MUST Institutional Research Ethics Review Committee (MIRERC)

MIRERC 074/2025: MODEL THE TIME TO HOSPITAL READMISSION OF TYPE 2 DIABETIC PATIENTS IN MERU COUNTY, USING THE COX PROPORTIONAL HAZARD MODEL WITH FRAILTY

Kelly Maganah, Dr. Muriungi Robert Gitunga, Dr Githinji Peter Murage — Mon, 22 Sep 2025 00:00:00 +0000

Hospital readmissions among diabetic patients are a growing healthcare concern worldwide, and Kenya is experiencing the burden rise. This study aims to identify and model the patient-level and clinical risk factors that influence the time to hospital readmission among type 2 diabetics in Meru County, Kenya. This study will adopt a retrospective cohort design and data will be collected from the Meru Teaching and Referral Hospital(MTRH) in Meru County. Data analysis will be performed using R software. Data exploration will be done to inform factor analysis and plots such as Kaplan-Meier will be used to inform the both the Cox and the extended Cox models. The study will adopt both the traditional CPHM and CPHM with frailty to determine the key predictors of time to readmission based on the hazard ratios. The study will fit two models; the traditional Cox proportional risk model and the Cox proportional risk model (CPHM) induced with frailty. A discriminative performance comparison will be established between the traditional CPHM and the extended CPHM with frailty using the Concordance Index. The results of this study will offer important knowledge of clinical, social and economic predictors of hospital re-admission, and provide a basis for designing effective interventions to reduce this burden. To the body of knowledge, this study will bridge clinical and statistical knowledge through the integration of statistical techniques with the clinical data in illustrating how the complex health phenomena can be quantified using statistical tools.

MIRERC 053/2025: Profiling of Lactic Acid Bacteria, Physicochemical and Nutritional Changes during Spontaneous Fermentation of Ameru Traditional Porridge

Ntongondu Caroline Kinya, Dr. Cynthia N. Mugo , Dr. Joan Simam — Fri, 18 Jul 2025 00:00:00 +0000

Traditional fermented foods and beverages are often linked to indigenous communities and differ according to ethnicity, geography, substrates and fermentation type employed. Ameru traditional fermented porridge locally known as “Ucuru bwa gukia” by the Ameru community; is a cereal-based beverage produced through spontaneous fermentation. Lactic acid bacteria (LAB) are the predominant microorganisms present in traditional fermented products. Cereal-based fermented beverages are a rich source of nutrients, and probiotics and therefore, reported as health promoting foods. However, there is paucity in scientific documentation of LAB succession, physicochemical attributes, and nutrient changes across the fermentation process of Ameru traditional fermented porridge. This study aims to profile LAB, physicochemical, and nutrient composition changes at different time intervals of fermentation of Ameru traditional porridge. Culture-based microbiological techniques coupled with molecular techniques based on 16S rRNA sequencing will be employed for the identification and characterization of predominant LAB respectively, at different time intervals during fermentation of Ameru traditional porridge. Variations of pH, temperature, total soluble solids, and titratable acidity will be determined using standard procedures for each parameter. Proximate nutrient analysis of carbohydrate, fats, fiber, protein and ash contents will be determined using the Association of Official Analytical Chemists (AOAC, 2000) method. DNA extraction and PCR amplification for the 16S rRNA bacteria gene will be performed using universal primers 27F and 1492R. The amplified PCR products will be sent for sequencing. Quality assessments for sequences obtained will be done using FASTQC and sequence processing using QIIME2 and DADA2. Statistical analysis for 16S will be performed using phyloseq. Microbial counts of the porridge samples will be analyzed using (ANOVA) analysis of variance and (LSD) least significance variance using p≤0.05. Data will be compiled in Excel and statistical analysis will be carried out using SPSS.

MIRERC 066/2025: Modelling Pneumonia Transmission Incorporating Asymptomatic Component and Media Awareness.

Mwenda Douglas Kubania, Dr. Grace Gakii Muthuri , Dr. Stephen Karanja — Mon, 22 Sep 2025 00:00:00 +0000

Pneumonia is a form of acute respiratory infection that affects the lungs. Pneumonia is a major cause of death, particularly in children under five and the elderly. It ranks as one of the top causes of death globally. The Kenya Health Information System data indicates a substantial increase in reported cases. Pneumonia cases rose from 477,186 in 2020/2021 to 793,864 in 2022/2023. Controlling pneumonia remains a significant challenge, especially due to its ability to spread through symptomatic and asymptomatic carriers. Notably, the existing mathematical models have given asymptomatic carriers less focus. This study considers media awareness as a behavioural intervention that can be used to provoke asymptomatic carriers to get screened and receive treatment. The main aim of this study is to develop a mathematical model that describes pneumonia transmission dynamics, incorporating the asymptomatic component and the impact of awareness programs. A population-based compartmental approach will be used to formulate the models, which culminate in systems of differential equations. The entire population(N) is divided into seven compartments: The Susceptible(S), Exposed(E), Infectious symptomatic (I_s), Infectious asymptomatic(I_a), Treated symptomatic(T_s),Treated asymptomatic(T_a), and the Recovered(R). Reproduction numbers will be determined from the eigenvalues of the next-generation matrix. Numerical simulations of the ordinary differential equations will be done using MATLAB software to determine the impact of awareness levels on asymptomatic individuals. The results of this study will stimulate discussions and a review of the current assumptions concerning the role of asymptomatic carriers in disease spread. This will, in turn, strengthen decision-making among health care officials regarding targeting asymptomatic infectious pneumonia patients in an endeavor to fight epidemics of this disease.

