Christine Ngaruiya

All Publications

• Bridging the gap: why Africa must invest in AI infrastructure for health care. The Lancet. Global health Omolo, C. A., Ngaruiya, C., Mutanu, L. 2026: 103955

  View details for DOI 10.1016/j.langlo.2026.103955

  View details for PubMedID 42155490

• 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

• Promise to Practice: Reimagining Artificial Intelligence for Equitable Global Health Impact. Annals of global health Patel, S., Robsky, K. O., Mao, W., Usman, U., Garcia, L., Omobowale, O., Mchunu, G., Sung, J., Clifford, G., Madabhushi, A., Ismail, A., Bidiwala, S., Mehmood, S., Ngaruiya, C., Kilgore, P. E., Martin, K. 2026; 92 (1): 51

  Abstract

  Artificial Intelligence (AI) is transforming health worldwide, yet its benefits remain unevenly distributed and insufficiently evaluated in real-world settings. Drawing on a structured narrative landscape review conducted by the Consortium of Universities of Global Health Research Committee's AI working group and deliberations from its 2025 pre-conference session (171 registrants), we synthesize AI applications across education, epidemiology, and clinical medicine, with an emphasis on data equity in global health. The review drew on peer-reviewed and gray literature across these domains and was synthesized thematically to identify implementation barriers, governance challenges, and equity implications. In conjunction with illustrative case studies, we identify five strategic imperatives: contextualized governance frameworks, equitable capacity-building, rigorous implementation and cost-effectiveness research, open knowledge repositories, and community-centered ethical design. We argue that AI must shift from technological optimism to locally led, evidence-driven, and equity-centered deployment. Without these paradigm shifts, AI risks reinforcing the very inequities it aims to solve.

  View details for DOI 10.5334/aogh.5268

  View details for PubMedID 42256553

• 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

• 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/journalpgph.0003240

  View details for Web of Science ID 001418792700001

  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

• Provider-identified barriers to performance at seven Nigerian accident & emergency units: A cross-sectional study PLOS GLOBAL PUBLIC HEALTH Muhammad, M., Umoga, K., Acquaye, A., Fleischer, B., Konkwo, C., Ogunyemi, K., Ngaruiya, C. 2023; 3 (5): e0001909

  Abstract

  Nigeria hosts much of Africa's morbidity and mortality from emergency medical conditions. We surveyed providers at seven Nigerian Accident & Emergency (A&E) units about (i) their unit's ability to manage six major types of emergency medical condition (sentinel conditions) and (ii) barriers to performing key functions (signal functions) to manage sentinel conditions. Here, we present our analysis of provider-reported barriers to signal function performance.503 Health Providers at 7 A&E units, across 7 states, were surveyed using a modified African Federation of Emergency Medicine (AFEM) Emergency Care Assessment Tool (ECAT). Providers indicating suboptimal performance ascribed this performance to any of eight multiple-choice barriers [infrastructural issues, absent and broken equipment, inadequate training, inadequate personnel, requirement of out-of-pocket payment, non-indication of that signal function for the sentinel condition, and hospital-specific policies barring signal function performance] or an open-ended "other" response. The average number of endorsements for each barrier was obtained for each sentinel condition. Differences in barrier endorsement were compared across site, barrier type and sentinel condition using a three-way ANOVA test. Open-ended responses were evaluated using inductive thematic analysis. Sentinel conditions were Shock, Respiratory Failure, Altered Mental Status, Pain, Trauma, and Maternal & Child Health. Study sites were the University of Calabar Teaching Hospital, the Lagos University Teaching Hospital, the Federal Medical Center, Katsina, the National Hospital Abuja, the Federal Teaching Hospital Gombe, the University of Ilorin Teaching Hospital (Kwara), and the Federal Medical Center Owerri (Imo).Barrier distribution varied widely by study site. Just three study sites shared any one barrier to signal function performance as their most common. The two barriers most commonly endorsed were (i) non-indication of, and (ii) insufficient infrastructure to perform signal functions. A three-way ANOVA test found significant differences in barrier endorsement by barrier type, study site and sentinel condition (p<0.05). Thematic analysis of open-ended responses highlighted (i) considerations disfavoring signal function performance and (ii) lack of experience with signal functions as barriers to signal function performance. Interrater reliability, calculated using Fleiss' Kappa, was found to be 0.5 across 11 initial codes and 0.51 for our two final themes.Provider perspective varied with regards to barriers to care. Despite these differences, the trends seen for infrastructure reflect the importance of sustained investment in Nigerian health infrastructure. The high level of endorsement seen for the non-indication barrier may signal need for better ECAT adaptation for local practice & education, and for improved Nigerian emergency medical education and training. A low endorsement was seen for patient-facing costs, despite the high burden of Nigerian private expenditure on healthcare, indicating limited representation of patient-facing barriers. Analysis of open-ended responses was limited by the brevity and ambiguity of these responses on the ECAT. Further investigation is needed towards better representation of patient-facing barriers and qualitative approaches to evaluating Nigerian emergency care provision.

  View details for DOI 10.1371/journal.pgph.0001909

  View details for Web of Science ID 001418927500001

  View details for PubMedID 37216332

  View details for PubMedCentralID PMC10202278

• 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

• Prevalence and correlates of depression and substance use disorders in emergency department populations: A cross-sectional study at East Africa's largest public hospital AFRICAN JOURNAL OF EMERGENCY MEDICINE Iheanacho, T., Maciejewski, K. R., Ogudebe, F., Chumo, F., Slade, T., Leff, R., Ngaruiya, C. 2022; 12 (4): 307-314

