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Item type: Item , Access status: Open Access , Developing the STOE Framework and Implementation Architecture: A Dual Model for e-Health Implementation in Resource-Constrained Public Healthcare Settings of Western Kenya(Journal of Research and Academic Writing, 2026-04-18) Ondulo, Jasper; Liyala, Samuel; Adong, Grace; Aduda, Dickens; Matoke, NahasonWell-funded e-Health pilot projects in low- and middle-income countries (LMICs) consistently fail to achieve sustainable integration into routine practice. Existing frameworks address single dimensions of this problem, lacking integrated, multi-level perspectives and actionable roadmaps. This paper presents the development and empirical validation of the STOE (Social-Technological-Organisational-Environmental) Framework and its complementary Implementation Architecture, a dual model for resource-constrained public healthcare settings. We employed a sequential explanatory mixed-methods design across three public healthcare facilities in Western Kenya. Following a deductive-inductive process, we deductively constructed the STOE Framework by synthesising Normalisation Process Theory, the Technology-Organisation-Environment framework, and the Four-in-Balance Model. This a priori model was then inductively tested through quantitative surveys (n=108 healthcare providers) and qualitative interviews (n=21 key informants). Empirical data confirmed the framework's validity. Implementation failures stemmed from structural disconnects across nested STOE contexts, not isolated technical deficits. Three disconnect patterns emerged: (1) environmental policy uncertainty paralysing organizational decision-making (E→O); (2) technologies procured without frontline user input leading to systematic social rejection (S↔T); and (3) fragmented funding creating unsustainable donor- dependent pilots that collapsed post-completion (E→O→S cascade). The validated dual framework offers a pragmatic two-stage approach for resource-constrained health systems: diagnose systemic weaknesses using the STOE lens, then target interventions precisely using the architectural blueprint. This moves the field beyond checklist-style models toward integrated diagnosis and action.Item type: Item , Access status: Open Access , Diagnostic Performance of Urine Leukocytes in Predicting Urinary Tract Infections among Adult Patients in Kisumu County, Kenya(African Urology, 2026-06) Oyugi, Ben Obola; Ayodo, George; Onguru, DanielBackground: Urinary tract infections (UTI) remain a major global health burden. Diagnosis in resource-limited settings often relies on biochemical markers, like leukocytes. However, the predictive value of leukocyturia in culture-confirmed UTI is under-described in Kisumu, Kenya. Objectives: This study determined the association between urine leukocyturia, uropathogen distribution, and antimicrobial resistance (AMR) among adult patients attending Synergy Clinics. Methods: A retrospective record review was conducted using routine urine, microscopy, culture, and sensitivity testing records. Based on the Cochran formula, a minimum sample size of 255 patient records was calculated, and a total of 348 samples were analysed. Descriptive statistics were used to summarise demographic characteristics. Associations between leukocyturia and culture positivity were assessed using chi-square tests. Logistic regression analysis identified predictors of culture-confirmed bacteriuria. Results: Most participants were male (79.6%). The largest age group was 46–64 years (39.6%). Of the samples, 22.7% were positive for leukocytes. Urine culture positivity was 57.6%, with Escherichia coli (E. coli) as the most frequently isolated pathogen (13.3%). Leukocyturia was significantly associated with culture positivity (p = 0.001). Multivariate analysis identified leukocyturia (odds ratio [OR] 3.36; p = 0.008) and sex (p < 0.001) as significant predictors of culture growth, while age and estimated glomerular filtration rate (eGFR) were not significant. Particularly high AMR was observed against trimethoprim/sulfamethoxazole (SXT) and ampicillin/cloxacillin (AMPCLX). Nitrofurantoin (NIT), aminoglycosides, and carbapenems demonstrated preserved effectiveness. Conclusion: Urine leukocytes were strongly associated with culture-confirmed UTI, supporting their role in diagnostic triage in resource strained settings. The predominance of E. coli and high resistance burden underscores the need for routine culture and susceptibility guided therapy.Item type: Item , Access status: Open Access , Beyond the Payout Window: Modelling the Durability of Poverty Graduation After Large Lump Sum Cash Transfers in Rural Kenya(SSRN, 2026-03) Oburu, Jeffar JuniorCash transfer programmes have generated compelling evidence of short to medium term welfare gains in sub-Saharan Africa, yet a fundamental question persists largely unanswered: how