Poster Presenters

Background:
Kenya faces recurrent public health threats that require sustained capacity to prevent, detect, and respond to health emergencies. The Joint External Evaluation (JEE) is a voluntary peer-to-peer mechanism for assessing implementation of the International Health Regulations (IHR 2005) core public health capacities. We evaluate Kenya's progress in developing these capacities and inform national health security strengthening priorities.

Methods:
We conducted a comprehensive qualitative assessment of Kenya’s IHR (2005) capacity using the World Health Organization (WHO) IHR JEE Tool, version 3.0. The evaluation covered 56 indicators across 19 technical areas organized under four domains: Prevent, Detect, Respond, and IHR-related hazards. Each indicator was assigned one score: 1 (no capacity), 2 (limited capacity), 3 (developed capacity), 4 (demonstrated capacity), and 5 (sustained capacity) based on capacity-specific attributes. To determine capacity scores, a consensus-based peer-to-peer method was employed, along with prior assessments and expert knowledge. An external team of experts subsequently reviewed the self-assessment results and conducted structured verification visits at national and subnational levels.

Results

Of 22 prevent indicators assessed, 14 (63.6%) had developed or demonstrated capacity, and 4 had limited or no capacity (18%). In the detect domain, 7/11 (63.6%) indicators had developed or demonstrated capacity, and 3 (27%) had no capacity. Of 16 indicators under response, 1 (6%) had sustainable capacity, 8 (50%) had developed or demonstrated capacity, and 6 (38%) had limited capacity. In the IHR-related hazard domain, only 1/7 (14%) indicators had developed capacity, with 6/7 (86%) having no or limited capacity. Overall, 31/56 (55%) indicators had developed, demonstrated, or sustainable capacity. 

 
Conclusion
These findings indicate that Kenya has developed capacity across many technical areas but still requires targeted improvements, particularly in areas with limited or no capacity. Strengthened advocacy, prioritization, and sustainable financing are essential to advance and maintain IHR (2005) capacities nationwide.

Introduction: Adolescent sexual and reproductive health (ASRH) remains a public health challenge, with unmet contraceptive needs contributing to sexually transmitted infections (STIs) and unintended pregnancies. In Kenya, contraceptive prevalence among adolescents aged 15–19 is only 10%, far below the government’s 2025 target of 55%. Despite the availability of services and the benefits of comprehensive sexuality education, access remains limited. This study examined determinants of contraceptive access and use among adolescent girls.

Methods: A retrospective cross-sectional study was conducted using secondary data from the 2021 Performance Monitoring for Action (PMA) survey. The analysis included 344 respondents aged 15–19 years who were sexually active, married or unmarried. Descriptive statistics were used to summarize characteristics, while multivariate logistic regression identified factors independently associated with contraceptive use.

Results: Of 344 adolescents, 169 reported using modern contraceptives, giving a prevalence of 49.1% (95% CI: 43.8–54.4). The mean age was 17.8 years (SD ±1.7). Older adolescents (18–19 years) were twice as likely to use modern contraceptives compared to those aged 15–17 (AOR 2.0, 95% CI: 1.21–3.45, p

Background: Cholera outbreaks remain recurrent in Kenya, particularly in hotspot areas where environmental and socioeconomic vulnerabilities facilitate transmission. Timely transport of specimens from peripheral facilities to reference laboratories is essential for early confirmation and rapid outbreak response. However, cholera surveillance currently relies on reactive, ad hoc specimen transport arrangements that cause delays and operational inefficiencies. This study evaluated the cost-effectiveness of alternative cholera sample transport models to inform efficient resource allocation under the National Multisectoral Cholera Elimination Plan (NMCEP) 2022–2030.

Methods: A stratified cost-effectiveness analysis was conducted from a healthcare system perspective over a ten-year horizon across 107 hotspot sub-counties identified under the Priority Areas for Multisectoral Interventions (PAMI) report. Sub-counties were stratified by transport accessibility and logistical complexity. A decision tree representing the specimen referral pathway was linked to a two-state Markov model capturing outbreak recurrence. Four strategies were compared: the current ad hoc system, public–private partnerships (PPP), an integrated specimen referral system (ISRS), and dedicated transport. The primary outcome was cost per cholera sample successfully transported and accepted for testing within 24 hours. Sensitivity, equity and sustainability analyses were conducted.

