MUST Institutional Research Ethics Review Committee System - MIRERC

Exploring Childbirth Experiences Among Adolescents in Imenti South Sub-County

2025-04-02T08:49:16+00:00

The aim of this study is to explore childbirth experiences among the adolescents who will have sought services,
Coming for some other services such as child immunization at Imenti South Sub County.
The sexual and reproductive health services of adolescents is a global concern with adolescent pregnancy
national average at 16% (KDHs, 2023) and Meru County average is at 24% above the national average.This
has contributed to a rise in maternal and neonatal obstetric complications (United Nations, 2013).
The research questions to be examined are:-
 What are the experiences of adolescents with different stakeholders across the care continuum?
 To what extent are healthcare services responsive to the needs of the adolescents?
 What are the met and unmet childbirth needs of adolescents across the care continuum?

Determinants of Health Outcomes of Traumatic Brain Injury Among Patients Attending Meru Teaching and Referral Hospital

2025-04-03T15:33:41+00:00

Introduction: Traumatic brain injury is the disruption of the brain structure with its function caused by the application of an external force, characterized by confusion, loss of consciousness, coma, or seizure. TBI is a public health concern globally and among the leading causes of admissions in hospitals, increased morbidity, mortality, and disability. The objective of this study is to assess the determinants of health outcomes of patients with traumatic brain injuries seeking treatment at Meru Teaching and Referral Hospital. Methods: A cross-sectional study design will be used to conduct this study at Meru Teaching and Referral Hospital. The study population will be medical files of adult patients who had a diagnosis of traumatic brain injury, who were admitted and discharged home, post-discharge patients attending the outpatient neurosurgical clinic on follow-up after discharge, and healthcare practitioners managing these patients at the Accident and Emergency department, adult surgical wards, and critical care unit. A sample size of 84 patient files, 20 patients attending neurological clinics, and 40 healthcare workers will be included in this study. Data will be collected using a checklist to collect data from patients’ medical record files, interview-guided questionnaires for patients attending Neuro Clinic and self-administered questionnaires will be administered to healthcare workers managing patients in selected surgical departments. Data collected will be entered into Statistical Package for Social Sciences (SPSS) version 24. Descriptive statistics will be used d to draw research conclusions- Inferential statistics such as chi-square, ANOVA, correlation, and t-test will be used to identify factors that influence the health outcome of patients with TBI. The correlation will be established using Pearson regression to check the effect of the factors on the health outcomes of TBI patients. Binary logistic regression analysis will help predict the strength of association between dependent and independent variables. The final analysis of variance ( ANOVA) will determine the significance of the results at 95% confidence. Research findings will be presented in figures and tables. All ethical considerations will be observed by seeking ethical clearance from Meru University of Science and Technology (MUST) Institutional Research Ethics Review Committee MIRERC and approval will be obtained from the Meru Teaching and Referral Hospital Research and Ethics Committee. Informed consent will be obtained from all the study participants.

Urine stabilization and treatment using lactic acid from fruit and vegetable peels: A potential source of nitrogen fertilizer

2025-04-03T13:59:49+00:00

This study proposes stabilising urine for use as nitrogen fertilizer in agriculture through lactic acid fermentation (LAF) from fruit and vegetable peel waste. Focused on onsite sanitation, it aims to utilize source-separated urine to enhance food production sustainably. Previous research shows LAF can suppress pathogens in fecal sludge and organic material preservation. The goal is to maximize lactic acid production, retain nitrogen, eradicate odor, and kill bacteria in human urine. Conducted at Meru University of Science and Technology, the research employs a quasi-experimental design. Urine samples from four volunteers will be analyzed for E. coli and nitrogen content before and after treatment. Peels from Gakoromone Market will be washed, air-dried, and stored. LAF will be performed on 300g of peels, fermented anaerobically for 72 hours at 34°C, 37°C, and 40°C, and analyzed with a UV-VIS spectrophotometer. The lactic acid produced will be added to urine samples and stored for seven days. Additionally, a direct fermentation setup will compare direct LAF with lactic acid addition to urine. Physicochemical properties, including temperature, pH, E. coli, and nitrogen content, will be measured using standard methods, such as the Kjeldahl method and MacConkey agar. Statistical analysis will use a Turkey test in one-way ANOVA to identify significant differences. Expected outcomes include higher nitrogen content, lower pH, minimal odor, and reduced E. coli levels in treated urine compared to untreated samples.

