Christine Ngaruiya

All Publications

• Multimodal approach to exploring neighbourhood and transportation dynamics in HIV care in Kenya: protocol. BMJ open Kimaru, L. J., Ngaruiya, C., Mugo, C., Madhivanan, P. 2026; 16 (5): e110803

  Abstract

  HIV is a major health challenge in Kenya, where prevalence exceeds global averages. Achieving viral suppression depends on consistent adherence to antiretroviral therapy (ART), but individuals in neighbourhoods perceived as disorderly often show low self-efficacy for ART adherence. Despite the importance of neighbourhood dynamics in shaping health behaviours, this area is under-explored in low- and middle-income countries (LMICs), especially regarding transportation barriers. Grounded in Social-Ecological Theory (SET) and the 'Broken Windows' Theory (BWT), SET suggests that health outcomes are influenced by environmental factors, while BWT posits visible signs of neighbourhood disorder, such as neglect and decay, can lead to a decline in healthy behaviours, creating an environment conducive to negative health outcomes. This protocol describes a multimodal qualitative study designed to examine how transportation challenges and perceived neighbourhood dynamics influence HIV care among people living with HIV (PLWH). This intersection of structural barriers, neighbourhood dynamics and HIV outcomes in LMIC settings remains under-researched.This theory-informed multimodal qualitative study, grounded in a Community-Based Participatory Research framework, integrates individual in-depth interviews (IDIs) and community-based photovoice focus group discussions (FGDs). 20 PLWH participated in IDIs accompanied by a survey with validated scales (~ 10 min) assessing perceived neighbourhood disorder, defined as visible physical and social signs of neglect such as crime, vandalism and deteriorated infrastructure, ART adherence self-efficacy, transportation, access to HIV care and fear of crime. An additional 20 PLWH took part in four photovoice FGD sessions. Photovoice FGD sessions were guided by the SHOWeD questioning technique, a structured reflection method that prompts participants to discuss what they see, what is happening, how it relates to their lives, why it exists and what can be done. In each component, participants were purposively sampled and stratified to ensure approximately equal representation by viral suppression status (10 suppressed, 10 unsuppressed), gender (10 women, 10 men) and age group (10 aged 18-24, 10 older than 24). Interviews and photovoice discussions were transcribed and are being analysed thematically using MAXQDA qualitative analysis software. Participant-generated photographs will be analysed alongside accompanying narratives using an integrated visual and textual coding approach combining inductive and theory-informed deductive analysis. Triangulation across interviews and validated survey measures will be conducted.This study has received ethical approval from the KNH-UoN Ethics and Research Committee (P635/08/2024) and the Stanford University Institutional Review Board (eProtocol #: 77260). Written informed consent was obtained from all participants. Findings will be disseminated through peer-reviewed publications, conference presentations and a photo exhibition.This study will contribute to an understudied body of research on how socio-environmental conditions influence HIV care engagement in LMICs. Through the integration of individual-focused in-depth interviews and community-centred photovoice FGD sessions, the study captures both personal perceptions and shared neighbourhood realities. Findings will inform interventions and policy adjustments to improve support for PLHIV in disordered environments.

  View details for DOI 10.1136/bmjopen-2025-110803

  View details for PubMedID 42082219

• Perspectives of adolescents and young people on Digital Health Interventions and their impact on health knowledge. PLOS global public health Macharia, P., Block Ngaybe, M. G., Ravi, P., Moraa, H., Hamzazai, W., Moikobu, B., Mugo, C., Ngaruiya, C. 2026; 6 (4): e0005611

