Poster Presenters

Abstract: Embedding Monitoring, Evaluation, Accountability and Learning (MEAL) in Subnational AMR Work Plans: Lessons from Nyeri County, Kenya

Introduction
Antimicrobial resistance (AMR) is a major global health threat that requires coordinated action across sectors. The draft Global Action Plan on AMR (2026–2035) highlights the need to strengthen governance, accountability, and learning systems to improve implementation at all levels. However, many subnational work plans lack structured systems for monitoring progress and adapting interventions. Nyeri County, through its County Antimicrobial Stewardship Interagency Committee (CASIC), has implemented AMR work plans since 2019 with integrated monitoring, evaluation, accountability, and learning approaches.

Aim of the Intervention
To demonstrate the importance of embedding active monitoring, evaluation, accountability, and learning systems within subnational AMR work plans to improve implementation and coordination.

Methods
A review of Nyeri County CASIC implementation was conducted using evidence from two work plans (2020–2022 and 2023–2025) and their respective midterm and end-term review reports. The process involved document review, stakeholder consultations across health, agriculture, and environment sectors, and structured assessment of activity implementation status, performance against targets, and emerging lessons. The reviews assessed relevance, effectiveness, efficiency, and sustainability of interventions, and tracked progress across 137 activities using standardised performance categories at midterm.

Results
Embedding these systems improved tracking of activities across sectors and enabled timely identification of gaps in governance, coordination, and resource mobilisation. Regular reviews supported corrective actions and strengthened integration of AMR activities into departmental plans and performance frameworks. The process also enhanced cross-sector collaboration under a One Health approach and generated lessons that informed the design of the subsequent work plan.

Conclusion
The Nyeri County experience shows that embedding monitoring, evaluation, accountability, and learning systems strengthens implementation and supports continuous improvement. Strengthening these systems at subnational level is critical for effective and sustainable AMR responses.

Hearing loss remains a significant public health challenge across Africa, affecting communication, education, employment, and overall quality of life. Despite the growing burden, access to hearing rehabilitation services remains limited due to a shortage of trained professionals, inadequate infrastructure, and low public awareness. Empowering hearing rehabilitation professionals is therefore critical to bridging this gap and improving outcomes for individuals with hearing impairment.

Capacity building through targeted education and training programs is a key strategy. Expanding audiology and speech therapy curricula in African institutions, alongside continuous professional development, ensures practitioners are equipped with up-to-date clinical skills and culturally relevant approaches. Partnerships with international organizations and universities can further strengthen knowledge exchange, mentorship, and research capacity.

Equally important is the integration of technology in hearing care. The adoption of affordable diagnostic tools, tele-audiology, and mobile health solutions can extend services to underserved and rural populations. Empowered professionals who are proficient in these technologies can deliver efficient, scalable, and patient-centered care.

Policy advocacy and leadership development also play a vital role. Hearing rehabilitation professionals must be supported to engage in health policy discussions, advocate for inclusive policies, and contribute to national strategies on ear and hearing care. Strengthening professional associations can amplify their voices and promote standardization of care.

Finally, community engagement and awareness campaigns are essential to reduce stigma and encourage early intervention. By fostering interdisciplinary collaboration and empowering professionals with skills, resources, and leadership opportunities, Africa can build a resilient hearing care workforce. This will not only enhance service delivery but also promote social inclusion and improved quality of life for individuals with hearing loss across the continent.

Introduction

Global air travel has accelerated the cross-border transmission of infectious diseases, placing international points of entry at the frontline of epidemic prevention. Despite Kenya’s adherence to the International Health Regulations (2005), limited evidence exists on how organizational structures translate into operational preparedness among frontline personnel. The COVID-19 pandemic highlighted this vulnerability, causing significant economic disruptions in the Kenyan aviation sector.

Aim

To examine the individual and organizational factors influencing epidemic preparedness and response capacity among first-line responders at air points of entry, Nairobi.

Methods

An explanatory sequential design where multi-stage sampling approach was used to select 163 first-line responders for the study. Quantitative data were collected through structured questionnaires based on the 4S model for disaster and epidemic preparedness and analyzed using SPSS v20. Qualitative data were analyzed thematically using NVivo v15.

