Gold Collection

Antibiotic dispensing practices and antimicrobial stewardship gaps in community pharmacies in Kakamega County, Kenya

2026-07-22T08:47:10Z

Antibiotic dispensing practices and antimicrobial stewardship gaps in community pharmacies in Kakamega County, Kenya Jones, Eleanor Turnbull; Langtree, Susannah; Mogoi, Nicholas; Sifuna, Anthony; Gadaffi, Lindsay; Jewell, Tony Background Antimicrobial resistance (AMR) is a major global health threat, with sub-Saharan Africa bearing a disproportionate burden. Community-level antibiotic dispensing practices remain poorly described in Kenya outside Nairobi. Methods A total of 504 antibiotic dispensing events were recorded across 22 community pharmacies in Kakamega County, western Kenya, between 3rd and 22nd August 2025. Data collected included dispensing source (over-the-counter [OTC] versus prescription), clinical indication, antibiotics dispensed, course completion, and self-reported repeat antibiotic use within the preceding month. Descriptive analyses were performed, and χ² tests were used to examine associations between dispensing source and selected non-antibiotic dispensing characteristics. Results Of the 504 dispensing events, 224 (44.4%) involved OTC dispensing and 278 (55.2%) were prescription-based. The most frequent indications for antibiotic dispensing were upper respiratory tract infections (URTI; n = 156, 31.0%), lower respiratory tract infections (LRTI; n = 95, 18.8%), gastrointestinal infections (n = 65, 12.9%), and skin or soft-tissue infections (n = 55, 10.9%). Across all events, amoxicillin, azithromycin, and metronidazole were the most frequently dispensed antibiotics, with cephalosporins and other broad-spectrum agents used across several indications. Partial antibiotic courses were supplied in 33 (6.5%) dispensing events, most commonly due to financial constraints (15/33, 45.5%). Self-reported antibiotic use within the preceding month occurred in 156 (31.0%) cases. Conclusions OTC antibiotic access remains widespread in Kakamega County, with substantial use of broad-spectrum agents across multiple clinical indications. Financial barriers contribute to incomplete antibiotic courses. These findings highlight the importance of incorporating community pharmacy dispensing data into county-level antimicrobial stewardship programmes and informing national strategies to optimise antibiotic use.

A Comparison of TPI Gene-Specific PCR and Stool Microscopy in Detecting Giardia lamblia Infection in Western, Kenya

2026-07-22T08:46:56Z

A Comparison of TPI Gene-Specific PCR and Stool Microscopy in Detecting Giardia lamblia Infection in Western, Kenya Sakwa, James; Otunga, Eliphalet; Okoth, Patrick; Shaviya, Nathan; Were, Tom Background and study aim: Giardia lamblia is a widespread pathogen of gastrointestinal infection in Kenya, the diagnosis of which is mostly based on stool microscopy. Molecular assays against conserved genes e.g. Triose Phosphate Isomerase (TPI) provide better detection. The objective of the study was to determine the diagnostic accuracy of TPI gene-specific PCR in the identification of G. lamblia in symptomatic patients in western Kenya with the colon microscopy used as the comparator. Patients and Methods: This was a cross-sectional study that was carried out among 147 patients who had presented with gastrointestinal symptoms at Busia County referral Hospital, western Kenya. Direct microscopy of stool samples and TPI gene-specific PCR were used to analyze the samples. Results: G. lamblia was identified in 78 (53.1) of the participants by microscopy and 53 (36.1) of the participants by TPI-PCR. TPI-PCR had sensitivity of 66.7% (95% CI: 55.1-76.9) and specificity 98.6% (95% CI: 92.3 -100). The predictive value (positive and negative) is 98.1 and 72.3 with the overall diagnostic accuracy standing at 81.6. Methods had a great deal of agreement (Cohen kappa = 0.639). The McNemar’s test showed that there was significant discordance (P < 0.0001). The participants who were positive by microscopy were 136 times more likely to be positive by TPI-PCR as compared to the negative (OR = 136; 95% CI: 17.9-1035.2, P = 0.00001). Conclusion: TPI gene-specific PCR was highly specific, generally diagnostic in its overall performance and showed a high agreement with stool microscopy but sensitivity was moderate.

Antimicrobial stewardship challenges at a referral Hospital in Western Kenya: insights from a Kakamega–Cambridge health partnership

2026-07-22T07:55:02Z

Antimicrobial stewardship challenges at a referral Hospital in Western Kenya: insights from a Kakamega–Cambridge health partnership Sifuna, Anthony; Wanjala, Christine; Mogoi, Nicholas Nyabera; Olima, Lindsey; Malaba, Rose; Brealey, Evelyn; Mandillah, Lucy; Njeru, Frida; Kindiki, Sarah; Omedo, Robin; Abwalaba, Roselyne; Serra, Cristiano; Rabiei, Bobbak; Nyumbile, Bonface; Nyongesa, Peter; Welch, Martin Objective: To identify ways of improving antimicrobial stewardship at Kakamega County Teaching and Referral Hospital (KCTRH) in western Kenya.Methods: A knowledge and awareness test was conducted among surgical ward healthcare workers to assess their understanding of how to counter antimicrobial resistance. In parallel, the global Point Prevalence Survey (PPS) was used to understand antibiotic prescription practices at the referral facility. Patient records from the adult surgical and pediatric surgical wards were examined for information on antibiotic prescription and usage. A total of 47 healthcare workers and 106 patient records were examined.Results: Healthcare workers showed the highest competence when tested on the appropriate use of antimicrobials, with a mean score of 78.7%. However, their understanding of surveillance and monitoring was lower, with a mean score of 60.2%, followed by awareness and education (which achieved a mean score of 64.5%). The majority of prescriptions (62.3%) were for empiric treatment, with a lack of laboratory data to support targeted therapies. Prolonged antibiotic courses were noted for surgical prophylaxes with over 83% of patients being administered antibiotics for more than 1 day. The survey also revealed over-prescription of broad-spectrum agents such as ceftriaxone at 36.7%.Conclusion: There is a high use of antibiotics, but a weakness in AMR monitoring at KCTRH. Better use of laboratory testing (AMR profiles for infecting bacteria, etc) is recommended as the best way to improve patient management and deployment of antibiotics.

Effect of Risk Assessment on the Financial Performance of Deposit-Taking Saccos in Kenya

2026-07-22T06:00:42Z

Effect of Risk Assessment on the Financial Performance of Deposit-Taking Saccos in Kenya Simiyu, Adelaides; Ali, Umulkher; Nelima, Mary Purpose: To determine the effect of risk assessment on the financial performance of deposit-taking SACCOs in Kenya. Design/Methodology/Approach: The study used the positivist research philosophy but employed descriptive and causal research designs. Twelve hundred and twenty (122) DTSACCOs were randomly sampled from the 176 SACCOs in the DTSACCO. Both primary and secondary data were collected from the SACCOs using questionnaires and financial statements. The data were analyzed using descriptive and inferential statistical methods in SPSS. Findings: There was a strong positive relationship between the risk assessment and the cost of operation performance (r = 0.690, p < 0.01). Implications/Originality/Value: The study provides critical insight into the role of risk assessment in enhancing the financial performance of DTSACCOs. The findings of the study reveal the critical role of risk assessment in enhancing the financial performance of DTSACCOs, as they can evaluate the risks and exposures they have to their operations and allocate their resources accordingly. The significance of risk assessment in determining the operational costs of DTSACCOs indicates that decision-making within these organizations has a significant bearing on their financial performance