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

Wed, 09 Apr 2025 00:00:00 +0000

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.

MIRERC 060/2025: Leveraging Community Health Workers for the Promotion of Breast Cancer Awareness and Timely Help-Seeking Behaviour (BreCATH-B study), Among Underserved Rural Population in Kenya

Dr Peter N. Kailemia, PhD — Fri, 18 Jul 2025 00:00:00 +0000

CLINICAL TRIAL SYNOPSIS
OVERALL GOAL: The overarching Aim of the BreCATH-B program is to co-create,
implement, and evaluate a theoretically informed, evidence-based, and culturally-sensitive
breast screening program that enables earlier diagnosis and reduces advanced-stage diagnosis
in an underserved rural population in Kenya. To accomplish this goal, the project will be
guided by several Specific Aims.
Specific Aim 1: Describe contextual facilitators and barriers to the implementation of the
BreCATH-B program from the perspectives of patient partners and stakeholders. This aim
will use mixed methods to explore implementation determinants using the PRISM
framework.
Specific Aim 2: Co-create the BreCATH-B program by adapting an existing evidence-based
intervention (EBI) that has been developed and evaluated in Rwanda through a randomised
controlled trial. This aim will draw on the results of Aim1 to tailor the breast cancer Early
Diagnosis intervention by Pace and colleagues focusing on awareness, clinical breast exams
and improving the referral system.
Specific Aim 3: Co-create an implementation package and tailoring implementation
strategies to the Kenyan context to improve intervention-context fit. This aim builds on the
results of Specific Aims 1 and 2 and involves the co-creation of a training package to enhance
the knowledge of Community Health Workers and primary healthcare workers on risk
factors, symptoms of female breast cancer, the importance of seeking timely medical
evaluation for breast concerns and reducing local barriers to accessing breast health care.
Primary healthcare workers will further be trained on the performance of clinical breast
examinations. This aim further involves the collaborative creation and tailoring of
implementation strategies considering the local implementation determinants.
Specific Aim 4: Evaluate the effectiveness of the BreCATH-B program by assessing its
impact on the level of breast cancer awareness, level of utilization of clinical breast
examination, length of patient and primary care intervals and number of referrals. The aim
focuses on evaluating the intervention’s primary and secondary outcomes arising from the
implementation of the intervention highlighted in Specific Aim 3.
Specific Aim 5: Describe the implementation process and degree to which the BreCATH-B
program was successfully implemented, with a focus on its reach, effectiveness, adoption,
implementation, and maintenance (RE-AIM domains), including health equity outcomes.

Specific Aim 6: Conduct an economic evaluation of implementation strategies for the
BreCATH-B program. The aim seeks to evaluate the cost of implementation strategies across
the phases of intervention implementation from a provider’s perspective.

MIRERC 062/2025: Assessment of Selected Laboratory Quality Management Essentials in the Haematology Department at Meru Teaching and Referral Hospital

Ian Muthomi Rugendo, Dr. Zakayo Maingi, Dr. Titus Mutwiri — Tue, 12 Aug 2025 00:00:00 +0000

Despite the critical role of accurate haematological testing in patient diagnosis and care, national audits reveal significant deficiencies in process control, facilities and safety, and equipment management, with Meru County scoring below national averages .This study aims to address these gaps by examining process control practices, assessing the adequacy of facilities and safety measures, and examining equipment management practices using the WHO’s Stepwise Laboratory Quality Improvement Process Towards Accreditation (SLIPTA) checklist. Employing a descriptive cross-sectional design, the study will involve laboratory technologists and technicians, utilizing census sampling, data collection through standard operating procedures, quality manuals, interviews, and observations, and analysis via SPSS with descriptive and inferential statistical tests. The findings will enhance diagnostic accuracy, inform hospital management and policy decisions, and contribute to academic research, ultimately improving patient outcomes at MeTRH.

MIRERC 061/2025: ASSESSMENT OF KNOWLEDGE, ATTITUDE AND PRACTICES AMONG HEALTHCARE WORKERS IN THE ADOPTION OF MOLECULAR DIAGNOSTICS IN CANCER CARE AND TREATMENT IN KENYA.

