified unsuppressed viral load (AOR = 10.83; P = 0.023), CD4+ T cell count <500 cells/μL (AOR = 4.01; P = 0.010), and elevated transferrin (AOR = 2.72; P = 0.047) as independent predictors of IDA. The findings suggest that poor ART adherence exacerbates inflammation, impairs iron metabolism, and increases anaemia risk. Integrating viral suppression, immune recovery, and iron biomarker monitoring in HIV care may improve early identification and management of IDA. Future studies should explore longitudinal trajectories of iron indices and anaemia in PLWHIV across different ART regimens. Anaemia remains a pervasive complication among people living with HIV (PLWHIV), with multifactorial origins that include poor antiretroviral therapy (ART) adherence, immune dysfunction, and iron dysregulation. This study investigated the interplay between nutritional status, immune markers, and iron biomarkers in contributing to anaemia and iron deficiency anaemia (IDA) in HIVinfected adults in Western Kenya. A cross-sectional study was conducted at Busia County Referral Hospital among 163 adults comprising HIV-infected ART-adherent (n = 47), ART-naive (n = 23), non-adherent (n = 42), and healthy control (n = 51) participants. Demographic, clinical, immunologic, and biochemical data were collected through interviews, physical measurements, and laboratory analyses. Iron indices (ferritin, serum iron, and transferrin), haemoglobin concentration, CD4+ T cell counts, HIV viral load, and body mass index (BMI) were measured using standardized protocols. Group comparisons were performed using Kruskal-Wallis and chi-square tests. Binary logistic regression was used to assess predictors of IDA. The highest prevalence of anaemia (61.9%) and iron deficiency anaemia (65.4%) was observed among non-adherent individuals, followed by ART-naïve (52.2% and 50.0%) and adherent participants (36.2% and 17.6%). Haemoglobin concentrations and iron levels were significantly lower (P < 0.0001), while transferrin levels were elevated (P < 0.0001) in ART non-adherent and naïve groups compared to controls. CD4+ T cell counts were markedly suppressed, and viral loads elevated in these groups, underscoring immune compromise. Logistic regression identified unsuppressed viral load (AOR = 10.83; P = 0.023), CD4+ T cell count <500 cells/μL (AOR = 4.01; P = 0.010), and elevated transferrin (AOR = 2.72; P = 0.047) as independent predictors of IDA. The findings suggest that poor ART adherence exacerbates inflammation, impairs iron metabolism, and increases anaemia risk. Integrating viral suppression, immune recovery, and iron biomarker monitoring in HIV care may improve early identification and management of IDA. Future studies should explore longitudinal trajectories of iron indices and anaemia in PLWHIV across different ART regimens. 2025-01-01T00:00:00Z