long do these gains last, and what determines whether a household that exits poverty after a transfer stays out? Conventional impact evaluations rely on fixed follow-up windows of twelve to thirty-six months, producing outcome snapshots that cannot characterise the durability of poverty graduation as a dynamic process. This paper proposes a methodological reorientation: applying actuarial survival analysis, specifically adapted Cox proportional hazards modelling, to the study of post-transfer poverty reversion among smallholder farming households in rural Kenya. Using a cohort design that maps directly onto the operational structure of large lump sum transfer programmes, we demonstrate how time-to-event methods transform our understanding of poverty graduation from a binary outcome into a time-varying trajectory shaped by household characteristics, asset dynamics, climate shocks, and the presence or absence of complementary support. The framework produces three outputs unavailable from conventional evaluation designs: poverty reversion survival curves, covariate-specific hazard ratios for reversion risk, and a predictive scoring tool that programme managers can deploy during recipient selection to stratify households by their projected graduation durability. We argue that this actuarial reorientation is not merely a methodological refinement. It represents a fundamental shift in how we ask whether cash transfers work: from did the transfer lift this household? to how long will this household remain lifted, and why?Item type: Item , Access status: Open Access , Unmasking Non-Malarial Mosquito Borne Infections Among Febrile Children in Malaria-Endemic Regions of Western Kenya(Scientific Reports, 2026-04-07) Ogony, Jack; Karanja, Simon; Ayodo, George; Akinyi, Ivy; Onguru, Daniel; Angira, Charles; Menya, Diana; Mangeni, JudithAlmost half of under-five children in health facilities are febrile in sub-Saharan Africa. The non-specific clinical symptoms coupled with; limited diagnostics capacities, overlapping endemicity and the surveillance gaps complicates accurate cause identification of an acute febrile illnesses in resource limited settings. This challenge leads to misdiagnosis, overtreatment, and delays in appropriate management, increasing morbidity and mortality. Health systems are often overloaded, with providers attributing fevers to the most common pathogen, while other emerging infections are the cause. This study unpacked the febrile illness by testing for dengue fever in parallel to malaria. Febrile ill children below 5 years seeking health services public health facilities in Busia and Kisumu Counties were screened using an approved malaria and dengue fever rapid test kits at the outpatient department. Those who screened positive were recruited into the study. A total of 1004 children were screened, 380 met the recruitment criteria. 215 (21.4%) tested positive for P. falciparum alone, 90 (8.9%) tested positive for dengue fever alone while 75 (7.5%) had co-infections. Busia had the highest P. falciparumonly infection (23.4%) while Kisumu had the highest dengue-only infections (12.6%). Dengue fever is a re-emerging neglected tropical, climate change driven disease in malaria endemic regions. Other than creating awareness to build capacity for diagnosis, this study unmasked and confirmed dengue as a major contributor to the non malarial febrile illnesses among children. There is need to revise the screening algorithm for febrile patients to improve arboviral surveillance.Item type: Item , Access status: Open Access , Depressive Symptoms, Alcohol, and Drug Dependence among Female Sex Workers in Kisumu, Kenya: A Cross-Sectional Study(African Journal of Reproductive Health, 2026-07) Osire, Edyth A.; Awandu, Shehu S.; Otieno, Fredrick O.; Zulaika, Garazi; Akinyi, Cynthia; Phillips-Howard , Penelope A.; Mehta, Supriya D.Female sex workers (FSW) have increased likelihood of depressive symptoms, alcohol and drug dependence. Analysis of cross-sectional baseline data from 407 women in a trial of menstrual cups was done to assess depressive symptoms (PHQ-9), alcohol (AUDIT) and drug dependence (DAST). Multinomial logistic regression identified factors associated with having 2 or 3 elevated scores, relative to having no elevated score. Median age was 27.3 years; 60% of the FSWs had less than secondary education, 41% had other jobs besides sex work, and over half (52.9%) reported experiencing sexual abuse during childhood. The prevalence of depressive symptoms was 20% (15% mild, 5% moderate or higher). One quarter (25%) of participants had some classification for alcohol dependence, and 15% were classified as having potentially hazardous drug dependence. Multiple problems were identified in 14.4% of participants. The results highlight the interconnectedness of mental health, drugs and alcohol use among FSWs in western Kenya. (Afr J Reprod Health 2026; 30 [14]:75-85).