RUTH NDUTA MBURU, Dr. Frank Onyambu, Dr. Patrick Kubai — Tue, 02 Sep 2025 00:00:00 +0000

Executive Summary

Molecular diagnostics offers significant potential in enhancing cancer care and treatment through early detection, personalized therapies, and improved outcomes. In Kenya, where the cancer-related cases and deaths continue to increase, the adoption of Molecular diagnostics remains limited. Challenges such as inadequate knowledge, negative attitude, and poor practices among healthcare coupled with limited infrastructural components, play a significant role in the adoption of these techniques. This study aims to assess the Knowledge, attitudes, and practices of healthcare workers in the adoption of Molecular diagnostics for cancer care and treatment, with a focus on facility readiness and barriers in implementation. A cross-sectional analytical study will be conducted to assess healthcare workers, including oncologists, pathologists, and Nurses, across public and private facilities in Kenya. The facilities will be selected through a stratified random sampling process. Data will be collected using a structured questionnaire, focused group discussions, and Key Informant interviews to evaluate KAP regarding molecular diagnostics. The study is grounded in two theoretical frameworks: the Health Belief Model (HBM), which examines perceived benefits, such as early cancer detection, and perceived barriers, including the costs associated with the proposed molecular diagnosis. The Diffusion of Innovation (DOI) Theory explains adoption through the lenses of relative advantages, complexity, and observability. Quantitative data will be analyzed using descriptive statistics and logistic regressions to identify predictors of adoption, while qualitative data will be analyzed thematically to explore barriers and facilitators of the same. Ethical approval will be obtained from the Meru University Ethical Review Board (MIREC) and the National Commission for Science, Technology and Innovation (NACOSTEC), and data collection approvals from the different counties and respective health facilities. The study will assess the existing gaps in knowledge, attitudes, and practices that hinder the adoption of molecular diagnostics. The findings will inform targeted interventions such as training and workshops to enhance the adoption of Molecular diagnostics, which will ultimately reduce cancer-related mortality, hence improving care in Kenya

MIRERC 055/2025: LONGITUDINAL STUDY OF PERSISTENT HIGH-RISK HUMAN PAPILLOMAVIRUS INFECTION IN WOMEN LIVING WITH HIV IN MERU, KENYA

Dr. Frank Onyambu, Celestine Kemunto , Sharon Nyagaka — Fri, 18 Jul 2025 00:00:00 +0000

Background: Cervical cancer remains the leading cause of cancer-related deaths among women in
Kenya, with high-risk human papillomavirus (hrHPV) as the primary etiological agent. Women living
with HIV (WLHIV) are disproportionately affected due to immunosuppression. The interactions
between hrHPV persistence, sexually transmitted infections (STIs), cytokine imbalances, and vaginal
microbiome disruptions is not fully understood in this population.
Objective: This study aims to investigate the determinants of persistent hrHPV infection among
WLHIV in Meru County, Kenya, focusing on STI co-infections, cytokine profiles, vaginal microbiome
structure, and sexual behavior patterns over a five-year period.
Methods: We will recruit 500 WLHIV, including 242 from a prior cohort. Annual clinical exams,
vaginal swabs, and blood samples will be collected. Data will be collected on behavioral
characteristics and other risk factors associated with STIs and HPV infection. HPV and STI screening
will be performed using GeneProof PCR kits, cytokines measured via ELISA, and vaginal
microbiomes profiled using 16S rRNA sequencing on Illumina MiSeq. Statistical analyses will be
conducted in R 4.4.1, using logistic regression and longitudinal mixed models.
Expected Outcomes: The study will generate data that will improve understanding of how into
microbial, immunological, and behavioral factors influencing hrHPV persistence. This will inform
new prevention strategies such as vaginal probiotics, immune-targeted therapies, and public health
interventions tailored to WLHIV.

MIRERC 063/2025: The Kenyan Reference Genome Initiative: Whole genome sequencing of 1,000 healthy adults

Dr. Frank Onyambu, Sharon Nyagaka, Celestine Kemunto, Mercy Ndavi — Tue, 12 Aug 2025 00:00:00 +0000

ABSTRACT
Background
African populations remain largely underrepresented in global genomic datasets despite significant advances in genomics and precision medicine, accounting for less than 3% of publicly available data. This underrepresentation has major implications for clinical care, as therapeutics and diagnostics developed in non-African populations may not work as effectively or safely in African settings. Africa is home to the most genetically diverse populations in the world, offering immense potential to uncover novel variants critical to understanding disease risk, treatment response, and human biology. However, this potential remains largely untapped due to limited investment in large-scale sequencing efforts. Kenya, with over 40 distinct ethnic and linguistic communities and growing biomedical infrastructure, is well-positioned to address this gap.
Aim
This study aims to establish the first nationally representative whole genome dataset from healthy, unrelated Kenyan adults to support pharmacogenomic discovery, ancestry research, and population-specific precision medicine. The Kenyan Reference Genome Initiative (KRGI) will sequence the genomes of 1,000 individuals drawn from all 47 counties, representing Kenya’s rich ethnic and geographic diversity.
Methods
We propose a cross-sectional, population-based study targeting healthy, unrelated adults aged 18–35 years enrolled in Kenyan universities and colleges. Participants will undergo clinical screening, and eligible individuals will provide blood samples for DNA extraction. Whole genome sequencing will be performed at 30x coverage using Illumina NovaSeq 6000 technology. Sequencing data will undergo comprehensive bioinformatics analysis to identify single nucleotide variants, INDELs, and structural variants, as well as to perform ancestry deconvolution and pharmacogenomic annotation. De-identified demographic, clinical, and genomic data will be securely stored within a Kenya-hosted genomic database, with controlled access for licensed academic and industry use.
Expected outcome
The Kenyan Reference Genome Initiative will generate a high-quality whole genome dataset from 1,000 healthy, unrelated adults across all 47 counties. This resource will reflect Kenya’s ethnic and geographic diversity and enable the identification of SNPs, INDELs, structural variants, ancestry markers, and pharmacogenomic alleles. These findings will improve understanding of population structure and drug response, supporting more accurate polygenic risk scoring, targeted treatment, and inclusive clinical research. The study will also establish a secure, Kenya-hosted genomic database with restricted access for approved research and industry partners, ensuring data sovereignty and ethical oversight. Findings will be published to inform future research, health policy, and the development of genomics-informed care in Africa. Collectively, these outcomes will position Kenya as a regional leader in population genomics and personalized medicine.