  Abstract

  There are persistent gaps in screening, identification, and access to care for common mental disorders in Low- and Middle-Income Countries. An initial step towards reducing this gap is identifying the prevalence, co-morbidities, and context of these disorders in different clinical settings and exploring opportunities for intervention. This study evaluates the prevalence and correlates of depression and substance use disorders among adults presenting to the Emergency Department (ED) of a major national hospital in East Africa.This study utilized the World Health Organization's STEPwise Approach to Surveillance (WHO-STEPS) tool and the Patient Health Questionnaire (PHQ-9) to conduct a cross-sectional survey capturing socio-demographic data, tobacco, and alcohol use and rates of depression in a sample of adults presenting to the ED. Bivariate and multivariate analyses were conducted for each outcome of interest and socio-demographics.Of 734 respondents, 298 (40.6%) had a PHQ-9 score in the "moderate" to "severe" range indicative of major depressive disorder. About 17% of respondents endorsed current tobacco use while about 30% reported being daily alcohol users. Those with high PHQ-9 score had higher odds of reporting current tobacco use ("severe range" = adjusted odds ratio (aOR) 1.85, 95% CI 1.05, 3.26). Those with a "severe" PHQ-9 scores were 9 times (aOR 2.3-35.3) more likely to be daily drinkers.Screening and identification of people with depression and substance use disorders in the ED of a large national hospital in Kenya is feasible. This offers an opportunity for brief intervention and referral to further treatment.

  View details for DOI 10.1016/j.afjem.2022.06.008

  View details for Web of Science ID 000931144000002

  View details for PubMedID 35892005

  View details for PubMedCentralID PMC9307521

• When women win, we all win-Call for a gendered global NCD agenda FASEB BIOADVANCES Ngaruiya, C. 2022; 4 (12): 741-757

  Abstract

  Gender is a social determinant of health, interacting with other factors such as income, education, and housing and affects health care access and health care outcomes. This paper reviews key literature and policies on health disparities and gender disparities within health. It examines noncommunicable disease (NCD) health outcomes through a gender lens and challenges existing prevailing measures of success for NCD outcomes that focus primarily on mortality. Chronic respiratory disease, one of the four leading contributors to NCD mortality, is highlighted as a case study to demonstrate the gender gap. Women have different risk factors and higher morbidity for chronic respiratory disease compared to men but morbidity is shadowed by a penultimate research focus on mortality, which results in less attention to the gap in women's NCD outcomes. This, in turn, affects how resources, programs, and interventions are implemented. It will likely slow progress in reducing overall NCD burden if we do not address risk factors in an equitable fashion. The article closes with recommendations to address these gender gaps in NCD outcomes. At the policy level, increasing representation and inclusion in global public health leadership, prioritizing NCDs among marginalized populations by global health societies and political organizations, aligning the gendered global NCD agenda with other well-established movements will each catalyze change for gender-based disparities in global NCDs specifically. Lastly, incorporating gender-based indicators and targets in major NCD-related goals and advancing gender-based NCD research will strengthen the evidence base for women's unique NCD risks and health outcomes.