Results

Overall, 46% of respondents reported being very prepared for epidemic events; however, significant gaps were observed. 50% demonstrated inadequate knowledge of epidemic preparedness, 54% were classified as unskilled, and only 1.2% attained the highest levels of knowledge or skills. While 30.1% exhibited very positive attitudes, vaccination coverage against priority diseases was low (24.5%). Key challenges included resource constraints, infection risk, constant procedural changes, and persistent fear. Regarding coping mechanisms, 37.4% reported using only one strategy, while 19% reported four strategies; 59.5% strictly adhered to personal protective measures. Statistical analysis revealed significant associations between preparedness levels and age, past experience, knowledge, skills, attitude, and coping strategies (p≤0.001). Ordinal regression identified age, years of experience, workstation, academic level, attitude, and coping strategies as significant predictors of preparedness, with positive attitudes strongly increasing the likelihood of higher preparedness (OR=4.751, 95% CI: 2.279–9.905).

Conclusion

First-line responders demonstrated substantial knowledge and skills gaps.Targeted capacity-building interventions and strengthened vaccination uptake amongst POE first line responders is necessary.

ABSTRACT

Methicillin-resistant Staphylococcus aureus (MRSA) remains a major global public health threat due to its rapid evolution, multidrug resistance, and association with severe clinical outcomes. Despite advances in diagnostic technologies and increasing antimicrobial resistance trends, genomic data on Staphylococcus aureus remain limited in many low- and middle-income settings. This gap restricts the development of effective treatment protocols and infection prevention strategies. This study aimed to determine the epidemiological and genomic patterns of MRSA isolates obtained from patients seeking treatment at Nakuru County Referral and Teaching Hospital (NCRTH).A retrospective cross-sectional study with a laboratory experimental component was conducted over six months using routinely collected clinical samples, including blood, urine, pus, and cerebrospinal fluid. NCRTH serves a diverse population from Nakuru County and the wider Rift Valley region. A total of 354 samples were selected through systematic random sampling. Demographic and clinical data were extracted from hospital records using a structured Clinical Case Report Form. Phenotypic identification of MRSA was performed, followed by whole genome sequencing for strain confirmation and genomic characterization. Data analysis was conducted using IBM SPSS version 23, applying Chi-square, Fisher’s exact, and Mann–Whitney U tests at a 5% significance level.The prevalence of S. aureus was 7.1%, with MRSA accounting for 2.3%, and the highest burden observed in the burns unit (28.6%). MRSA isolates showed high resistance to penicillin G, erythromycin, and clindamycin (64%) but demonstrated notable susceptibility to cefoxitin, doripenem, and sulfamethoxazole. Genomic analysis revealed clonal complexes CC8 and CC15 as dominant, with sequence type ST152 most prevalent. Virulence genes lukF-PV and lukS-PV were detected in 52% of isolates. Prolonged hospitalization and prior antibiotic use were significant risk factors. These findings highlight the need for strengthened genomic surveillance and targeted antimicrobial stewardship to improve MRSA control in the region.

Background: Entamoeba, a zoonotic pathogen known to cause amoebic dysentery, infects human and  various animals. With the increasing interactions of humans and non-human primates (NHPs), monitoring zoonotic pathogens remains essential for mitigating the transmission of zoonotic diseases.

Aim: To investigate the prevalence and molecular diversity of Entamoeba species circulating in selected non-human primate populations in Tana River County and Trans Nzoia County, with the aim of evaluating their zoonotic potential and the risk of transmission across the human–wildlife interface where close interactions may facilitate spillover to human populations.

Methods: This study identified and characterized circulating Entamoeba spp in selected NHPs from different geographic locations in Kenya. Fecal samples were collected from NHPs and screened for the presence of Entamoeba spp. via microscopy and molecular techniques.

Results: Entamoeba prevalence via microscopy in NHPs, was reported as follows: Cercocebus galeritus (83.3%), Cercopithecus neglectus (57.9%), Colobus guereza ssp. matschiei (79.2%), Piliocolobus rufomitratus (64.0%), and Cercopithecus mitis ssp. albotorquatus (54.5%). Compared to microscopy, PCR was more sensitive in detecting Entamoeba species and sequencing identified E. hartmanni.

Conclusion: These findings establish critical baselines for zoonotic risk assessment of Entamoeba at the human-wildlife interface underscoring the importance of expanding routine surveillance of circulating parasites surveillance to humans, livestock, other wildlife species to detect spillover potential. Sensitivity of molecular detection over microscopy underscores the need for advanced diagnostic technologies to improve the accuracy of Entamoeba detection.