MIRERC 058/2025: ANALYSIS OF TRENDS IN OVARIAN, ENDOMETRIAL, AND CERVICAL CANCERS IN NAKURU COUNTY, KENYA.

Ann Wanjiru Kamau, Dr. Frank G. Onyambu, PhD, Dr. Patrick Kubai, — Fri, 18 Jul 2025 00:00:00 +0000

Ovarian, endometrial and cervical cancers are the most common gynecological cancers that continue to undermine the quality of life of women globally, regionally and in Kenya. The disease burden of gynecological cancers is concerning, with trends in morbidity and mortality predicted to increase over the years. This study aims to analyze the trends in ovarian, endometrial and cervical cancers in Nakuru County. A cross-sectional retrospective study design will be used to abstract health records from the Nakuru Regional Cancer Centre in the period May 2018 to December 2024. The data will be collected using a standard data collection tool prepared using Kobo Collect and analysis done using R Studio. The research findings are expected to describe the annual incidence and prevalence of ovarian, endometrial and cervical cancer from 2018 to 2024, the geographical distribution, the prevalence of comorbidities, and prediction of the statistically significant factors influencing survivorship of patients with ovarian, endometrial and cervical cancer in Nakuru county. The research findings will be useful in accurately quantifying the morbidity and mortality of the selected gynecological cancers in Nakuru county, which will play a critical role in informing evidence-based and data-driven decision-making towards public health prevention and control interventions

MIRERC 064/2025: ASSESSMENT OF MENTAL HEALTH INEQUALITIES, ACCESS TO MENTAL HEALTH SERVICES IN SAMBURU EAST SUB -COUNTY , KENYA

Lekilit Jacob Satonik, Dr. Dorothy Kagendo Kithinji, Dr. Patrick Kinyua Kubai — Fri, 18 Jul 2025 00:00:00 +0000

From a global perspective, mental health is believed to be caused by scientific issues and environmental factors. But locally, many individuals have a firm belief that mental health disorders are caused by cultural beliefs and possession by evil spirits. More so in Samburu East Sub-County, beliefs that mental health disorders are caused by supernatural beings are on the rise. This study aims to investigate the current state of mental health inequalities and access to mental healthcare services in Samburu East Sub-County, Kenya. Other objectives include determining the types of selected mental health disorders prevalent in Samburu East and identifying socio-economic factors influencing mental health inequalities in Samburu East.

Data collection methods to be used in this study will be a cross-sectional descriptive study with sequential mixed methods to determine the inequalities in prevalence of mental health disorders and access to health care services in the Sub-County, Kenya. We will collect both qualitative and quantitative data through interviews, surveys, and focus group discussions with community members, health workers, and traditional healers.

The expected outcomes of this study are that people of Samburu East are not getting the required care because of a lack of knowledge and a belief that mental illness is caused by supernatural factors. Also, it is expected that findings will expose gaps in mental health infrastructure, workforce shortages, and limited awareness of existing services. Cultural stigma and marginalization, compounded by poverty and lack of implementation of national mental health policies, will be the key barriers to mental health equity in the region. These findings will be important in informing local policy and care models that respect cultural context while promoting access to scientifically grounded mental health care.

MIRERC 038/2025: EFFECTIVE USE OF ELECTRONIC HEALTH RECORDS IN TUBERCULOSIS SURVEILLANCE: A SURVEY OF TIGANIA EAST SUB-COUNTY, MERU COUNTY, KENYA

Mon, 23 Jun 2025 00:00:00 +0000

MIRERC 056/2025: The Prevalence and Factors Associated with Multi Drug Resistant E. Coli Causing Urinary Tract Infections Among Women in Nyambene Hospital and Meru Level Five Hospital, Kenya

KIMANTHI CLEOPHAS MBOGO, Dr. Dorothy Kagendo Kithinji, Dr. Patrick Kinyua Kubai — Tue, 12 Aug 2025 00:00:00 +0000