  Abstract

  Adolescents and young people (AYP) in Kenya face unique health challenges, but there is a lack of research on their health knowledge and awareness needs. Digital health interventions (DHIs) could help address these gaps. Understanding AYP's current knowledge will inform the development of effective, adolescent-centered interventions. Grounded in the inter-agency framework from WHO, UNICEF, UNFPA, and UNESCO for youth-centered DHIs, this study assessed AYP's health knowledge and awareness in three regions of Kenya. The study focused specifically on HIV, intimate partner violence (IPV), substance use, mental health, sexual health, and nutrition. Additionally, it evaluated AYP's preferences for and use of DHIs. This qualitative study used focus group discussions to assess health knowledge and awareness among AYP 19-24 years of age in Kibra (urban), Kikuyu (peri-urban), and Nachu (rural) Kenya. Participants were purposively selected. Data analysis involved independent coding using MAXQDA and thematic analysis to identify key themes. Seventy participants were included in the study with almost similar gender distribution of 36 female and 34 male participants. Young people in Kenya utilize online resources and apps for health information. Despite a general awareness of health issues, knowledge gaps exist concerning HIV prevention, stigma, and treatment. Participants also linked substance use with mental health problems. Cost of internet use and misinformation were barriers to using DHIs. The participants expressed a preference for future DHIs to enable interaction with peers and experts, include referral services, and prioritize privacy. Our study highlights that a targeted health-related app could benefit many adolescents across Kenya. The participatory design of our study was a notable strength. However, future studies could benefit from a less structured interview guide, allowing for deeper understanding of less common health issues. This research will inform the development of a health-focused DHI for Kenyan AYPs, utilizing a user-centered design approach.

  View details for DOI 10.1371/journal.pgph.0005611

  View details for PubMedID 41945604

  View details for PubMedCentralID PMC13056157

• Assessment of emergency care services in Nigerian hospitals: A cross-sectional study. African journal of emergency medicine : Revue africaine de la medecine d'urgence Umoga, K., Muhammad, M., Meeker, M. A., Rayo, J., Ogunyemi, K. O., Ngaruiya, C. 2026; 16 (1): 100939

  Abstract

  The Accident and Emergency (A&E) unit is a key entry point for healthcare in Nigeria, yet data on its functionality and capacity for emergency care remain limited. This study evaluates the functional capacity of A&E units in Nigeria using a modified Emergency Care Assessment Tool (ECAT).A cross-sectional study was conducted from September to October 2020 in seven tertiary hospitals across Nigeria. Six hospitals, one from each of the country's six geopolitical zones, were randomly selected, while the seventh-Nigeria's main trauma center located in the capital-was purposively included. Doctors and nurses routinely working in A&E units were interviewed using a modified Emergency Care Assessment Tool (ECAT), which evaluates the availability of essential medical interventions (signal functions) for managing six common, life-threatening sentinel conditions: Maternal and Child emergencies, Respiratory failure, Trauma, Shock, Altered mental status, and Severe pain.Among 503 healthcare providers surveyed (393 doctors and 110 nurses), significant differences were observed in the performance of signal functions across all six sentinel conditions (p < 0·001) and across the seven study sites (p < 0·001). The overall average capacity score was 2·69 out of 3. Federal Medical Center Katsina (North-West zone) recorded the highest mean score of 2·92 (95% CI: 2·77 - 3·07), while UCTH (South-South zone) had the lowest at 2.44 (95% CI: 2·27 - 2·60). Among the conditions assessed, respiratory failure had the lowest mean score at 2·55 (1·88-3·21).This study reveals a higher-than-expected national average A&E capacity score (2·69 out of 3) in Nigerian tertiary hospitals but highlights ongoing challenges, particularly in managing respiratory emergencies. Notable regional disparities were observed, with the Northern region outperforming others. Findings emphasize the need for objective, on-site evaluations and broader inclusion of facilities, along with targeted, region-specific investments to improve equitable emergency care nationwide.

  View details for DOI 10.1016/j.afjem.2025.100939

  View details for PubMedID 41657729

  View details for PubMedCentralID PMC12873727

• The current state of oncological emergency services in Kenya: challenges and opportunities. BMJ global health Abdihamid, O., Affey, F., Maina, J., Ngaruiya, C. 2026; 11 (1)

  Abstract

  Cancer remains a leading cause of morbidity and mortality in Kenya, with the healthcare system increasingly challenged by oncologic emergencies (OEs)-acute, life-threatening complications that require immediate intervention. Although Kenya has advanced in decentralising cancer care through regional centres and expanding access to chemotherapy, radiotherapy and palliative care, a critical gap persists in the recognition and management of OEs. Conditions such as spinal cord compression, febrile neutropenia, tumour lysis syndrome and superior vena cava obstruction are common but often underdiagnosed or inadequately managed in acute settings. Poor outcomes are largely driven by workforce shortages, weak triage systems, financial toxicity and limited provider training. This paper calls for a national strategy to integrate OEs management into cancer centres and emergency departments through standardised clinical guidelines, capacity building, improved referral networks and inclusion in health insurance coverage. Strengthening infrastructure, workforce education and longitudinal research on OEs patterns will be essential to improving outcomes. A timely, coordinated response to OEs can substantially enhance survival, reduce complications and promote equitable access to life-saving care across Kenya.