Background:  In August 2025, Kilifi North Sub-County reported four confirmed rabies cases in dogs, with one dog having bitten household members before it died. In addition, one person died of suspected rabies following a recorded 30% increase in human dog bites cases between April–October 2025.  We sought to determine the magnitude of the outbreak, assess county preparedness and sensitize the community on rabies.

Methods: Active cases search and verbal autopsy for deceased cases were conducted at facility and community levels. Human and animal health-records were reviewed from January 2021–November 2025. All concenting animal health, human health and community stakeholders were interviewed using questionnaires. Data were analyzed using descriptive statistics. Sensitization were conducted at community gatherings and the facilities.

Results: There were 1278 animal bites cases between January 2021–November 2025) and males were 60.1% (718). The median age among cases was 22 (IQR 32.75) years. Species involved were mainly dogs 1077 (84.3%) and cats 135 (10.6%). Domesticated dogs (763, 70.8%) and cats (81, 60%) contributed most to 66% of bites in humans. Bites trends increased by 175 (95.6%) from the year 2024 (183) to 2025 (358). Some bites patients 93 (7.3%) did not receive anti-rabies post exposure prophylaxis (PEP). Two human rabies death among females after their first anti-rabies PEP at 61 and 21 days following bites from unvaccinated dogs were recorded in June and Sep 2025 respectively.  No animal rabies vaccination was undertaken in Kilifi County during 2024/2025 financial year. Rabies sensitisation undertaken on 52 public health officers and 9 village members.

Conclusion: Inadequate vaccination against rabies may have led to increase in population of rabid animals. Death could have resulted from untimely initiation of anti-rabies PEP among humans after animal bites.  Annual animal vaccinations was recommende to reduce rabies incidences in the county. 

Intro & Aim: Primary Health Care Networks (PCNs) have emerged as a key strategy for strengthening healthcare delivery in Kenya towards achieving universal health coverage. PCNs enable a people-centred service. In Murang’a County, nine PCNs were established between 2023 and 2024, linking 165 health facilities across the county. These networks were subsequently transformed into “smart PCNs” through the digitalisation of all health systems, including patient records, referral pathways, reporting systems, telemedicine services, payment systems and administrative functions.

Methods: A systematic review methodology was applied using county reports, government publications, policy documents, health sector plans, and published literature on PCN implementation and digital health in Kenya. Relevant evidence on the establishment, structure, and digital transformation of PCNs in Murang’a County was identified, screened, and synthesised narratively.

Results: The review found that Murang’a County’s PCNs were designed around hub-and-spoke models, where higher-level facilities served as referral hubs connected to lower-level facilities and community health units. Various private and faith-based facilities formed mini-hubs. The nine PCNs improved coordination of care, enhanced referral systems, and strengthened continuity of services across the 167 facilities. Digitalisation opened the way for paperless services by introducing electronic medical records, online reporting systems, digital payment platforms, telemedicine, and data-driven decision-making processes. These innovations improved patient tracking, reduced delays in referrals, enhanced access to specialist consultations, and strengthened disease surveillance and service monitoring. The digital transformation also contributed to reduced congestion in major hospitals and improved efficiency in service delivery. Revenue from the facilities also doubled.

Conclusion: The establishment and digitalisation of PCNs in Murang’a County represent an important advancement in primary healthcare delivery. Smart PCNs have strengthened integration, improved efficiency, doubled revenue and enhanced access to healthcare services. Murang’a County’s experience provides a practical model for other counties seeking to modernise primary healthcare through network-based and digital approaches.

Background: Diarrhoea is a major global health problem among children under five years, with approximately 1.7 billion cases and 525,000 deaths annually. Busia County is among the highest in prevalence with Bunyala Sub-County accounting for over 70% of the cases in 2021. Bukoma and Magombe community units (CUs) in this Sub-County were the most affected according to this study.

Objectives: To determine etiological agents and associated risk factors of diarrhoea among under five years in Bukoma and Magombe CUs, Busia County. 

Methods: A community-based cross-sectional study was conducted in Bukoma and Magombe Community Units, purposively selected,. Using a multistage sampling strategy, 359 children under five years were recruited from a sampling frame of 2,134 households.