Abstract

Urinary tract infections are major health challenges among women globally. Urinary tract infections affect more than 400 million people globally each year. According to WHO about 60% of adult women experience urinary tract infection in their lifetime. Globally the prevalence of multidrug resistant urinary tract infection is between 35% to 50% with the most infections caused by E.coli. The prevalence of multidrug resistant E.coli in the US is 7.1%. The prevalence of multidrug resistant E.coli in European countries is 12 to 30%. The prevalence of multidrug resistant E.coli in Uganda and Tanzania is above 50% while the prevalence in Kenya is around 30% among all the infected patients. The increase in the number of cases of drug resistant strains of bacteria has made it very challenging to manage patients with urinary tract infection. Using empirical treatments without checking antimicrobial sensitivity and misuse of antibiotics has increased the prevalence of drug resistant urinary tract infections. E. coli account for about 70% of all urinary tract infections among women making it the most important organism for study. The objectives of the study are determine the antibiotics susceptibility pattern, the prevalence of and the risk factors associated with drug resistant E.coli among female patients in Meru level 5 and Nyambene Hospital.The study will be done among 288 female patients seeking services at Meru level five hospital and in Nyambene sub county Hospital. The study will be done between the month of March 2025 and May 2025. Data collection will be done using purposive sampling method as only those with active urinary tract infection will be selected for the study. Samples of patients confirmed to be having active urinary tract infections will be subjected to culture in CLED and MacConkey Agars after which sensitivity test will be performed to determine the antibiotic susceptibility. Data analysis will be done using SPSS and presentation will be done using graphs and charts.

MIRERC 068/2025: Assessment of the Effectiveness of Community Health Promoters in Hypertension Care in Imenti North Sub-County

Vincent Mukundi, Dr. Ananias Njagi Nkonge , Dr. Elias Kinoti — Tue, 12 Aug 2025 00:00:00 +0000

This study aims to assess the effectiveness of Community Health Promoters (CHPs) in hypertension care by examining the availability and utilization of resources, support for treatment adherence, and the challenges CHPs face in Imenti North Sub County. Limited documentation and research in this region have created a critical knowledge gap regarding the contribution of CHPs to hypertension management. A descriptive survey design will be employed, targeting CHPs in Imenti North Sub County. CHPs will be selected through simple random sampling for participation in the study. Data will be gathered using a structured questionnaire, and the collected data will be analyzed using SPSS, employing descriptive and inferential statistics to address the research objectives. This study will identify gaps in the current role of CHPs in hypertension care, offering insights into areas for improvement and providing recommendations to enhance their effectiveness. By addressing these gaps, the research aims to strengthen healthcare delivery in Imenti North Sub County and potentially inform policy and practice in similar regions.

MIRERC 027/2025; Gender Based Violence in Meru County, Kenya: Prevalence, Injury Characteristics, Health Facility Preparedness and Cost of Care

Mon, 22 Sep 2025 00:00:00 +0000

Background: Injury remains a leading cause of morbidity, mortality and disability adjusted life years across the world. Gender Based Violence (a subset of Interpersonal violence) with its various forms has negative impacts on physical heath, mental health, local and national economy and global sustainable development. Meru County, Kenya is among those counties with the leading cases of gender-based violence.

Objective: To evaluate the prevalence, injury characteristics, Cost of Care and facility preparedness for Gender Based Violence care in Meru County of Kenya.

Methods: This will be a multicentre mixed methods study across select level IV and V facilities in the study setting. Researcher-administered questionnaires will be utilized to extract data from level 4 and level 5 facilities in assessment of facility readiness and GBV prevalence. GBV prevalence assessed before and after introduction of a validated GBV screening tool.

Injury characteristics will be collected from patient files through a preformed questionnaire while the cost of injury will be evaluated and by assessing the patient medical bills and extrapolated through financial modelling.

Data analysis will be done through descriptive and inferential statistics and relevant statistical tests will be employed.

MIRERC 072/2025: Prevalence and Genotype Distribution of High-risk HPV Among Women in Ghana and Kenya

Mon, 22 Sep 2025 00:00:00 +0000

Abstract

Background: The burden of cervical cancer is highest in Africa. HPV infection is the major cause of cervical cancer. There are over 200 different HPV genotypes, with 15 considered (potential) high-risk genotypes for developing cancer. Due to lack of systematic screening programs in most African countries there is limited data available on which HPV-genotypes are most prevalent in the population.

Methods: We want to analyze a database of HPV-genotyping data from cervical samples submitted for diagnostic HPV-genotype testing. We have data available from HPV genotyping in Ghana (n = 1451) and Kenya (n = 46). The data will be analyzed to assess the prevalence of HPV infection in this database and to determine the distribution of high-risk HPV genotypes.

Expected outcome and implications: We expect that the outcomes from our analysis of the HPV genotyping data will contribute to a better understanding of HPV infection in African women. This will also help to inform decision making on HPV screening and HPV vaccination strategies.