  View details for DOI 10.1096/fba.2021-00140

  View details for Web of Science ID 000890518500001

  View details for PubMedID 36479209

  View details for PubMedCentralID PMC9721093

• A multinational Delphi consensus to end the COVID-19 public health threat NATURE Lazarus, J., Romero, D., Kopka, C. J., Karim, S., Abu-Raddad, L. J., Almeida, G., Baptista-Leite, R., Barocas, J. A., Barreto, M. L., Bar-Yam, Y., Bassat, Q., Batista, C., Bazilian, M., Chiou, S., del Rio, C., Dore, G. J., Gao, G. F., Gostin, L. O., Hellard, M., Jimenez, J. L., Kang, G., Lee, N., Maticic, M., McKee, M., Nsanzimana, S., Oliu-Barton, M., Pradelski, B., Pyzik, O., Rabin, K., Raina, S., Rashid, S., Rathe, M., Saenz, R., Singh, S., Trock-Hempler, M., Villapol, S., Yap, P., Binagwaho, A., Kamarulzaman, A., El-Mohandes, A., Abdulla, S., Addleman, S., Aghayeva, G., Agius, R., Ahmed, M., Ramy, M., Aide, P., Aleman, S., Alfred, J., Ali, S., Aliaga, J., Aloudat, T., Alqahtani, S. A., Al-Salman, J., Amuasi, J. H., Agrawal, A., Anwar, W., Araujo-Jorge, T., Artaza, O., Asadi, L., Awuku, Y., Baker, M., Barberia, L., Bascolo, E., Belcher, P., Bell, L., Benzaken, A., Bergholtz, E., Bhadelia, N., Bhan, A., Bilodeau, S., Bitran, R., Bluyssen, P., Bosman, A., Bozza, F. A., Brinkmann, M. M., Brown, A., Mellado, B., Bukusi, E., Bullen, C., Buonanno, G., Burgess, R., Butler, M., Byakika-Kibwika, P., Cabieses, B., Carlsson, G., Cascini, F., Chabala, C., Chakroun, M., Cheng, K. K., Chetty, A., Chumachenko, D., Consalves, G., Morris, A., Cordie, A., Corrah, T., Crabtree-Ramirez, B., Dashdorj, N., Davidovitch, N., de Souza, L., Dhariwal, A., Druica, E., Ergonul, O., Erondu, N. A., Essar, M., Ewing, A., Fanjul, G., Feierstein, D., Feigl-Ding, E., Figueroa, R., Figueroa, J., Fisher, D., Flores, W., Forero-Pena, D. A., Frumkin, H., Gamkrelidze, A., Gandhi, M., Garcia, P., Garcia-Basteiro, A. L., Garcia-Sastre, A., Garg, S., Gbeasor-Komlanvi, F. A., Gershenson, C., Gilada, I., Giovanella, L., Gonzalez, M., Green, M. S., Greenhalgh, T., Griffin, P., Griffin, S., Grinsztejn, B., Anand, T., Guerra, G., Guinto, R., Gujski, M., Guner, R., Hamdy, A., Hancean, M., Haniffa, A., Hartigan-Go, K. Y., Hassan, H. K., Hay, S. I., Heino, M. T. J., Hel, Z., Hotez, P., Hu, J., Hukic, M., IJsselmuiden, C., Iroko, D., Iskarous, M., Izugbara, C., Jacobs, C., Jadad, A. R., Jehan, F., Jordan, A., Jroundi, I., Kain, K., Kamberi, F., Karamov, E., Karan, A., Katz, R., Katzourakis, A., Kazembe, A., Khamis, F., Khamzayev, K., Khanyola, J., Khunti, K., Kiguli-Malwadde, E., Kim, W., Kirenga, B. J., Klimovsky, D., Kmush, B. L., Knaul, F., Kogevinas, M., Kristensen, F., Kumar, D., Kumar, R., Kvalsvig, A., Lacerda, M. V., Lal, A., Lawton, T., Lemery, J., Leonardi, A. J., Li, Y., Loettvall, J., Lounis, M., Maceira, D., MacIntyre, C., Madani, A., Magiorkinis, G., Malekzadeh, R., Choisy, M., Marcelin, J. R., Marks, G. B., Marr, L., Marrazzo, J., Martina, A., Martin-Moreno, J. M., Mateos, C., Mayxay, M., Mazarati, J., Mboup, S., McDonald, J., McMillan, F., Mechili, E., Medici, A., Davis, S. L. M., Meier, P., Memish, Z. A., Menon, J., Menon, P., Mesiano-Crookston, J., Michie, S., Mikolasevic, I., Milicevic, O., Mishra, A., Mohamed, R., Mokdad, A. H., Monroy-Valle, M., Morawska, L., Moschos, S. A., Motawea, K., Mousavi, S., Mumtaz, G., Munene, P. K., Almagro, C., Muriuki, J., Muyingo, S., Naniche, D., Naylor, C., Ndembi, N., Nemec, J., Nesteruk, I., Ngaruiya, C., Nguyen, H., Nikolova, D., Nitzan, D., Norheim, O., Noushad, M., Ntoumi, F., Nyborg, G., Ochodo, E., Odabasi, Z., Okwen, M., Olivia, K., Ong, D. S. Y., Opara, I., Orozco, M., Oshitani, H., Pagel, C., Pai, M., Palsdottir, B., Papatheodoridis, G., Paraskevis, D., Leigh, J., Pecoul, B., Peichl, A., Perez-Then, E., Phuc Pham Duc, Philippe, C., Rojas, A., Pladsen, C., Pozniak, A., Quiroga, R., Qureshi, H., Rampal, S., Ranney, M., Rathe, L., Ratzan, S., Raventos, H., Rees, H., Reis, R., Ricciardi, W., Rizk, N., Robalo, M., Robertson, E., Robinson, L., Rokx, C., Ros, T., Rottingen, J., Rubin, M., Ruxrungtam, K., Sadirova, S., Saha, S., Salgado, N., Sanchez, L., Sangaramoorthy, T., Santamaria-Ulloa, C., Santos, R., Sawaf, B., Schneider, M. F., Schooley, R. T., Sener, A., Sepulveda, J., Shah, J., Shibani, M., Shoib, S., Sikazwe, I., Simaitis, A., Gill, A., Skhvitaridze, N., Sokolovic, M., Solomon, R., Solorzano, X., Springer, S. A., Srol, J., Staines, A., Stelfox, H. T., Strathdee, S., Sulaiman, L., Sutton, B., Svanaes, D., Swed, S., Sypsa, V., Sorensen, K., Tajudeen, R., Tan, A., Tang, J., Tanner, M., Sethi, T., Temmerman, M., Than, K., Tinto, H., Tometissi, S., Torres, I., Tshering, K. P., Tsiodras, S., Tsofa, B., Vahlne, A., Vargas, J., Bernal, I., Ventura, D., Vilasanjuan, R., Vipond, J., Wamala-Andersson, S., Wargocki, P., West, R., Weyand, A., White, T. M., Wolff, G., Yao, M., Yates, C. A., Yeboah, G., Yee-Sin, L., Yi, S., Teo, Y., Yong, P., Zamora-Mesia, V., Ovrehus, A., COVID-19 Consensus Statement Panel 2022; 611 (7935): 332-345

  Abstract

  Despite notable scientific and medical advances, broader political, socioeconomic and behavioural factors continue to undercut the response to the COVID-19 pandemic1,2. Here we convened, as part of this Delphi study, a diverse, multidisciplinary panel of 386 academic, health, non-governmental organization, government and other experts in COVID-19 response from 112 countries and territories to recommend specific actions to end this persistent global threat to public health. The panel developed a set of 41 consensus statements and 57 recommendations to governments, health systems, industry and other key stakeholders across six domains: communication; health systems; vaccination; prevention; treatment and care; and inequities. In the wake of nearly three years of fragmented global and national responses, it is instructive to note that three of the highest-ranked recommendations call for the adoption of whole-of-society and whole-of-government approaches1, while maintaining proven prevention measures using a vaccines-plus approach2 that employs a range of public health and financial support measures to complement vaccination. Other recommendations with at least 99% combined agreement advise governments and other stakeholders to improve communication, rebuild public trust and engage communities3 in the management of pandemic responses. The findings of the study, which have been further endorsed by 184 organizations globally, include points of unanimous agreement, as well as six recommendations with >5% disagreement, that provide health and social policy actions to address inadequacies in the pandemic response and help to bring this public health threat to an end.