MIRERC 048/2025: CONTEXTUAL FACTORS, COMMUNICATION AND FINANCING STRATEGIES ON ADOPTION OF COMMUNITY-LED TOTAL SANITATION IN PASTORAL COMMUNITIES IN MARSABIT, KENYA

2025-04-28T08:17:37+00:00

Access to sanitation facilities is an important human right and a critical United Nation’s agenda, yet millions of people globally still lack such a necessity. Open defecation and adoption of low-quality toilets remain a problem particularly in Sub-Saharan African countries, Kenya included, which amplify risk of disease exposure to the population. Despite approaches to end open defecation such as Community-Led Total Sanitation (CLTS), Kenya is among the global hotspots of open defecation. Although success in CLTS activities has been witnessed in different Kenyan contexts, the approach has shown different results in contexts with pastoral communities. The burden of open defecation in such communities is high with negative trends maintained for years. Context-appropriate approaches to behaviour change are required if universal access to sanitation is to be attained by 2030. The study objectives are to: examine the influence of contextual factors on adoption of Community-Led Total Sanitation, establish the moderating influence of financing strategies and the mediating influence of communication strategies on the relationship between contextual factors and adoption of Community-Led Total Sanitation and to examine the joint influence of contextual factors, financing strategies and information communication on adoption of the approach in the selected pastoral areas in Marsabit, Kenya. The study will employ convergent design and will involve collection of both qualitative and quantitative data. Quantitative data will be gathered from a sample of 395 household heads, a sample calculated using Yamane’s formula. The study will be conducted in two purposively selected Sub-Counties in Marsabit County with the highest and lowest open defecation rates for comparison. A proportionate-to-size simple random sampling technique will be used in selection of household heads from each of the selected areas. The data will be gathered using a questionnaire, an interview guide and an observation checklist. Key informant interviews will be conducted among 12 purposively selected informants who will include Public Health Officers, Community Health Officers, CLTS implementers and selected natural leaders. The quantitative data obtained will be analysed in both descriptives and logistic regressions using the Statistical Package for Social Sciences (SPSS) Version 26. Themes will be identified from the interview data and be presented as narratives. Grey literature sources will also be used to complement data presentation. The study will provide an understanding of the dynamics in pastoral contexts that interact to influence CLTS interventions. It will point out aspects in CLTS that may constrain or enable achievement of the desired outcomes and inform strategies for successful adoption of behaviour change approaches in pastoral communities.

MIRERC(A)017/2025: Identifying Breast Cancer Genetic Risk Factors in Kenya (BreCXome)

2025-04-09T05:55:34+00:00

Per GLOBOCAN 2020, breast cancer has surpassed lung cancer as the most diagnosed cancer worldwide. In most parts of Africa, breast cancer is the leading cause of cancer deaths among women. Although cancers present with racial disparities that are largely influenced by genetic factors, there is a significant dearth of genetic studies in Sub-Saharan Africa in general. Globally, patients of African descent suffer the shortest survival rates and poorest outcomes. Due to considerable difference in linkage
disequilibrium structure between African and Caucasian populations, largely Eurocentric research data are not representative of African people. African genomes are the most diverse and therefore the most likely to reveal the genetic basis of complex human traits. Despite this immense potential, there is a profound paucity of African cancer genomic data. Due to the dearth of genetic studies conducted among people of African descent, the proposed study presents an opportunity to identify novel variants. The
pathogenesis of breast cancer remains largely unexplained; therefore, the objective of the proposed study is to identify genes and pathways underpinning breast cancer pathogenesis in a Kenyan cohort. The long-term goal is to provide a comprehensive genetic landscape of breast cancer in Black Africans and develop resources for novel molecular diagnostics and therapeutics. Study samples will be obtained from The Meru Teaching and Referral Hospital and Pathologists Lancet, both in Kenya. The proposed study will have both retrospective and prospective arms. In the retrospective arm, we will retrieve data for all breast cancer cases from the medical records and utilize available archived breast cancer FFPE samples whereas in the prospective arm, we will collect blood and breast cancer tumor samples (i.e., FFPE). Genomic or cell-free DNA isolated from the FFPEand blood will be subjected to whole genome sequencing and bioinformatics analyses to identify novel loci and elucidate pathways associated with breast cancer pathogenesis among Black Africans. This study also aims to create a comprehensive breast cancer database by integrating data from breast cancer cases into a cloud-based clinical data management application (Uvosyo). This streamlined approach will allow efficient organization and retrieval of information, offering valuable insights into breast cancer trends, treatment outcomes, and patient profiles. Ultimately, this will lead to more informed decision-making and improved patient care.