MIRERC 076/2025: Assessment of Factors Influencing Outcome of Drug-Resistant Tuberculosis Treatment Among Patients Enrolled in Meru County, Kenya

Dr. Geoffrey Muthuri Koome , Dr. Patrick K. Kubai, Dr. Dorothy Kagendo Kithinji — Mon, 22 Sep 2025 00:00:00 +0000

Globally, the World Health Organization (WHO) reported that a total of 175, 923 cases of drug-resistant Tuberculosis were notified in 2023 with Africa, being among the regions that contribute to a substantial proportion of the cases globally. Kenya being among the 30 high burden countries with a huge burden of both drug-susceptible and drug-resistant Tuberculosis. Drug-resistant tuberculosis is a major cause of morbidity and mortality across population demographics. Although there has been availability of treatment which has saved millions of lives globally, drug-resistant tuberculosis treatment outcome remain sub-optimal globally. The World health organization reported that only 63 percent of drug-resistant tuberculosis cases enrolled in 2020 were successfully treated with 13 percent mortality and a loss to follow-up of 11 percent. In Kenya, only 67 percent of all cases enrolled in 2020 were cured against a national target of 90 percent. Meru County is among the counties in Kenya harboring a high burden of both drug-susceptible and drug-resistant Tuberculosis reported 348 cases of drug-resistant Tuberculosis between 2020 and 2023. Treatment outcomes remain sub-optimal with the county achieving an average of less than 90 percent treatment success rate, mortality rate of 4 percent and loss to follow-up of 6 percent among patients reported in the 2020 to 2023 cohort. Treatment for drug-resistant tuberculosis is complex and often requires intensive patient monitoring so as to achieve optimum treatment success. This study aims to assess the factors influencing the outcome of drug-resistant tuberculosis treatment among patients enrolled in Meru County, Kenya. Specifically, the study will assess the patient characteristics, the clinical factors and health service delivery factors influencing the outcome of drug-resistant Tuberculosis treatment. A retrospective cohort study design will be used to assess the variables of patient characteristics, healthcare service delivery factors and clinical factors and their influence on treatment outcomes. Data from records of patients enrolled in health facilities within Meru County between January 2020 and December 2023 will be analyzed. Study data will be collected by use of a structured data collection tool and analyzed using the Statistical Package for Social Sciences (SPSS) version 28.0. Descriptive and inferential statistics will be utilized to describe relationships between the independent and the dependent variables. Bivariate and multivariate analysis will be done by use of regression models and associations will be interpreted using Chi square test. Study data will be presented using tables, graphs and charts. The study results will be significant in informing policy and practices aimed at enhancing the quality of care offered to patients with drug-resistant Tuberculosis

MIRERC 077/2025: Assessing the Effectiveness of Social Health Authority Maternal Health Services on Maternal Health Care in Nyambene Sub-County Hospital

Monica Gakii Maina, Dr. Zachary Muriuki, Dr. Mary Amatu — Mon, 22 Sep 2025 00:00:00 +0000

Social Health Authority is a Kenyan state corporation established under the Social Health Insurance Act of 2023 to manage public health insurance including maternal health services. Despite progress in maternal health services in Kenya and Meru County, significant gaps persist in the utilization of maternal health services. These challenges are compounded by high maternal mortality rates, prevalent obstetric complications, and insufficient facility-specific research and documentation. This study assesses the effectiveness of SHA-funded maternal healthcare services at Nyambene Sub-County Hospital in Igembe South, a leading health facility in Meru County with a high volume of patients seeking maternal health services. It assesses maternal healthcare utilization, maternal morbidity and mortality, and beneficiary satisfaction. A cross-sectional study will involve randomly selected women who have benefited from SHA maternal health services. Data will be collected using pretested, structured questionnaires and a checklist to extract information from the DHIS, with assistance from health record officers. The data will be analyzed using SPSS to generate descriptive and inferential statistics. Ethical clearance will be secured from the Meru University Institutional Research Ethics Committee, NACOSTI and Meru County government, alongside informed consent from participants. The study’s results will offer evidence-based insights to refine maternal health initiatives, guide policy development, and improve service provision in Nyambene Sub County Hospital and comparable areas, supporting Kenya’s pursuit of universal health coverage and Sustainable Development Goal 3. 1.

MIRERC013/2025: Determinants of Health Outcomes of Traumatic Brain Injury Among Patients Attending Meru Teaching and Referral Hospital

Faith Kinya Mukindu — Thu, 03 Apr 2025 00:00:00 +0000

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.

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

Dennis Kithinji — Wed, 09 Apr 2025 00:00:00 +0000

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

Joseph Kathurima Muite — Wed, 09 Apr 2025 00:00:00 +0000

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

Nikita Muthuuri — Thu, 05 Jun 2025 00:00:00 +0000

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.

MIRERC007/2025: Exploring Childbirth Experiences Among Adolescents in Imenti South Sub-County

Jacqueline Gatabi Manene — Thu, 03 Apr 2025 00:00:00 +0000

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?

MIRERC 035/2025 FACTORS INFLUENCING HPV VACCINATION UPTAKE AMONG CAREGIVERS OF ADOLESCENT GIRLS IN THE PASTORALIST COMMUNITY OF GARBATULLA, ISIOLO COUNTY, KENYA.