  View details for DOI 10.1038/s41586-022-05398-2

  View details for Web of Science ID 000878444000001

  View details for PubMedID 36329272

  View details for PubMedCentralID PMC9646517

• Patient preferences for facility-based management of hypertension and diabetes in rural Uganda: a discrete choice experiment BMJ OPEN Moor, S. E. G., Tusubira, A. K., Wood, D., Akiteng, A. R., Galusha, D., Tessier-Sherman, B., Donroe, E., Ngaruiya, C., Rabin, T. L., Hawley, N. L., Armstrong-Hough, M., Nakirya, B. D., Nugent, R., Kalyesubula, R., Nalwadda, C., Ssinabulya, I., Schwartz, J. 2022; 12 (7): e059949

  Abstract

  To explore how respondents with common chronic conditions-hypertension (HTN) and diabetes mellitus (DM)-make healthcare-seeking decisions.Three health facilities in Nakaseke District, Uganda.Discrete choice experiment (DCE).496 adults with HTN and/or DM.Willingness to pay for changes in DCE attributes: getting to the facility, interactions with healthcare providers, availability of medicines for condition, patient peer-support groups; and education at the facility.Respondents were willing to pay more to attend facilities that offer peer-support groups, friendly healthcare providers with low staff turnover and greater availabilities of medicines. Specifically, we found the average respondent was willing to pay an additional 77 121 Ugandan shillings (UGX) for facilities with peer-support groups over facilities with none; and 49 282 UGX for 1 month of medicine over none, all other things being equal. However, respondents would have to compensated to accept facilities that were further away or offered health education. Specifically, the average respondent would have to be paid 3929 UGX to be willing to accept each additional kilometre they would have to travel to the facilities, all other things being equal. Similarly, the average respondent would have to be paid 60 402 UGX to accept facilities with some health education, all other things being equal.Our findings revealed significant preferences for health facilities based on the availability of medicines, costs of treatment and interactions with healthcare providers. Understanding patient preferences can inform intervention design to optimise healthcare service delivery for patients with HTN and DM in rural Uganda and other low-resource settings.

  View details for DOI 10.1136/bmjopen-2021-059949

  View details for Web of Science ID 000829479100001

  View details for PubMedID 35863829

  View details for PubMedCentralID PMC9310153

• Systematic review on chronic non-communicable disease in disaster settings BMC PUBLIC HEALTH Ngaruiya, C., Bernstein, R., Leff, R., Wallace, L., Agrawal, P., Selvam, A., Hersey, D., Hayward, A. 2022; 22 (1): 1234

  Abstract

  Non-communicable diseases (NCDs) constitute the leading cause of mortality globally. Low and middle-income countries (LMICs) not only experience the largest burden of humanitarian emergencies but are also disproportionately affected by NCDs, yet primary focus on the topic is lagging. We conducted a systematic review on the effect of humanitarian disasters on NCDs in LMICs assessing epidemiology, interventions, and treatment.A systematic search in MEDLINE, MEDLINE (PubMed, for in-process and non-indexed citations), Social Science Citation Index, and Global Health (EBSCO) for indexed articles published before December 11, 2017 was conducted, and publications reporting on NCDs and humanitarian emergencies in LMICs were included. We extracted and synthesized results using a thematic analysis approach and present the results by disease type. The study is registered at PROSPERO (CRD42018088769).Of the 85 included publications, most reported on observational research studies and almost half (48.9%) reported on studies in the Eastern Mediterranean Region (EMRO), with scant studies reporting on the African and Americas regions. NCDs represented a significant burden for populations affected by humanitarian crises in our findings, despite a dearth of data from particular regions and disease categories. The majority of studies included in our review presented epidemiologic evidence for the burden of disease, while few studies addressed clinical management or intervention delivery. Commonly cited barriers to healthcare access in all phases of disaster and major disease diagnoses studied included: low levels of education, financial difficulties, displacement, illiteracy, lack of access to medications, affordability of treatment and monitoring devices, and centralized healthcare infrastructure for NCDs. Screening and prevention for NCDs in disaster-prone settings was supported. Refugee status was independently identified both as a risk factor for diagnosis with an NCD and conferring worse morbidity.An increased focus on the effects of, and mitigating factors for, NCDs occurring in disaster-afflicted LMICs is needed. While the majority of studies included in our review presented epidemiologic evidence for the burden of disease, research is needed to address contributing factors, interventions, and means of managing disease during humanitarian emergencies in LMICs.

  View details for DOI 10.1186/s12889-022-13399-z

  View details for Web of Science ID 000814246400005

  View details for PubMedID 35729507

  View details for PubMedCentralID PMC9210736

• Using community-based participatory research methods to inform care for patients experiencing homelessness: An opportunity for resident education on health care disparities AEM EDUCATION AND TRAINING Ryus, C. R., Yang, D., Tsai, J., Meldrum, J., Ngaruiya, C. 2021; 5: S121-S125

  Abstract

  People experiencing homelessness (PEH) suffer higher burdens of chronic illnesses, have higher rates of emergency medicine (ED) use and hospitalization, and ultimately are at increased risk for premature death compared to housed counterparts. Structural racism contributes to a disproportionate burden of homelessness among people of color. PEH experience not only significant medical concerns but also complex social needs that need to be addressed concurrently for effective healing, issues that have been magnified by the COVID-19 pandemic. As health disparities and structural racism intersect among PEH, it is critically important to develop PEH-centered interventions to improve care and health outcomes as part of an effort to dismantle racism. One opportunity to address these disparities in care for PEH is through training ED physicians on methods for identifying and intervening on the unique needs of vulnerable patient groups. The Accreditation Council for Graduate Medical Education has outlined health quality pathways in the clinical learning environment to address health disparities. Community-based participatory research (CBPR) is particularly well suited for this scenario as it allows experiential learning for trainees to work with and understand a diverse group of stakeholders, to deepen their knowledge of local health disparities, and to lead research and measure outcomes of interventions to tackle health disparities. In this paper, we highlight the utility of CBPR in fostering experiential learning for EM residents on tackling health disparities and the importance of community collaboration in trainee-led interventions for comprehensive ED care.