Results: The ISRS ranked as the most cost-effective and sustainable strategy across incremental cost-effectiveness ratios, equity and sustainability analyses, dominating PPP by achieving greater effectiveness at lower cost. Dedicated transport produced only marginal gains at substantially higher cost. Incremental net monetary benefit analysis showed ISRS generated the greatest value across willingness-to-pay thresholds (KES 3,000-38,000). Findings were consistent across hotspot sub-counties with larger gains in remote, infrastructure-constrained areas. Sensitivity analysis confirmed the robustness of the results.

Conclusion: Integrated specimen referral systems provide a cost-effective, equitable and fiscally sustainable approach to strengthening cholera surveillance in Kenya. Prioritizing hard-to-reach areas and shifting from reactive transport to structured integrated referral systems can improve the timeliness of outbreak detection and response.

Background

International travel played a central role in the global spread of COVID-19, highlighting the importance of robust surveillance systems at points of entry for early detection and mitigation of public health threats. In response, Jomo Kenyatta International Airport in Nairobi, Kenya, implemented a digital traveler screening system integrating the Emergency Alert and Response System and the Jitenge platform. 

Methods

A retrospective descriptive epidemiological study was conducted using routine traveler screening data collected at Jomo Kenyatta International Airport between August 2020 and July 2021. The data was analyzed to describe traveler volumes, airline usage, travel destinations, travel history, symptom prevalence, test certificate verification, and referral outcomes.

Results

A total of 1,105,644 travelers were screened, with monthly volumes increasing from 30,832 in August 2020 to 156,980 in July 2021, reflecting the gradual resumption of international travel and associated importation risk. Kenya Airways (23.1%) accounted for the largest proportion of travelers, followed by Ethiopian Airlines (13.9%) and Qatar Airways (10.8%), highlighting key travel corridors. Majority (10.7%) had travel history to Kenya, followed by the United States (6.5%) and the United Arab Emirates (4.4%). Chills (34.7%) and fever (32.3%) were the most frequently reported symptoms. A small proportion (5.2%) of travelers reporting symptoms were referred for further assessment, indicating that most travelers were classified as low risk at the point of entry. Most travelers (89.8%) presented valid test certificates, indicating high compliance with travel requirements, although a gradual increase in those without certificates (9.9%) suggested emerging gaps in verification.

Conclusion

Overall, the findings demonstrate that an integrated digital surveillance system can effectively support large-scale screening, risk assessment, and public health decision-making at points of entry, while the linkage of entry screening with post-arrival monitoring through Jitenge strengthens detection beyond the airport and enhances preparedness for future public health emergencies.

Background: Kenya’s pediatric cancer survival rate of 21% signals urgent health security gaps. In Meru County, supernatural attributions and medical eclecticism such as prioritizing traditional cleansing over clinical intervention drive diagnostic delays of three to six months, elevating mortality and undermining biomedical equity.

Objective: This study aimed to map culturally embedded barriers and pluralistic treatment pathways among rural caregivers in Meru County, proposing an equity-centered, integrated care model to advance health security.

Methods: This qualitative study utilized thematic analysis to examine care-seeking trajectories. Data collection involved 20 in-depth interviews (IDIs) with primary caregivers and 8 key informant interviews (KIIs) using purposive and snowball sampling. IDIs were prioritized over Focus Group Discussions (FGDs) to mitigate social desirability bias and protect participant confidentiality, given the high levels of social stigma associated with witchcraft accusations and the emotional trauma of pediatric oncology. Kimeru narratives were analyzed using Explanatory Framework Analysis to maintain cultural nuances and indigenous meanings of illness.

Results: Results indicate a high prevalence of supernatural etiology, with 85% (n=17/20) of caregivers attributing malignancy to witchcraft or ancestral curses. Symptom misattribution was significant, with 70% (n=14/20) of cases initially treated as malaria. Sequential care pathways typically involved traditional medicine 65% (n=13/20) and faith healing, with clinical presentation at Kenyatta National Hospital occurring only at Stage III or IV. These cultural frameworks act as primary determinants of late-stage diagnosis and treatment abandonment.