SABLA GALGALO KUBI, Dr. MaryJoy Kaimuri, Dr. Jane Rutto — Mon, 23 Jun 2025 00:00:00 +0000

ABSTRACT

The prevalence of infection with high-risk human papilloma virus among Kenyans
and globally is rising and posing a public health concern. This has begun to reflect on
the steady increases in cervical cancer cases in the country. Currently, cervical cancer
is the second most common cancer among women in Kenya, after breast cancer. Two
major strategies to control the rise of HPV infections and cervical cancer is
vaccination and the regular screening of young women. The World Health
Organization has recommended the vaccination of all girls between the ages of 9-14
years before their coitarche. In 2019, Kenya launched national vaccination drive
targeting girls 10 years old and which was integrated into the routine immunization
schedule. However, coverage remain low across the country particularly among the
hard-to-reach populations such as the nomadic pastoralist communities.
This study aims to investigate the factors influencing HPV vaccination uptake among
age-eligible girls in the pastoralist community of Garbatulla, Isiolo County. The study
will employ a cross-sectional mixed-methods design on sample size of 347 caregivers
with adolescent girls aged 15-18 years. Quantitative data will be collected using
structured questionnaires administered by the research team while qualitative data will
be collected with aid of Focus Group Discussion guides and Key Informant Interview
guides. Pretesting will be conducted on 10% of the sample size in Sericho Ward.
SPSS version 27 will be utilized to facilitate the analysis. Descriptive statistics will be
presented using frequencies and percentages for categorical data and means and
medians for continuous data. chi-square test will be used to test associations between
categorical variables while and binary logistics regression analysis will be utilized to
investigate the predictor variables for vaccinate uptakes among the participant
adolescents while thematic content analysis will be used for qualitative data. Findings
will be presented using tables and charts. Ethical approval will be sought from Meru
University Ethical Review Committee.
Research approval will be sought from the Meru University Graduate School, while a
research permit will be sought from the National Commission for Science Technology
and Innovation (NACOSTI). Potential respondents will be enrolled to participate
based on their informed consent.

MIRERC 036/2025: DETERMINANTS OF SEVERE ACUTE MALNUTRTION AMONG CHILDREN AGED 6-59 MONTHS, MARSABIT COUNTY, KENYA.

BENEDICT LNGERIYON NATUWAKI, Dr Kubai P.K, Dr Kagendo Dorothy — Mon, 23 Jun 2025 00:00:00 +0000

ABSTRACT

Severe Acute Malnutrition (SAM) remains a significant global health issue, with 17 million
children affected, and Africa contributing to 46% of the related deaths. In Kenya, ASAL counties
like Marsabit have some of the highest rates of SAM. SAM is a life-threatening condition caused
by deficiencies in protein, calories, and essential micronutrients. The World Health Organization
(WHO) reports that 19 million children under five years old are affected globally, with over
400,000 deaths annually attributed to SAM.This study aims to investigate the risk factors
influencing severe acute malnutrition among children aged 6–59 months in Marsabit County.
Specifically, the study seeks to determine the socioeconomic factors contributing to SAM, assess
the role of maternal nutrition and health status in increasing the risk of SAM in infants and
young children, examine the influence of dietary practices on SAM, and investigate how
healthcare services and the utilization of preventive health measures impact the risk of SAM in
the region. A cross-sectional and case-control design will be employed with a sample size of 385
respondents, selected through simple random and purposive sampling methods. Data will be
collected using structured questionnaires, clinical record checklists, and Key Informant
Interviews (KIIs) with healthcare professionals. The data will be cleaned, coded, and analysed
using SPSS version 28. Descriptive statistics will summarize the demographic and health
characteristics, while inferential statistics, such as ordinary least squares regression, will be used
to assess the relationships between the identified risk factors and SAM at a 0.05 significance
level.

MIRERC 039/2025: POINT PREVALENCE SURVEY OF ANTIMICROBIAL USE AND HEALTHCARE-ASSOCIATED INFECTIONS THROUGH THE GLOBAL-PPS PROGRAM AT MERU TEACHING AND REFERRAL HOSPITAL

Dr. Mungania Joyster, Dr. Divina Onchari — Mon, 23 Jun 2025 00:00:00 +0000

Background: Antimicrobial resistance (AMR) is a growing public health crisis, especially in low-resource settings. High antimicrobial use is one of the
major drivers of AMR at the hospital level, exacerbated by healthcare-associated infections (HAIs) that lead to increased morbidity, mortality, and
healthcare costs. The Global-PPS program provides quantifiable measures to assess and compare the quantity and quality of antimicrobial prescribing,
prevalence of healthcare-associated infections (HAI), and resistance.
Objectives: This study aims to determine the prevalence and appropriateness of antimicrobial use, the prevalence of healthcare-associated infections,
and the identification of targets to inform antimicrobial stewardship interventions.
Methodology: A point prevalence study collecting data from patient records across all inpatient units at MeTRH. Antimicrobial use will be taken as any
patient on any antimicrobial agent at 8.00 am on the day of data collection. Other parameters such as missed antimicrobial doses, indications,
healthcare-associated infections, and use of susceptibility testing will also be assessed.
Data Analysis: Data will be analyzed through the Global-PPS program, which will provide a report on all parameters and units. The data will be
presented in proportions and figures.
Expected outcomes: The report from this study will provide baseline data to help the hospital’s antimicrobial stewardship committee identify targets for
antimicrobial stewardship and help change practice. Future iterations will allow comparison to assess the effectiveness of such interventions.