  View details for DOI 10.1136/bmjgh-2025-020895

  View details for PubMedID 41500660

  View details for PubMedCentralID PMC12781983

• The era of no review: an appraisal on transparency in global health funding. The Lancet. Global health Ngaruiya, C., Omolo, C. 2025; 13 (2): e194-e195

  View details for DOI 10.1016/S2214-109X(24)00485-6

  View details for PubMedID 39890220

• Community Based Participatory Research in Global Health: Time to Provide Appropriate Ethics Training for Community Researchers. Inquiry : a journal of medical care organization, provision and financing Ganjeh, Y., Ngaruiya, C., Albee, B., Funaro, M. C., Bongomin, F., Vergara Greeno, R., Bothwell, L., Ebbs, D. 2025; 62: 469580251350492

  Abstract

  Community-based participatory research (CBPR) and participatory action research (PAR) methodologies incorporate community engagement throughout the research process to reduce health inequities, support research capacity, and ensure that research supports community goals. To foster true reciprocity between academic institutions and community members, ethics training required by academic institutions should be culturally and linguistically adapted to partnering communities in low- and middle-income countries (LMICs). Current ethics resources have been adapted for non-academic populations. However, these ethics resources do not yet effectively allow community researchers in LMICs to develop their own framework or tailor trainings to their specific communities. A framework guiding the adaptation of ethics training methods specific to conducting CBPR and PAR in LMICs is necessary in developing research capacity in LMICs. Such adaptive ethics training models could also be beneficial for research conducted among marginalized populations in HICs.

  View details for DOI 10.1177/00469580251350492

  View details for PubMedID 40605544

• Identification of Gender Differences in Acute Myocardial Infarction Presentation and Management at Aga Khan University Hospital-Pakistan: Natural Language Processing Application in a Dataset of Patients With Cardiovascular Disease. JMIR formative research Ngaruiya, C., Samad, Z., Tajuddin, S., Nasim, Z., Leff, R., Farhad, A., Pires, K., Khan, M. A., Hartz, L., Safdar, B. 2024; 8: e42774

  Abstract

  BACKGROUND: Ischemic heart disease is a leading cause of death globally with a disproportionate burden in low- and middle-income countries (LMICs). Natural language processing (NLP) allows for data enrichment in large datasets to facilitate key clinical research. We used NLP to assess gender differences in symptoms and management of patients hospitalized with acute myocardial infarction (AMI) at Aga Khan University Hospital-Pakistan.OBJECTIVE: The primary objective of this study was to use NLP to assess gender differences in the symptoms and management of patients hospitalized with AMI at a tertiary care hospital in Pakistan.METHODS: We developed an NLP-based methodology to extract AMI symptoms and medications from 5358 discharge summaries spanning the years 1988 to 2018. This dataset included patients admitted and discharged between January 1, 1988, and December 31, 2018, who were older than 18 years with a primary discharge diagnosis of AMI (using ICD-9 [International Classification of Diseases, Ninth Revision], diagnostic codes). The methodology used a fuzzy keyword-matching algorithm to extract AMI symptoms from the discharge summaries automatically. It first preprocesses the free text within the discharge summaries to extract passages indicating the presenting symptoms. Then, it applies fuzzy matching techniques to identify relevant keywords or phrases indicative of AMI symptoms, incorporating negation handling to minimize false positives. After manually reviewing the quality of extracted symptoms in a subset of discharge summaries through preliminary experiments, a similarity threshold of 80% was determined.RESULTS: Among 1769 women and 3589 men with AMI, women had higher odds of presenting with shortness of breath (odds ratio [OR] 1.46, 95% CI 1.26-1.70) and lower odds of presenting with chest pain (OR 0.65, 95% CI 0.55-0.75), even after adjustment for diabetes and age. Presentation with abdominal pain, nausea, or vomiting was much less frequent but consistently more common in women (P<.001). "Ghabrahat," a culturally distinct term for a feeling of impending doom was used by 5.09% of women and 3.69% of men as presenting symptom for AMI (P=.06). First-line medication prescription (statin and beta-blockers) was lower in women: women had nearly 30% lower odds (OR 0.71, 95% CI 0.57-0.90) of being prescribed statins, and they had 40% lower odds (OR 0.67, 95% CI 0.57-0.78) of being prescribed beta-blockers.CONCLUSIONS: Gender-based differences in clinical presentation and medication management were demonstrated in patients with AMI at a tertiary care hospital in Pakistan. The use of NLP for the identification of culturally nuanced clinical characteristics and management is feasible in LMICs and could be used as a tool to understand gender disparities and address key clinical priorities in LMICs.