  View details for DOI 10.1002/aet2.10681

  View details for Web of Science ID 000701048000020

  View details for PubMedID 34616985

  View details for PubMedCentralID PMC8480493

• Identifying homeless population needs in the Emergency Department using Community-Based Participatory Research BMC HEALTH SERVICES RESEARCH Franco, A., Meldrum, J., Ngaruiya, C. 2021; 21 (1): 428

  Abstract

  Annually 1.5 million Americans face housing insecurity, and compared to their domiciled counterparts are three times more likely to utilize the Emergency Department (ED). Community Based Participatory Research (CBPR) methods have been employed in underserved populations, but use in the ED has been limited. We employed CBPR in an urban American hospital with a primary goal of improved linkage to care, reduced ED recidivism, and improved homeless health care.A needs analysis was performed using semi-structured individual interviews with participants experiencing homelessness as well as with stakeholders. Results were analyzed using principles of grounded theory. At the end of the interviews, respondents were invited to join the "CBPR team". At CBPR team meetings, results from interviews were expounded upon and discussions on intervention development were conducted.Twenty-five stakeholders were interviewed including people experiencing housing insecurity, ED staff, inpatient staff, and community shelters and services. Three themes emerged from the interviews. First, the homeless population lack access to basic needs, thus management of medical needs must be managed alongside social ones. Second, specific challenges to address homeless needs in the ED include episodic care, inability to recognize housing insecurity, timely involvement of ancillary staff, and provider attitudes towards homeless patients affecting quality of care. Lastly, improved discharge planning and communication with outside resources is essential to improving homeless health and decreasing ED overutilization. A limitation of results is difficulty for participants experiencing homelessness to commit to regular CBPR meetings, as well as possible bias towards social networks influencing included stakeholders.CBPR is a promising approach to address gaps in homeless health care as it provides a comprehensive view incorporating various critical perspectives. Key ED-based interventions addressing recidivism include improved identification of housing insecurity, reinforced relationships between ED and community resources, and better discharge planning.

  View details for DOI 10.1186/s12913-021-06426-z

  View details for Web of Science ID 001027937400004

  View details for PubMedID 33952265

  View details for PubMedCentralID PMC8097852

• Systematic review on epidemiology, interventions and management of noncommunicable diseases in acute and emergency care settings in Kenya AFRICAN JOURNAL OF EMERGENCY MEDICINE Ngaruiya, C., Kawira, A., Mali, F., Kambua, F., Mwangi, B., Wambua, M., Hersey, D., Obare, L., Leff, R., Wachira, B. 2021; 11 (2): 264-276

  Abstract

  Mortality and morbidity from Non-Communicable Diseases (NCDs) in Africa are expected to worsen if the status quo is maintained. Emergency care settings act as a primary point of entry into the health system for a spectrum of NCD-related illnesses, however, there is a dearth of literature on this population. We conducted a systematic review assessing available evidence on epidemiology, interventions and management of NCDs in acute and emergency care settings in Kenya, the largest economy in East Africa and a medical hub for the continent.All searches were run on July 15, 2015 and updated on December 11, 2020, capturing concepts of NCDs, and acute and emergency care. The study is registered at PROSPERO (CRD42018088621).We retrieved a total of 461 references, and an additional 23 articles in grey literature. 391 studies were excluded by title or abstract, and 93 articles read in full. We included 10 articles in final thematic analysis. The majority of studies were conducted in tertiary referral or private/mission hospitals. Cancer, diabetes, cardiovascular disease and renal disease were addressed. Majority of the studies were retrospective, cross-sectional in design; no interventions or clinical trials were identified. There was a lack of access to basic diagnostic tools, and management of NCDs and their complications was limited.There is a paucity of literature on NCDs in Kenyan emergency care settings, with particular gaps on interventions and management. Opportunities include nationally representative, longitudinal research such as surveillance and registries, as well as clinical trials and implementation science to advance evidence-based, context-specific care.

  View details for DOI 10.1016/j.afjem.2021.02.005

  View details for Web of Science ID 000654637100012

  View details for PubMedID 33859931

  View details for PubMedCentralID PMC8027527

• The last frontier for global non-communicable disease action: The emergency department-A cross-sectional study from East Africa PLOS ONE Ngaruiya, C., Wambua, M., Mutua, T., Owambo, D., Muchemi, M., Rop, K., Maciejewski, K. R., Leff, R., Mutua, M., Wachira, B. 2021; 16 (4): e0248709

  Abstract

  Deaths due to non-communicable diseases (NCDs) have surpassed those due to communicable diseases globally and are projected to do so in Africa by 2030. Despite demonstrated effectiveness in high-income country (HIC) settings, the ED is a primary source of NCD care that has been under-prioritized in Africa. In this study, we assess the burden of leading NCDs and NCD risk factors in Kenyan Casualty Department patients to inform interventions targeting patients with NCDs in emergency care settings.Using the WHO STEPwise approach to surveillance (STEPS) tool and the Personal Health Questionnaire (PHQ-9), we conducted a survey of 923 adults aged 18 and over at Kenyatta National Hospital Emergency Department (KNH ED) between May-October 2018. Age, income, household size(t-test), sex, education, marital status, work status, and poverty status (chi-squared test or fisher's exact test) were assessed using descriptive statistics and analyzed using covariate-adjusted logistic analysis.Over a third of respondents had hypertension (35.8%, n = 225/628), 18.3% had raised blood sugar or diabetes (18.3%, n = 61/333), and 11.7% reported having cardiovascular disease (11.7%, n = 90/769). Having lower levels of education was associated with tobacco use (OR 6.0, 95% CI 2.808-12.618, p < 0.0001), while those with higher levels of education reported increased alcohol use (OR 0.620 (95% CI 0.386-0.994, p = 0. 0472). While a predominant proportion of respondents had had some form of screening for either hypertension (80.3%, n = 630/772), blood sugar (42.6%, n = 334/767) or cholesterol (13.9%, n = 109/766), the proportion of those on treatment was low, with the highest proportion being half of those diagnosed with hypertension reporting taking medication (51.6%, n = 116/225).This study establishes the ED as a high-risk population with potential for high impact in East Africa, should targeted interventions be implemented. Comprehension of the unique epidemiology and characteristics of patients presenting to the ED is key to guide care in African populations.