Conclusion: Cultural fatalism and medical pluralism function as structural barriers to oncology care. This study proposes an Integrated Referral Model bridging traditional healers and Community Health Promoters. Implementation of Kimeru-language early-warning campaigns and formalizing traditional healer involvement could potentially reduce diagnostic delays by 40%. This evidence-based approach offers a scalable framework for strengthening Universal Health Coverage and enhancing national health system resilience against non-communicable diseases.

Background: Tuberculosis (TB) remains a major global public health challenge, with approximately 10.6 million cases and 1.3 million deaths reported in 2022. Drug-resistant tuberculosis (DRTB) is a growing concern, with an estimated 410,000 cases globally. In Kenya, 752 DRTB cases were reported, with Meru County contributing 111 cases (14.8%), the highest in the country. This increasing burden highlights the need to identify determinants of DRTB to inform targeted interventions.

Methods: A case-control study was conducted among patients with TB. Cases were defined as patients resistant to at least one first-line anti-TB drug, while controls were bacteriologically confirmed TB patients who achieved sputum smear conversion (cured) at months 2, 5, and 6. DRTB and TB registers were reviewed to identify cases, and two unmatched controls were randomly selected per case. Data were collected through structured questionnaires following consent. Data was analysed using STATA software version 15. Descriptive analysis was performed to summarize continuous and categorical variables. Variables with p

Background: Globally, delayed outbreak detection poses a major health threat affecting the communities. Community Event-Based Surveillance (CEBS) enables early detection through community reporting of unusual health events ("signals"). In Kenya, CEBS uses the mdharura mobile application, but Busia County has experienced declining signal reporting with limited evidence on causes.

Methodology: This mixed cross-sectional study assessed mdharura utilization and its determinants among Community Health Promoters (CHPs) in Busia County, Western Kenya. Quantitative surveys were conducted alongside a retrospective review of mdharura signal data (January 2022–April 2025). Descriptive statistics summarized utilization and signal characteristics; logistic regression identified determinants of utilization using SPSS version 27.

Results: 

Most CHPs were aged 48–60 (52.9%), female (68.8%), with secondary education (66.7%) and >6 years’ experience (78%). Overall, 48.3% had high m-Dharura utilization; 38.5% used it daily, and primary purpose was disease surveillance (44.6%). Accessibility was reported by 64.5%, and 78.9% had high confidence in event detection. Of 16,030 signals (May 2022–April 2025), Nambale contributed the most (35.2%) and Teso South the least (3.9%). In multivariable analysis, higher utilization was associated with good knowledge (AOR=7.28, 95% CI: 3.21–16.51), weekly use (AOR=6.01, 95% CI: 3.15–11.48), daily use (AOR=9.30, 95% CI: 4.26–20.27), and very high confidence in system use (AOR=22.89, 95% CI: 5.85–89.64). Lower utilization was linked to poor accessibility (AOR=0.02, 95%CI:0.003–0.15), delayed technical support (AOR=0.06, 95%CI:0.02–0.17), and limited feedback (AOR=0.08, 95%CI:0.03–0.18). Key barriers were lack of reporting awareness (67.3%) and stigma (21.7%).

Conclusion: m-Dharura utilization in Busia County is moderately high, indicating effective community-level early warning capacity. However, utilization remains strongly dependent on CHP knowledge, platform accessibility, connectivity, and responsive health system support. Continuous capacity building, infrastructure improvements, and strengthened feedback loops can further optimize CEBS performance and strengthen public health surveillance.

Introduction: Quality-assured laboratory diagnosis are critical to achieving the ambitious National goals of universal health coverage. To achieve this, participation in external quality assessment (EQA) or Inter-laboratory comparisons is essential. However, the existing commercial EQA schemes are economically unsustainable by rural laboratories in low-income settings. Homa Bay County developed an inter-laboratory comparison network in 2020 to assess the diagnostic capacities and performance of community led laboratories.

Method Biannual surveys comprising of 3-5 Tuberculosis smear slides, Malaria blood slides, Serum sample for syphilis and Hepatitis, whole blood for CD4 and complete Blood Count (CBC) were prepared by the Network committee using standard procedures and validated by an accredited laboratory then distributed to enrolled participants, tested and result submitted back to the committee. Results are analyzed and feedback reports sent back with advice for corrective action on unsatisfactory performance.