MIRERC018/2025: Association of eHealth Literacy with Knowledge of Social Health Authority (SHA) And Social Health Insurance Fund (SHIF) Among Undergraduate Health Students in Kenya

2025-04-09T06:53:10+00:00

The rapid expansion of digital health resources has made eHealth literacy a crucial skill for accessing and understanding health-related information. In Kenya, the Social Health Authority (SHA) and Social Health Insurance Fund (SHIF) were introduced in October 2024 to replace the National Hospital Insurance Fund (NHIF). Despite 19.3 million registrations, only 3.5 million formally employed individuals actively contribute to SHIF, suggesting hesitancy in the voluntary uptake of the program, perhaps due to knowledge inadequacies about SHA and SHIF. Yet, considering the high internet penetration in Kenya, eHealth literacy among Kenyans is presumably high. This study assesses the association between eHealth literacy and SHA/SHIF knowledge among undergraduate students in health-related courses in Kenya, who are among the Kenyans likely to have high eHealth literacy given their youthfulness and exposure to health information. An analytical cross-sectional study will be conducted with 450 students recruited via convenience sampling using an online survey. eHealth literacy will be measured using the eHealth Literacy Scale (eHEALS), while SHA/SHIF knowledge will be assessed through an adapted Kaiser Family Foundation quiz. Descriptive statistics will summarize the data on eHealth literacy levels and SHA/SHIF knowledge levels. Pearson correlation and multiple regression analysis will examine the relationship between eHealth literacy and SHA/SHIF knowledge, controlling for age, gender, year of study, and socio-economic status. Findings from this study will provide empirical insights into the role of digital literacy
in health policy awareness, thus setting the ground for designing evidence-based digital literacy interventions. Furthermore, institutions of higher elearning can leverage the findings to advocacte for institutionalization of eHealth literacy to enhance SHA/SHIF public engagement strategies toward universal health coverage.

Assessment of Water Quality and Its Effects on Human Health in Ruiri/Rwarera Ward, Meru County, Kenya

2025-04-09T07:12:49+00:00

Water quality includes Physical, chemical and biological characteristics based on the standards of its usage. It is one of the main indicators of the quality of life provided to consumers. Water quality impacts both the public health and aesthetic value of a consumable product. Inadequate management of industrial and agricultural wastewater means the drinking water of hundreds of
millions of people is dangerously contaminated or chemically polluted. The natural presence of chemicals, particularly in groundwater, can also be of health significance, including arsenic and fluoride. In contrast, other chemicals, such as lead, may be elevated in drinking water as a result of leaching from water supply components in contact with drinking water. The main objective of study is to access the water quality and its effects on health in Ruiri/Rwarera ward in Buuri - sub county Meru County in Kenya. The study will involve onsite and laboratory tests which will all be aimed to get the water content from different water sources. The study area is the Ruiri/Rwarera ward, which is situated in the Buuri sub-county in Meru County, Kenya. It has an
area of approximately 131.50 square kilometers and a population of 18,754 people. The main source of drinking water from the study area includes; the boreholes, springs, aquifers, rain water among other sources. Many of these sources get polluted so fast.. Research on the assessment of water quality and its effects on health in the Ruiri/Rwarera ward has not been done before.
Hence, the study will be useful for policy-making by the county government of Meru in Kenya. The objectives of this research is to establish biological pollutants, chemical pollutants and methods of water treatment used by the residents in domestic water sources and to access the water treatment methods used by the ward authorities and residents to treat domestic water in the
area of study. This research study will address these gaps by discovering the extent of water pollution for domestic water in the Ruiri/Rwarera ward. Water samples collected from the field of study will be analyzed in Laboratory by use of equipment’s like spectrophotometers, chromatographs and mass spectrometers in order to identify and quantify different pollutants.
Quantitative data will be collected using a structured research questionnaire. The collected data from the laboratory will be entered into the computer and analyzed by Statistical Package for Social Sciences (SPSS) and Microsoft excel. The results will be presented in percentages, tables and chats. The expected results will be a detailed analytical analysis of water content and
retrospective data on water related diseases from the area of study. The study will help the county government and other stakeholders to intervene on matters of water hygiene.