Results:  Diarrhoea was reported in (48.2%) of the under-five children. At bivariate analysis, risk factors included untreated drinking water (OR=2.0, 95% CI: 1.04–3.86), unsafe stool disposal in lake/rivers (OR=10.18, 95% CI: 4.66–22.22), direct consumption of lake water (OR=2.79, 95% CI: 1.17–6.65), failure to clean drinking water containers (OR=29.0, 95% CI: 3.29–255.94), poor environmental hygiene (OR=7.69, 95% CI: 1.92–25.0). The most prevalent parasitic infection was caused by Ascaris lumbricoides (11.1%), while Salmonella typhi was the leading pathogenic bacterium isolated, (11.4%). Multivariable analysis revealed that households that did not treat drinking water (aOR=3.1, 95% CI: 1.2-7.85), disposed of stool in the lake or river (aOR=24.1, 95% CI: 6.09-96.04) and those that did not clean drinking water storage containers (aOR=87.0, 95% CI: (6.4,193.94)) were factors independently associated with diarrhoea.

Conclusion: Diarrhoea affects nearly half of the children under five years in Bukoma and Magombe Community Units (48.2%), largely due to inadequate water, sanitation and hygiene (WaSH) practices.

Recommendations: The Busia County Department of Health should promote community-level safe water treatment, advocate for improved sanitation, enforcing safe disposal practices, strengthen household hygiene.

Globally,  antimicrobial resistance (AMR) is recognized as silent pandemic  projected to cause up to 10 million deaths by 2050. Kenya’s situational analysis in 2011 showed AMR trends without showing exact burden due to lack of systematic surveillance. In 2017, Kenya commenced implementing laboratory-based AMR surveillance using Sistema Laboratorio (SiLAB) to monitor AMR patterns, guide veterinary antimicrobials stewardship and policy decisions. This study evaluated SiLAB to assess its performance and effectiveness as an AMR surveillance system.

The study evaluated data quality, timeliness, acceptability, usefullness and simplicity of AMR surveillance system using updated CDC guidelines for surveillance system evaluation. Data was collected using semistructured questionnaires to system users and data extraction from SiLAB system in National Veterinary Investigation Laboratories. Analysis was done using R software. 

Twenty-three system user responses (bachelors 78.26%, masters 13.04%, diploma 8.70%) and 52,353 laboratory records monitoring 25 antibiotics were analysed. Resistance was detected in all antibiotics monitored including tetracycline (23.27%), streptomycin (16.32%), ampicilin (13.92%), Kanamycin (13.46%), sulfamethoxalzole-Trimethoprim (9.25%) and cotrimoxazole (5.81%). Nakuru, Nyeri, Uasin Gishu, Kericho and Kiambu counties reported highest resistance patterns while nine counties didn’t report any data. Missing data on sex, animal type, breed and age was observed. Data for 17 species were captured with bovines (80.73%) and avians (12.83%) being majority. Median period between receiving sample to reporting results was 6 days with 65.9% of results reported within 7 days. System users (90.9%) reported ease of  integrating new procedures. Insufficient human resources (65.21%) and inconsistent essential supplies (78.26%) were cited as challenges to sustaining routine surveillance.

The surveillance system is operational and generating data that moderately meet its objectives. System performance on turnaround time doesn’t meet optimal surveillance benchmark of over 80%. There is need to strengthen structural and functional limitations that reduce epidemiologic robustness and utility of collected data. 

 Background

Snakebite envenoming, a neglected tropical disease, causes functional limitations and disability, yet the burden and optimal assessment methods remain unclear. We report the frequency and severity of snakebite survivors in Kenya and validate a tool to evaluate interventions and guide rehabilitation.

 Aims

This study aimed to assess the prevalence and severity of disability among snakebite survivors in Kitui, Kenya, and to validate the Buruli Ulcer Functional Limitation Scale (BUFLS) for measuring functional limitations in this population.

 Methods

Snakebite survivors whose incident occurred at least six months prior to the survey day and healthy community controls in Kitui County, Kenya, were sampled and assessed using the World Health Organization Disability Assessment Schedule (WHODAS 2.0) and the Buruli Ulcer Functional Limitation Scale (BUFLS). The BUFLS was tested for construct validity based on five a priori hypotheses and discriminant validity. 