  View details for DOI 10.2196/42774

  View details for PubMedID 39705071

• Bridging gaps in automated acute myocardial infarction detection between high-income and low-income countries. PLOS global public health Chiou, N., Koyejo, S., Ngaruiya, C. 2024; 4 (6): e0003240

  View details for DOI 10.1371/journal.pgph.0003240

  View details for PubMedID 38941326

• A proposed guide to reducing bias and improving assessments of decolonization in global health research FRONTIERS IN EDUCATION Ngaruiya, C., Muhammad, M., Sam-Agudu, N. A. 2024; 9

  View details for DOI 10.3389/feduc.2024.1233343

  View details for Web of Science ID 001249753400001

• Self-care and healthcare seeking practices among patients with hypertension and diabetes in rural Uganda. PLOS global public health Tusubira, A. K., Ssinabulya, I., Kalyesubula, R., Nalwadda, C. K., Akiteng, A. R., Ngaruiya, C., Rabin, T. L., Katahoire, A., Armstrong-Hough, M., Hsieh, E., Hawley, N. L., Schwartz, J. I. 2023; 3 (12): e0001777

  Abstract

  BACKGROUND: Implementing effective self-care practices for non-communicable diseases (NCD) prevents complications and morbidity. However, scanty evidence exists among patients in rural sub-Saharan Africa (SSA). We sought to describe and compare existing self-care practices among patients with hypertension (HTN) and diabetes (DM) in rural Uganda.METHODS: Between April and August 2019, we executed a cross-sectional investigation involving 385 adult patients diagnosed with HTN and/or DM. These participants were systematically randomly selected from three outpatient NCD clinics in the Nakaseke district. Data collection was facilitated using a structured survey that inquired about participants' healthcare-seeking patterns, access to self-care services, education on self-care, medication compliance, and overall health-related quality of life. We utilized Chi-square tests and logistic regression analyses to discern disparities in self-care practices, education, and healthcare-seeking actions based on the patient's conditions.RESULTS: Of the 385 participants, 39.2% had only DM, 36.9% had only HTN, and 23.9% had both conditions (HTN/DM). Participants with DM or both conditions reported more clinic visits in the past year than those with only HTN (P = 0.005). Similarly, most DM-only and HTN/DM participants monitored their weight monthly, unlike those with only HTN (P<0.0001). Participants with DM or HTN/DM were more frequently educated about their health condition(s), dietary habits, and weight management than those with only HTN. Specifically, education about their conditions yielded adjusted odds ratios (aOR) of 5.57 for DM-only and 4.12 for HTN/DM. Similarly, for diet, aORs were 2.77 (DM-only) and 4.21 (HTN/DM), and for weight management, aORs were 3.62 (DM-only) and 4.02 (HTN/DM). Medication adherence was notably higher in DM-only participants (aOR = 2.19). Challenges in self-care were significantly more reported by women (aOR = 2.07) and those above 65 years (aOR = 5.91), regardless of their specific condition(s).CONCLUSION: Compared to rural Ugandans with HTN-only, participants with DM had greater utilization of healthcare services, exposure to self-care education, and adherence to medicine and self-monitoring behaviors. These findings should inform ongoing efforts to improve and integrate NCD service delivery in rural SSA.

  View details for DOI 10.1371/journal.pgph.0001777

  View details for PubMedID 38079386