MIRERC 046/2025: Knowledge, Attitudes, and Practices of Radiologists and Radiology Residents in Kenya on the Use of Artificial Intelligence for Breast Cancer Screening

2025-05-08T12:21:37+00:00

Background
While Artificial Intelligence (AI) offers potential solutions to radiologist shortages and diagnostic challenges, its adoption is met with mixed reactions by key stakeholders, most often skepticism.
Objective
This study examines the knowledge, attitudes, and practices (KAP) of radiologists and radiology residents in Kenya regarding Artificial Intelligence (AI) in breast cancer imaging, particularly in screening mammography.
Methodology
Using a mixed-methods, cross-sectional design, data will be collected from radiologists and radiology residents nationally via structured surveys and key informant interviews (KIIs). Quantitative data will undergo descriptive and inferential analysis, while thematic analysis will extract qualitative insights. The findings will inform collaboration between Machine Learning (ML) engineers and radiologists towards adoption of safe, effective AI tools that augment radiologists’ breast cancer screening workflows.
Utility of the study
The findings will also inform policy recommendations and integration strategies, supporting early breast cancer detection through scaled-up screening programs in Kenya.

MIRERC 019/2025: Joint study of social media and affective polarization in Kenya

2025-05-08T06:04:18+00:00

This study aims to develop a comprehensive methodology for measuring polarization on social media
platforms, focusing specifically on affective polarization—where users distance themselves from others
due to identity or group affiliation rather than issue-based disagreements. The research will measure the
degree of polarization and polarizing behaviors across different platforms, providing a comparative
ranking of platforms based on their polarization footprint. By revealing numeric representations of
polarization, the study intends to encourage user reflection and potentially prompt behavioral changes.
The study will consist of three parts:
1. Field Study: A methodology for measuring affective polarization on platforms through
observational methods, by scraping and classifying content that appears in the feeds of users,
and the structure of the social graph.
2. Experiment: An survey-based experiment to explore the interplay between individual-level
polarization and types of polarizing content, aiming to understand the causal impact of such
content on political attitudes.
3. Survey: A survey examining user experiences on social media, adapted from the Neely Social
Media Index, to understand the perceived negative and positive effects of social media use.
By comparing the findings from all three parts, the study seeks to draw insights into the correlation
between perceived experiences and observable polarization, as well as the impact of polarizing content
on attitudes.
Kenya has been selected as the study location for several reasons:
● The country is at a critical juncture in terms of platform regulation, offering an opportunity to
influence policy discussions.
● The study aims to diversify the research on digital conflict beyond the USA and Europe,
contributing to the decolonization of the field.
● Build Up has established links with Kenyan policy bodies such as the National Cohesion and
Integration Commission, Media Council, and Communications Authority of Kenya.
The study will also explore how platforms can be incentivized to reduce polarization through league
tables, as well as investigate potential policy solutions, such as taxing platforms based on their
polarization footprint. Ultimately, the research will provide a globally replicable template for
measuring polarization and inform policies to address the growing impact of affective polarization on
society.

MIRERC 033/2025: Impact of Digital Connectivity on family well-being in Kibera: A Participatory Approach

2025-05-08T08:49:08+00:00

This study examines the impact of affordable high-speed internet access on youth and family
well-being in Kibera, one of Nairobi’s largest informal settlements. Despite the rapid expansion of
digital technologies, much of the research on their effects remains focused on Western contexts,
leaving a significant knowledge gap in Africa. This study seeks to address this gap by assessing the
influence of broadband connectivity on key well-being indicators, including mental health, family
dynamics, education, and employment opportunities. Additionally, it aims to develop a culturally relevant framework for measuring digital well-being in the Global South and provide empirical
evidence to inform policies on digital inclusion and socio-economic development.

MIRERC (A)031/2025. Testing gamification concepts for effectiveness in the lab to help optimize Farmer and Agent engagement for Agribusinesses in Machakos, Makueni, and Embu, and other locations in Kenya

2025-05-08T07:03:50+00:00

Scientific Abstract
This study explores the application of gamification principles to optimize key components in
agribusiness, specifically agent recruitment, trust-building between farmers and agents, and agent
training. Gamification involves incorporating game-like elements such as points, badges,
leaderboards, and interactive challenges into non-game contexts to enhance engagement and
motivation. Through a series of controlled lab experiments, we aim to identify the most effective
gamification strategies that increase engagement, efficiency, and satisfaction among participants.
Farmers and agents will be introduced to various gamified recruitment processes, trust-building
activities, and training modules. Data will be collected through surveys, interviews, and
performance metrics to evaluate the effectiveness of each gamified intervention. The controlled
environment of the lab experiments will enable the isolation of specific variables, providing a
deeper understanding of the mechanisms behind the success of gamification.
The findings from this research will offer actionable insights for agribusinesses, demonstrating how
gamification can enhance recruitment, foster stronger trust relationships, and improve training
outcomes. This study aims to ensure that agribusiness practices are more engaging and effective,
ultimately leading to better support and motivation for both farmers and agents and improving
overall agribusiness performance.