  View details for DOI 10.1371/journal.pone.0248709

  View details for Web of Science ID 000636737700018

  View details for PubMedID 33798234

  View details for PubMedCentralID PMC8018633

• Social Support for Self-Care: Patient Strategies for Managing Diabetes and Hypertension in Rural Uganda ANNALS OF GLOBAL HEALTH Tusubira, A. K., Nalwadda, C. K., Akiteng, A. R., Hsieh, E., Ngaruiya, C., Rabin, T. L., Katahoire, A., Hawley, N. L., Kalyesubula, R., Ssinabulya, I., Schwartz, J., Armstrong-Hough, M. 2021; 87 (1): 86

  Abstract

  Low-income countries suffer a growing burden of non-communicable diseases (NCDs). Self-care practices are crucial for successfully managing NCDs to prevent complications. However, little is known about how patients practice self-care in resource-limited settings.We sought to understand self-care efforts and their facilitators among patients with diabetes and hypertension in rural Uganda.Between April and June 2019, we conducted a cross-sectional qualitative study among adult patients from outpatient NCD clinics at three health facilities in Uganda. We conducted in-depth interviews exploring self-care practices for hypertension and/or diabetes and used content analysis to identify emergent themes.Nineteen patients participated. Patients said they preferred conventional medicines as their first resort, but often used traditional medicines to mitigate the impact of inconsistent access to prescribed medicines or as a supplement to those medicines. Patients adopted a wide range of vernacular practices to supplement treatment or replace unavailable diagnostic tests, such as tasting urine to gauge blood-sugar level. Finally, patients sought and received both instrumental and emotional support for self-care activities from networks of family and peers. Patients saw their children as their most reliable source of support facilitating self-care, especially as a source of money for medicines, transport and home necessities.Patients valued conventional medicines but engaged in varied self-care practices. They depended upon networks of social support from family and peers to facilitate self-care. Interventions to improve self-care may be more effective if they improve access to prescribed medicines and engage or enhance patients' social support networks.

  View details for DOI 10.5334/aogh.3308

  View details for Web of Science ID 000687293700002

  View details for PubMedID 34458110

  View details for PubMedCentralID PMC8378074

• Target women: Equity in access to mHealth technology in a non-communicable disease care intervention in Kenya PLOS ONE Ngaruiya, C., Oti, S., van de Vijver, S., Kyobutungi, C., Free, C. 2019; 14 (9): e0220834

  Abstract

  Non-Communicable Diseases (NCDs) constitute 40 million deaths annually. Eighty-percent of these deaths occur in Low- and Middle-Income Countries. MHealth provides a potentially highly effective modality for global public health, however access is poorly understood. The objective of our study was to assess equity in access to mHealth in an NCD intervention in Kenya.This is a secondary analysis of a complex NCD intervention targeting slum residents in Kenya. The primary outcomes were: willingness to receive SMS, whether SMS was received, and access to SMS compared to alternative health information modalities. Age, sex, level of education, level of income, type of work, number of hours worked, and home environment were explanatory variables considered. Multivariable regression analyses were used to test for association using likelihood ratio testing.7,618 individual participants were included in the analysis. The median age was 44 years old. Majority (75%, n = 3,691/ 4,927) had only attended up to primary (elementary) school. Majority reported earning "KShs 7,500 or greater" (27%, n = 1,276/ 4,736). Age and level of income had evidence of association with willingness to receive SMS, and age, sex and number of hours work with whether SMS was received. SMS was the health information modality with highest odds of being accessed in older age groups (OR 4.70, 8.72 and 28.89, for age brackets 60-69, 70-79 and 80 years or older, respectively), among women (OR = 1.86, 95% CI 1.19-2.89), and second only to Baraazas (community gatherings) among those with lowest income.Women had the greatest likelihood of receiving SMS. SMS performed equitably well amongst marginalized populations (elderly, women, and low-income) as compared to alternative health information modalities, though sensitization prior to implementation of mHealth interventions may be needed. These findings provide guidance for developing mHealth interventions targeting marginalized populations in these settings.

  View details for DOI 10.1371/journal.pone.0220834

  View details for Web of Science ID 000532188200009

  View details for PubMedID 31509540

  View details for PubMedCentralID PMC6738613

• Emergency care surveillance and emergency care registries in low-income and middle-income countries: conceptual challenges and future directions for research BMJ GLOBAL HEALTH Mowafi, H., Ngaruiya, C., O'Reilly, G., Kobusingye, O., Kapil, V., Rubiano, A. M., Ong, M., Puyana, J., Rahman, A., Jooma, R., Beecroft, B., Razzak, J. 2019; 4: e001442

  Abstract

  Despite the fact that the 15 leading causes of global deaths and disability-adjusted life years are from conditions amenable to emergency care, and that this burden is highest in low-income and middle-income countries (LMICs), there is a paucity of research on LMIC emergency care to guide policy making, resource allocation and service provision. A literature review of the 550 articles on LMIC emergency care published in the 10-year period from 2007 to 2016 yielded 106 articles for LMIC emergency care surveillance and registry research. Few articles were from established longitudinal surveillance or registries and primarily composed of short-term data collection. Using these articles, a working group was convened by the US National Institutes of Health Fogarty International Center to discuss challenges and potential solutions for established systems to better understand global emergency care in LMICs. The working group focused on potential uses for emergency care surveillance and registry data to improve the quality of services provided to patients. Challenges included a lack of dedicated resources for such research in LMIC settings as well as over-reliance on facility-based data collection without known correlation to the overall burden of emergency conditions in the broader community. The group outlined potential solutions including incorporating data from sources beyond traditional health records, use of standard clinical forms that embed data needed for research and policy making and structured population-based research to establish clear linkages between what is seen in emergency units and the wider community. The group then identified current gaps in LMIC emergency care surveillance and registry research to form a research agenda for the future.