Results: Seven surveys have been conducted with participant enrolment increasing from 10 at pilot to 55 at survey seven. Malaria parasite species identification performance increased from 70% (7/10) at baseline survey to 97%. Parasite quantification remained poor at 40% being the highest ever achieved. Errors of High false negative in TB microscopy were the highest at 14% (33/235). Serology has sustained a performance of 100% across the surveys; however, participation in CD4 and CBC has not been optimal due to inconsistent reagent supplies. Corrective actions and mentorship has been utilized to support unsatisfactory performance across sites with quarterly performance reviews incorporating all the stakeholders.

Conclusion: This inter-laboratory comparison network has proved to be an important tool in assessing the quality of laboratory diagnosis in resource limited settings and also identification of poorly performing areas. Effective implementation of this program can be used to assess staff competency, performance of equipment and reagents as part of post-market surveillance.

Background: Timely epidemic detection depends on complete and rapid reporting through the Integrated Disease Surveillance and Response (IDSR) system. In many resource-limited settings, surveillance remains paper-based and diagnostic confirmation is limited. The DIDIDA project in Kisumu County, Kenya addresses these gaps by strengthening digital surveillance, introducing diagnostic innovations, and integrating One Health monitoring to improve epidemic preparedness.

Methods: Initiated in April 2023, DIDIDA operates in 25 health facilities serving ~39% of Kisumu County’s population. In collaboration with the County Ministry of Health, the MoH 505 tool was digitized using Kobo for near real-time IDSR reporting. Data are visualized through a Power BI dashboard enabling disease trend monitoring, hotspot mapping, laboratory tracking, and reporting completeness. Quarterly review meetings with the Department of Health were institutionalized to support data-driven decision-making. The project also integrates wastewater surveillance and supports development of affordable rapid diagnostic tests.

Results: Traditionally, surveillance data are compiled at facility level, verified at sub-county level, and submitted to the national Kenya Health Information System, often taking days or weeksDIDIDA enables direct facility-level reporting, improving timeliness, accuracy, and access to real-time insights. Since April 2023, over one million surveillance records have been generated. Malaria testing reached 99.0% (547,600/553,131) with 23.2% positivity, while typhoid testing reached 95.9% (13,174/13,738). Use of DIDIDA data informed response actions, including rapid containment of the May 2025 cholera outbreak, targeted malaria interventions among adolescents with a reduction in positivity (33% to 29%), and strengthened preparedness for emerging threats such as mpox.

Conclusions: Digital strengthening of IDSR systems, combined with diagnostic innovation and routine data review, enhances epidemic preparedness and enables timely, data-driven public health action.

Keywords: Pandemic preparedness; digital surveillance; One Health; diagnostics; epidemic intelligence

Background

Visceral leishmaniasis (VL) remains a significant neglected tropical disease in Kenya’s arid and semi-arid regions, with recurrent outbreaks reported in Isiolo County. The interaction between environmental changes, vector ecology, and socio-cultural practices continues to sustain transmission. This study assessed VL burden, epidemiological trends, and key determinants in Isiolo County from 2021 to 2025.

Methods

A mixed-methods retrospective study was conducted. Quantitative data were obtained through health facility record reviews at Isiolo County Teaching and Referral Hospital. Community-level data were collected using structured household surveys (n = 214 households) and complemented by participatory photo voice methods in Merti and Garbatulla sub-counties. Environmental assessments were undertaken to characterize vector habitats associated with Prosopis juliflora. Descriptive statistics summarized case frequencies and proportions, while thematic analysis was applied to qualitative data.

Results

A total of 408 VL cases were reported between 2021 and 2025, with a case fatality rate of 3.5% (14/408). Household surveys showed that 63% (135/214) of households reported at least one VL case. Annual incidence peaked in 2022 (156 cases) and 2023 (146 cases), declined in 2024 (72 cases), and increased again in 2025 (106 cases), coinciding with expansion into Isiolo Sub-County. Key transmission drivers included Prosopis juliflora invasion, creating favorable sandfly habitats; climatic variability, particularly increased temperatures and erratic rainfall; and nomadic pastoralist practices that increase human–vector contact. Control efforts were constrained by low community awareness, delayed care-seeking, and limited multi-sectoral coordination.

