Publications

In developing nations, primary healthcare (PHC) is the first crucial level of contact for patients including emergencies. We examined the capacity of PHC for cardiovascular diseases (CVDs) prevention and management in Kenya from health workforce experiences in order to inform strategies for strengthening their capability and associated implications for measures of accessibility. The study was conducted in urban and rural settings of Nairobi and Machakos counties, Kenya. The cross-sectional study adopted purposive sampling applying mixed methods approach through health facility survey and key informant interviews. Despite the rural-urban populations variations, a higher proportion of rural facilities (81.2%) offered monthly CVD outpatient services than the urban counterparts (46.2%). More CVD home visits were predominantly conducted by rural PHC facilities at 17.6% versus 6.6% for urban. Unpredictable early access to diagnostic testing and medication occasioning missed opportunities and unwarranted referrals was a critical concern. Most facilities stocked anti-arrhythmia, a diuretic antihypertensive and anti-thrombolytic for essential CVDs related medications. Healthcare providers were emphatic on the need for continuous medical education opportunities for up-to-date evidence-based clinical decisions support competence. Moreover, the health workers advocated for increased outpatient financing for CVDs due to costly out of pocket financing limiting early treatment uptake. Efforts to streamline and upscale CVD resources mainly supply and health labour force at PHC will go a long way in alienating unnecessary referrals and patients' attrition in the continuum of care. More efficient and continuous medical education particularly in the rural and urban poor settings with emphasis on the evolving CVDs burden is desirable. Electronic health record system is a timely endeavor for enhanced patients' systematic referral and tracking considering that CVDs are lifelong conditions.

In developing nations, primary healthcare (PHC) is the first crucial level of contact for patients including emergencies. We examined the capacity of PHC for cardiovascular diseases (CVDs) prevention and management in Kenya from health workforce experiences in order to inform strategies for strengthening their capability and associated implications for measures of accessibility. The study was conducted in urban and rural settings of Nairobi and Machakos counties, Kenya. The cross-sectional study adopted purposive sampling applying mixed methods approach through health facility survey and key informant interviews. Despite the rural-urban populations variations, a higher proportion of rural facilities (81.2%) offered monthly CVD outpatient services than the urban counterparts (46.2%). More CVD home visits were predominantly conducted by rural PHC facilities at 17.6% versus 6.6% for urban. Unpredictable early access to diagnostic testing and medication occasioning missed opportunities and unwarranted referrals was a critical concern. Most facilities stocked anti-arrhythmia, a diuretic antihypertensive and anti-thrombolytic for essential CVDs related medications. Healthcare providers were emphatic on the need for continuous medical education opportunities for up-to-date evidence-based clinical decisions support competence. Moreover, the health workers advocated for increased outpatient financing for CVDs due to costly out of pocket financing limiting early treatment uptake. Efforts to streamline and upscale CVD resources mainly supply and health labour force at PHC will go a long way in alienating unnecessary referrals and patients' attrition in the continuum of care. More efficient and continuous medical education particularly in the rural and urban poor settings with emphasis on the evolving CVDs burden is desirable. Electronic health record system is a timely endeavor for enhanced patients' systematic referral and tracking considering that CVDs are lifelong conditions.

Sub-Saharan Africa has one of the world's richest selections of indigenous fermented foods which constitute valuable cultural heritage with significant socio-economic impact. The review provides an in-depth examination of the diversity of indigenous fermented foods of Kenya in the cultural practices context, interlinked microbiome, associated nutritional and food security aspects while positing valorisation perspective. The traditional fermented foods are profiled into five clusters with significant valorisation potential for food systems in: (i) non-alcoholic cereal-based thin porridge (uji) and (ii) fermented milk products (mursik and suusac). This is informed by agro-productivity resilience and evolving consumption preferences. Whereas these foods are commonly processed via artisanal methods, often resulting in inconsistent products, locally tailored starter culture trials in uji and suusac have shown a promising model to guarantee microbiological safety, mitigate contamination and assure stable sensory characteristics. It is thus plausible to posit, that integrated microbial ecology of traditional fermentation and food systems policy-level research targeted at a reengineering of the unit operations with the intent of improving safety and nutritional quality while being cognizant of organoleptic traits and intertwined biocultural diversity is highly desirable. Particularly, with a broader foresight for promoting sustainable food systems at the base of the pyramid.

Sub-Saharan Africa has one of the world's richest selections of indigenous fermented foods which constitute valuable cultural heritage with significant socio-economic impact. The review provides an in-depth examination of the diversity of indigenous fermented foods of Kenya in the cultural practices context, interlinked microbiome, associated nutritional and food security aspects while positing valorisation perspective. The traditional fermented foods are profiled into five clusters with significant valorisation potential for food systems in: (i) non-alcoholic cereal-based thin porridge (uji) and (ii) fermented milk products (mursik and suusac). This is informed by agro-productivity resilience and evolving consumption preferences. Whereas these foods are commonly processed via artisanal methods, often resulting in inconsistent products, locally tailored starter culture trials in uji and suusac have shown a promising model to guarantee microbiological safety, mitigate contamination and assure stable sensory characteristics. It is thus plausible to posit, that integrated microbial ecology of traditional fermentation and food systems policy-level research targeted at a reengineering of the unit operations with the intent of improving safety and nutritional quality while being cognizant of organoleptic traits and intertwined biocultural diversity is highly desirable. Particularly, with a broader foresight for promoting sustainable food systems at the base of the pyramid.