  View details for DOI 10.1136/bmjgh-2019-001442

  View details for Web of Science ID 000500402400004

  View details for PubMedID 31406601

  View details for PubMedCentralID PMC6666805

• Tobacco use and its determinants in the 2015 Kenya WHO STEPS survey BMC PUBLIC HEALTH Ngaruiya, C., Abubakar, H., Kiptui, D., Kendagor, A., Ntakuka, M. W., Nyakundi, P., Gathecha, G. 2018; 18: 1223

  Abstract

  According to the World Health Organization (WHO), in 2015, over 1.1 billion people smoked tobacco, which represents around 15% of the global population. In Africa, around one in five adults smoke tobacco. The 2014 Kenya Global Adult Tobacco Survey reported that 2.5 million adults use tobacco products. The objective of our study was to describe patterns and determinants of tobacco use from the 2015 Kenya STEPS survey, including use of "smokeless" tobacco products and the more novel e-cigarettes.The WHO STEPwise approach to surveillance (STEPS) was completed in Kenya between April and June 2015. Logistic regression analyses was used to assess factors affecting prevalence and frequency of tobacco use. Sociodemographic variables associated with tobacco use were considered: age, sex, level of education, wealth quintile, and residence. The relationship with alcohol as an intervening risk factor was also assessed. Our main outcomes of interest were current tobacco use, daily tobacco use and use of smokeless tobacco products.Of 4484 respondents, 605 (13.5%) reported being current tobacco users. Most active tobacco users were male (n = 507/605, 83.8%). Three out of four tobacco users (n = 468/605, 77.4%) reported being less than 50 years old, with the average start age being 21 (20.6, 95% CI 19.3-21.8) and the average quit age 27 (27.2, 95% CI 25.8-28.6). Most tobacco users had only ever attended up to primary school (n = 434/605, 71.7%). Men had nearly seven times higher odds of being tobacco users as compared to women (OR 7.63, 95% CI 5.63-10.33). Alcohol use had a positive effect on tobacco use. Finally, less than ten respondents reported having used e-cigarettes.The 2015 Kenya WHO STEPS provided primary data on the status of tobacco use in the country and other leading NCD risk factors, such as alcohol, and associated diseases. Our findings highlight key target populations for tobacco cessation efforts: young people, men, those with lower levels of education, and alcohol consumers. Further data is needed on the use of smokeless tobacco, and its impact on smoked tobacco products, as well as on the novel use of e-cigarettes.

  View details for DOI 10.1186/s12889-018-6058-5

  View details for Web of Science ID 000449361900008

  View details for PubMedID 30400915

  View details for PubMedCentralID PMC6219013

• Prevalence and determinants of heavy episodic drinking among adults in Kenya: analysis of the STEPwise survey, 2015 BMC PUBLIC HEALTH Kendagor, A., Gathecha, G., Ntakuka, M. W., Nyakundi, P., Gathere, S., Kiptui, D., Abubakar, H., Ombiro, O., Juma, P., Ngaruiya, C. 2018; 18: 1216

  Abstract

  Globally, alcohol consumption contributes to 3.3 million deaths and 5.1% of Disability Adjusted Life Years (DALYs), and its use is linked with more than 200 disease and injury conditions. Our study assessed the frequency and patterns of Heavy Episodic Drinking (HED) in Kenya. HED is defined as consumption of 60 or more grams of pure alcohol (6+ standard drinks in most countries) on at least one single occasion per month. Understanding the burden and patterns of heavy episodic drinking will be helpful to inform strategies that would curb the problem in Kenya.Using the WHO STEPwise approach to surveillance (STEPS) tool, a nationally representative household survey of 4203 adults aged 18-69 years was conducted in Kenya between April and June 2015. We used logistic regression analysis to assess factors associated with HED among both current and former alcohol drinkers. We included the following socio-demographic variables: age, sex, and marital status, level of education, socio-economic status, residence, and tobacco as an interaction factor.The prevalence of HED was 12.6%. Men were more likely to engage in HED than women (unadjusted OR 9.9 95%, CI 5.5-18.8). The highest proportion of HED was reported in the 18-29-year age group (35.5%). Those currently married/ cohabiting had the highest prevalence of HED (60%). Respondents who were separated had three times higher odds of HED compared to married counterparts (OR 2.7, 95% CI 1.3-5.7). Approximately 16.0% of respondents reported cessation of alcohol use due to health reasons. Nearly two thirds reported drinking home-brewed beers or wines. Tobacco consumption was associated with higher odds of HED (unadjusted OR 6.9, 95% CI 4.4-10.8); those that smoke (34.4%) were more likely to engage in HED compared to their non-smoking counterparts.Our findings highlight a significant prevalence of HED among alcohol drinkers in Kenya. Young males, those with less education, married people, and tobacco users were more likely to report heavy alcohol use, with male sex as the primary driving factor. These findings are novel to the country and region; they provide guidance to target alcohol control interventions for different groups in Kenya.

  View details for DOI 10.1186/s12889-018-6057-6

  View details for Web of Science ID 000449361900007

  View details for PubMedID 30400910

  View details for PubMedCentralID PMC6219062

• Prevalence and predictors of injuries in Kenya: findings from the national STEPs survey BMC PUBLIC HEALTH Gathecha, G., Ngaruiya, C., Mwai, W., Kendagor, A., Owondo, S., Nyanjau, L., Kibogong, D., Odero, W., Kibachio, J. 2018; 18: 1222

  Abstract

  Injuries are becoming an increasingly important public health challenge globally, and are responsible for 9% of deaths. Beyond their impact on health and well-being, fatal and non-fatal injuries also affect social and economic development for individuals concerned. Kenya has limited data on the magnitude and factors associated with injuries. This study sought to determine the magnitude and risk factors for injuries in Kenya and to identify where the largest burden lies.A national population-based household survey was conducted from April-June 2015 among adults age 18-69 years. A three-stage cluster sample design was used to select clusters, households and eligible individuals based on WHO guidelines. We estimated the prevalence of injuries, identified factors associated with injuries and the use of protective devices/practices among road users. Multivariate logistic regression was used to identify potential factors associated with injuries.A total of 4484 adults were included in the study. Approximately 15% had injuries from the past 12 months, 60.3% were males. Four percent of the respondents had been injured in a road traffic crash, 10.9% had experienced unintentional injuries other than road traffic injuries while 3.7% had been injured in violent incidents. Among drivers and passengers 12.5% reported always using a seatbelt and 8.1% of the drivers reported driving while drunk. The leading causes of injuries other than road traffic crashes were falls (47.6%) and cuts (34.0%). Males (p = 0.001), age 18-29 (p < 0.05) and smokers (p = 0.001) were significantly more likely to be injured in a road traffic crash. A higher social economic status (p = 0.001) was protective against other unintentional injuries while students had higher odds for such types of injuries. Heavy episodic drinking (p = 0.001) and smoking (p < 0.05) were associated with increased likelihood of occurrence of a violent injury.Our study found that male, heavy episodic drinkers, current smokers and students were associated with various injury types. Our study findings highlight the need to scale up interventions for injury prevention for specific injury mechanisms and target groups. There is need for sustained road safety mass media campaigns and strengthened enforcement on helmet wearing, seatbelt use and drink driving.