Lay Summary
This project aims to test how key components in agribusiness, such as agent recruitment, the
development of trust between farmers and agents, and the training of agents, can be optimized
using gamification principles. .Gamification principles involve integrating game design elements such as points, rewards, and challenges into non-game contexts to engage and
motivate individuals. These principles leverage the natural human desire for competition,
achievement, and recognition to drive behavior and enhance participation in activities.By
integrating elements commonly found in games like points, badges, leaderboards, and
interactive challenges we seek to enhance these processes, making them more engaging and
effective. Our goal is to understand the specific role gamification can play in improving these
areas to ensure that farmers and agents are fully supported and motivated, ultimately leading to
better outcomes for agribusinesses.

To achieve this, we will conduct a series of lab experiments where farmers and agents will be
introduced to various gamification principles. Through these controlled experiments, we will
assess which gamified concepts yield the highest levels of engagement, efficiency, and
satisfaction, and understand the reasons behind their effectiveness. The findings from this
research will provide valuable insights for agribusinesses looking to refine their recruitment,
trust-building, and training practices, ensuring that these processes place the needs and
experiences of farmers and agents at the forefront.

MIRERC 032/2025: An academic course by the University of Chicago(Harris School) and Busara Center:

2025-05-08T07:41:25+00:00

Executive Summary
Behavioral experiments offer a unique lens of examining the intricate nature of the human decision
making process and in recent years, behavioral insights have been used in the design and
implementation of developmental programs. For 10 years now, Busara has applied the use of
behavioral science across disciplines to test behaviorally informed solutions and advance its
application in the Global South context including Kenya. The behavior change agenda across
governments is most developed in the policy areas of environment, health, and transport (Darnton,
2008). Indeed, we cannot downplay the promising nature of the use of behavioral experiments in
international development. By uncovering behavioral barriers and enablers to development outcomes,
experimental studies offer actionable insights for designing more effective, targeted interventions that
resonate with the preferences and motivations of beneficiaries.
To bridge this gap, Busara is running a course on behavioral experiments in international development
with students from the University of Chicago to help them unpack how experiments can be a powerful
tool for good policy, what is necessary to consider when designing an experiment and to think through
what makes a good policy recommendation. The students will be guided through the process of
developing a research question, designing formative research instruments, contextualizing them to fit
into the study context and analyzing the findings. Students will work in groups, on an experiment
design that they will refine throughout the course as they go through the steps of understanding good
research design (including considerations of what produces good evidence for policy), being ethical
and inclusive, designing, conducting, and analyzing formative interviews, learning from formative
research and identifying policy implications.
As per tradition, Busara provides opportunities for students from local universities and junior staff
within the organization to participate in similar courses. This course, offered by the University of
Chicago, will follow the same approach. To enhance the learning experience, five local students will
be recruited to collaborate with foreign students during the instrument and experimental design phases.
This setup is designed to foster a shared learning experience, allowing students to engage, interact, and
learn from one another.
Over a 10-week period, students will progress through the course, with a key milestone in Week 5
requiring them to submit their group-developed formative research instruments on selected topics for
data collection in Kenya. Before the data collection phase, these instruments will be submitted for
ethics approvals by MIREC. For the rest of the course, students will analyze the insights gathered from
the formative interviews to refine their experimental designs, culminating in final submissions of
research designs in Week 10.

MIRERC 034/2025: Socialization, Framing, and Motivation:

2025-05-08T09:18:25+00:00

Executive Summary
There is enormous cultural variation in how American workers are socialized to think
about their work and home lives. Communities of color are more community-oriented
(Nobles 1991); political conservatives think more holistically (Talhelm et al. 2015);
workers in the Mountain West and Great Plains are especially individualistic (Vandello
and Cohen 1999). In higher social class contexts, social networks tend to be large,
far-reaching, diverse and loosely connected (Carey and Markus 2017). In addition to this
cross-sectional variation, each successive generation is socialized to prioritize work,
family, and the self differently. How will this evolution impact the future of labor markets?

The aim of this project is to clarify the basic psychological mechanisms underlying
cultural variation in work attitudes. That is, how much can socialization impact labor
supply beyond typical economic forces such as wealth and outside opportunities? To
isolate the impact of socialization, I propose a lab-in-the-field experiment among
multilingual Kenyans to identify whether wage elasticity responds to cultural framing. I
hypothesize that participants will become more responsive to piece-rate pay when
randomized to access mental schema that are more influenced by markets and
transactions.