 Results

In total, 140 snakebite survivors and 57 community controls were included. Disabilities, as measured with WHODAS 2.0, were experienced by 77.1% of survivors versus 28.1% of controls. 8% of survivors with more severe envenoming had moderate-to-severe disabilities compared with 5.7% in the snakebite survivors who presented with less severe symptoms of envenoming. The highest levels of disabilities were observed in the domains of participation, mobility, and life activities. The control group reported mild disabilities only. The BUFLS met the predefined construct validity criteria and displayed good discrimination between snakebite survivors and controls. The activities mainly affected were those requiring gross motor skills within the BULFS domains of food preparation, personal care, work, and mobility.

 Conclusion

Snakebite survivors exhibit high rates of long-term disability and gross motor skill functional limitations, which must be considered when designing and evaluating public health interventions to improve management and rehabilitation. The BUFLS provides a valid tool for assessing functional limitations in regions where cytotoxic envenoming predominates.

Coronavirus disease of 2019 (COVID-19) is an infectious disease caused by SARS-CoV-2, a highly transmissible virus. During the initial stages of COVID-19 pandemic there was an urgent need for remedies to counter the disease’s effects. Among alternative remedies to conventional ones was steam inhalation, locally called Ukufutikila in Zambia. Steam inhalation was conducted with or without the presence of various herbs, including Eucalyptus leaves. Therefore, this study aimed to determine the effects of temperature attained during steam inhalation, both in the presence and absence of Eucalyptus saligna fresh leaves crude extract on SARS-CoV-2’s in vitro infectivity of Vero T2 cells. Eight human participants, above 18 years of age, were recruited to undergo steam inhalation for 20 minutes following the determined temperature profile from steam inhalation. Steam inhalation temperatures ranged from 94.7°C to 54.4°C. The 20-minute heat-treated SARS-CoV-2 material following the determined steam inhalation temperature profile and the non-heat-treated SARS-CoV-2 material was inoculated into Vero T2 cells, both in the absence and presence of E. saligna crude hydro extracts. No cytopathic effects on Vero T2 cells were observed in any assay over a period of 72 hours after inoculation with heat-treated SARS-CoV-2 material or SARS-CoV-2 material exposed to E. saligna crude extract. In addition, there was no significant virus growth (p = 0.771) estimated after exposure to the two treatments. The results shed light on the use of steam inhalation to diminish SARS-CoV-2 in vitro infection of mammalian cells in a period of three days less than 4.96 days incubation period of the most infective and highly transmissible Delta and Omicron variants of SARS-CoV-2. Further investigations are needed to establish any synergistic nature of the combined use of heat inactivation of SARS-CoV-2 and E. saligna fresh leaves crude extracts.

Background:Wild birds are natural reservoirs of avian influenza viruses and play an important role in global spread through migratory flyways. Kenya lies along key migratory routes and hosts wetlands that attract large populations of migratory and resident wild birds, placing the country at risk of avian influenza introduction. Active wild bird surveillance is conducted through periodic sampling at high-risk sites during peak migratory periods to enhance virus detection and provide early warning before spillover to poultry or humans. This supports early warning helping protect poultry-dependent livelihoods and strengthen national preparedness.

Objective:We assessed the structure and effectiveness of the active wild bird component of Kenya’s avian influenza surveillance system in providing early warning at the wildlife–poultry interface, evaluated key surveillance attributes and characterized influenza A viruses detected during the November 2024 and November 2025 surveillance rounds.

Methods:A descriptive cross-sectional study was conducted using the Updated CDC Guidelines for Evaluating Public Health Surveillance Systems, 2003. Data was obtained through key informant interviews with stakeholders and retrospective review of surveillance and laboratory records.Descriptive statistics including frequencies, proportions and positivity rates were generated to describe surveillance coverage, laboratory results and system attributes: usefulness, simplicity, acceptability and flexibility.

Results:4,307 samples were collected across 18 sites. Influenza A virus detection was low: 0.6% individual positivity in 2024 and 0.09% in 2025. No H5, H7 or H9 subtypes were detected. Surveillance system attributes showed strong performance :Usefulness;94% system contributes to preventing avian influenza outbreaks. Simplicity; 94% sampling procedures were clear and easy to implement. Flexibility; 94% adoption of new surveillance tools, 88% adaptation to changes. Acceptability; 100% willingness to continue participating in surveillance.

Conclusion:The active wild bird avian influenza surveillance system demonstrated strong performance across key attributes and provides an important One Health early warning mechanism for detecting avian influenza at the wildlife–poultry interface.