  View details for DOI 10.1186/s12889-018-6061-x

  View details for Web of Science ID 000449361900011

  View details for PubMedID 30400906

  View details for PubMedCentralID PMC6219001

• Individual and household level factors associated with presence of multiple non-communicable disease risk factors in Kenyan adults BMC PUBLIC HEALTH Wekesah, F. M., Nyanjau, L., Kibachio, J., Mutua, M. K., Mohamed, S. F., Grobbee, D. E., Klipstein-Grobusch, K., Ngaruiya, C., Haregu, T. N., Asiki, G., Kyobutungi, C. K. 2018; 18: 1220

  Abstract

  Non-communicable diseases (NCDs), are increasing globally, causing about 60% of disability-adjusted life years and 39.8 million deaths in 2015. Risk factors often cluster and interact multiplicatively in an individual and this is strongly associated with the development and severity of NCDs. We assessed the sociodemographic factors associated with the presence of multiple NCD risk factors among individuals aged 18 years and older in the Kenyan population.We used national representative data from 4066 individuals out of 4500 who participated in the WHO STEPs study in 2015. NCD risk factor counts were derived by summing the risk factors present in an individual and categorising into 1-3, 4-6 and 7+ risk factors in any combination of the 12 assessed NCD risk factors (hypertension, diabetes mellitus, cholesterol, insufficient physical activity, excessive alcohol use, tobacco use and obesity, excess sugar intake, insufficient fruit and vegetables intake, high salt consumption, and use of unhealthy cooking fats and oils). Ordered logistic regression was used to investigate the sociodemographic factors associated with an individual possesing multiple NCD risk factors.Majority (75.8%) of the individuals in the study possesed 4-6 and 10% had ≥7 NCDs risk factors. Nearly everyone (99.8%) had insufficient fruits and vegetable intakes, 89.5% consumed high salt in their diet and 80.3% did not engage in sufficient physical activity. Apart from NCD risk count which increased with age among both men and women, associations with other socio-demographic factors differed between men and women. A woman of Akamba ethinicity had lower odds (0.43) while Meru women had higher odds (3.58) of higher NCD risk factor count, compared to the Kalenjin women. Among men, being a Kisii or Luo was associated with lower odds (0.48 and 0.25 respectively) of higher NCD risk factor count. Women in a marital union had higher odds (1.58) of a higher NCD risk factor count.Majority of Kenyan adults possess more than four NCD risk factors; a clear indication of an emerging epidemic of NCDs in this population. Effective and multi-sectoral interventions targeting multiple risk factors in individuals are required to mitigate especially the behavioural and modifiable NCD risk factors in Kenya.

  View details for DOI 10.1186/s12889-018-6055-8

  View details for Web of Science ID 000449361900005

  View details for PubMedID 30400905

  View details for PubMedCentralID PMC6219015

• Obesity as a form of malnutrition: over-nutrition on the Uganda "malnutrition" agenda PAN AFRICAN MEDICAL JOURNAL Ngaruiya, C., Hayward, A., Post, L., Mowafi, H. 2017; 28: 49

  Abstract

  The objectives were to highlight the burden of overweight and obesity as an additional area of importance for the malnutrition agenda in Uganda and to provide evidence-based considerations for stakeholders involved.Mirroring other Low- and Middle-Income Countries (LMICs), Uganda is experiencing a "double burden" of over-nutrition related issues - both obesity and overweight, and related non-communicable diseases (NCDs) alongside the under-nutrition that has long plagued the country. Despite the commonplace assumption that under-nutrition is the predominant form of malnutrition in Uganda, we explore recent literature that in fact, challenges this notion. While food insecurity has contributed to the under-nutrition problem, a lack of dietary diversity also has a demonstrated role in increasing over-nutrition. We cannot afford to ignore over-nutrition concomitant with stunting and wasting in the country. Increase in the burden of this less acknowledged form of malnutrition in Uganda is critical to investigate, and yet poorly understood. A move towards increased regionally targeted over-nutrition research, funding, government prioritization and advocacy is needed.

  View details for DOI 10.11604/pamj.2017.28.49.11176

  View details for Web of Science ID 000425657500003

  View details for PubMedID 29184601

  View details for PubMedCentralID PMC5697987

• ACUTE PROMYELOCYTIC LEUKEMIA PRESENTING AS FOCAL NEUROLOGIC FINDINGS AND DETERIORATING MENTAL STATUS JOURNAL OF EMERGENCY MEDICINE Dolan, M., Ngaruiya, C. 2017; 52 (1): E5-E8

  Abstract

  Acute promyelocytic leukemia (APL) is a rare but particularly malignant form of acute leukemia that is characterized by a rapid progression to fatal hemorrhage. Survival rates of patients with APL have increased with the introduction of all-trans retinoic acid (ATRA), but early deaths caused by hemorrhage still persist.A man with undiagnosed APL presenting with focal neurologic findings and deteriorating altered mental status caused by an intracranial hemorrhage is discussed. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: It is important to consider APL when diagnosing etiologies for intracranial hemorrhage. In addition to standard care, early administration of ATRA is recommended upon clinical suspicion of the disease.

  View details for DOI 10.1016/j.jemermed.2016.07.010

  View details for Web of Science ID 000396434300002

  View details for PubMedID 27658551