Conclusion

VL remains a persistent public health threat in Isiolo County, driven by ecological, climatic, and socio-cultural factors, alongside health system constraints. Integrated control strategies should prioritize targeted vector management in Prosopis-dominated habitats, strengthen climate-sensitive surveillance, expand mobile health services for nomadic populations, and enhance culturally appropriate community engagement and risk communication.

Background: Breast milk is important in infant nutrition, growth, immune development, and microbiome establishment. Microorganisms present in breast milk influence development of infant’s intestinal microbiota. Resistant microorganisms negatively affect microbial composition of the gut hence increased long-term health risks.

AIM: We evaluated the diversity and resistance profiles of bacterial contaminants of human donor breast milk from a donor milk bank in Nairobi, Kenya. 

Methodology: A cross-sectional pre – post pasteurization study analyzed results of 89 (71 pre- and 18 post-pasteurized) donors. 1 mL was cultured followed by VITEK® analysis for phenotypic identification and Antimicrobial susceptibility testing. Whole genome sequencing was done for resistant and virulent genes present. Socio-demographic and clinical characteristics was also assessed. 

Results: All post-pasteurized samples had no growth whereas 77.5% (55/71) of pre-pasteurized samples recorded growth. Staphylococcus spp was most prevalent (92.3% (51/55)) with Staphylococcus epidermidis (58% (30/51)) and Staphylococcus haemolyticus (26.6% (11/51)) being frequently isolated. Rare organisms including Kytococcus spp, Pantoea spp. and Gram negative Acinetobacter baumannii complex were also isolated. 71.4% (40/56) organisms were Multidrug-resistant (MDR) with 69.6% (39/56) being commensals. 14.3% (8/56) and 5.4% (3/56) of commensals were Extensively drug-resistant (XDR) and Pandrug-resistant (Pan-sus) respectively. Young mothers (18-23 years) accounted for 64% (32/50) of MDR. There was a significant association between MDR and informal settlements of Mathare and Kiambui in Nairobi (OR= 2.85; p=0.048 and OR = 4.2; p=0.046 respectively). High resistance was recorded among β‑lactams (39.6%) and Macrolides (22.5%). blaZ, tet(K), fosB and mecAgenes were prevalent in Gram positives whereas AmpR, gent/tobra resistance, cip/levo resistance, SXT resistance, blaZ + fluoroquinolone genes detected in Acinetobacter baumannii complex.

Conclusion: This study underscores a potential role of commensals in resistance transmission, highlighting a potential role of breast milk as a route of resistance transmission to the gut microbiota aggravating health risks in infants. 

Introduction: Antimicrobial resistance (AMR) is a major public health challenge, increasing the demand for rapid AMR testing technologies, early identification and monitoring of antimicrobial resistance in tuberculosis (TB) patients are crucial for controlling TB and improving treatment outcomes. Surveillance and testing inform public health strategies, resource allocation, and policy decisions, allowing for timely treatment adjustments and preventing the spread of resistant strains. Traditional TB diagnostic methods are tedious, slow, and costly. This study evaluated the use of GeneXpert platforms for detecting and monitoring antimicrobial resistance within conventional TB management.

Methods: We conducted a retrospective descriptive study by analyzing TB culture results and data from the GeneXpert Laboratory Information Management Systems (GX-LIMS) for patients tested for TB in Homabay County from January to December 2023 to determine drug-susceptible and drug-resistant TB. We extracted data on patients' demographics, HIV status, TB detection outcomes, rifampicin resistance results, turnaround time, and the use of short message service (SMS) for results relay within 24 hours into Microsoft Excel. Data was de-identified and descriptive analysis was performed, and the results were presented as percentages.

Results:  A total of 16,617 tests were conducted using GeneXpert, with 819 (5%) turning positive for TB, majority 506 (62%) of TB positive were males. Among the 819 positives, 506 (62%) were male. Most cases 99% (809/ 819) were susceptible to Rifampicin, while 10 out of 819 (1%) were resistant. Rifampicin resistance was more prevalent among HIV-negative clients 70% (7/ 10) and males 60% (6/10). According to culture reports, 30% (3/10) of these clients were resistant to both rifampicin and isoniazid. Most results, 90% (735/819), were delivered within the required turnaround time (TAT).

Conclusion: TB Rifampicin resistance, though infrequent, shows higher incidence among HIV-negative clients and males. Increased surveillance is crucial to better understand TB drug resistance patterns.