MIRERC 043/2025: PATTERNS, RISK FACTORS AND TREATMENT OUTCOMES OF DRUG-RESISTANT TUBERCULOSIS IN MERU COUNTY.

Dr. Divina Onchari, Dr. Joyster Mungania — Mon, 23 Jun 2025 00:00:00 +0000

Background: Tuberculosis (TB) infection is a significant global public health threat and one of the
leading causes of mortality from an infectious disease. The emergence of drug-resistant forms of
tuberculosis complicates efforts to control the disease, as these strains are more difficult to treat, leading
to prolonged illness, increased healthcare costs, and higher mortality rates. Different types of resistance
have been documented globally, but these and contributors to DR TB in Meru County are not well
established. This study aims to document resistance rates and factors that could contribute to resistance,
which can then be targeted for modification whenever feasible.
Objectives: To describe the resistance patterns to DR TB, determine risk factors associated with drug
resistance, and document subsequent treatment outcomes in patients with DR TB in Meru County.
Study site: All eleven sub-counties of Meru County.
Methodology: This retrospective study will collect data on patients with bacteriologically confirmed TB
from the TIBU platform from January 2021 to December 2024. Demographics, clinical characteristics,
and treatment outcomes will be summarized in frequencies and proportions. Factors associated with DR
TB will be determined through Pearson’s chi-square test at the bivariate level and subjected to multivariate
logistic regression to identify independent association. A P level of less than 0.05 will be considered
significant.
Expected outcomes: Understanding the risk factors contributing to drug-resistant TB can guide targeted
prevention efforts and inform public health strategies to mitigate these risks. Insights into treatment

outcomes, including success, failure, mortality, relapse rates, and adverse effects, will help refine existing
treatment protocols.

MIRERC 037/2025: UTILIZATION OF SELECTED MOBILE PHONE APPLICATIONS AMONG HEALTHCARE WORKERS TO COMBAT SELECTED NFECTIOUS DISEASES IN MERU COUNTY, KENYA

CHEMUTAI TANUI SHARON , DR. Patrick Kubai, PROF. Amos Omamo — Mon, 23 Jun 2025 00:00:00 +0000

ABSTRACT

Infectious diseases remain a significant public health challenge, contributing substantially to
morbidity and mortality worldwide, particularly in resource-limited settings. While
traditional public health interventions have played a crucial role, the integration of mobile
phone applications (mHealth) offers a promising avenue for enhancing disease control. This
study investigates the utilization of selected mobile phone applications among healthcare
workers in Meru County, Kenya, focusing on their role in combating specific infectious
diseases prevalent in the region. The primary aim is to comprehensively assess the impact of
these applications on various aspects of disease management. Specifically, this research
explores the effectiveness of mHealth applications in: delivering targeted health education
and awareness campaigns to the community; providing diagnostic support to healthcare
professionals; facilitating remote health monitoring of patients; and supporting health
research initiatives related to infectious diseases. Employing a convergent mixed methods
design, this study will integrate quantitative and qualitative data to provide a holistic
understanding of mHealth application utilization. Quantitative data will be collected through
structured questionnaires administered to a sample of 321 healthcare workers, determined
using proportionate simple random sampling within a purposively selected population of
healthcare facilities in Meru County. Qualitative data will be gathered through focused
group discussions (FGDs) with 7-11 participants per group, purposively selected to
represent diverse professional roles and experiences. Quantitative data will be analyzed
using Statistical Package for Social Science (SPSS) version 27.0, employing descriptive
statistics (frequencies and percentages) and logistic regression analysis at a 95% Confidence
Interval (CI). Statistical significance will be determined at a p-value of less than 0.05.
Findings will be presented through tables, charts, and cross-tabulations. Qualitative data will
be transcribed, coded, and thematically analyzed using NVivo software, with results
presented as coherent themes. This study anticipates revealing critical insights into the
current utilization patterns, perceived benefits, and challenges associated with mHealth
application use among healthcare workers in Meru County. The findings are expected to
contribute significantly to the development of evidence-based strategies for enhancing
healthcare delivery and disease prevention, particularly in the context of infectious diseases.

Furthermore, the results will inform the formulation of targeted policies and interventions
aimed at strengthening infectious disease control efforts, ultimately improving public health
outcomes in the region. By elucidating the role of mobile technology in healthcare, this
research will offer valuable guidance for scaling up effective mHealth interventions in
similar settings.

MIRERC 040/2025: A Two-Stream Deep Learning Approach for Freshness Classification in Beef

Martin Muthomi, Dr. Samson Munialo, Dr. Mary Mwadulo — Fri, 18 Jul 2025 00:00:00 +0000

Meat is an essential part of the human diet, providing necessary nutrients and protein(Cocking et
al., 2020). However, during storage the quality of beef can go down due to chemical spoilage
thereby posing danger to human health (Catherine et al., 2021). The freshness of meat plays a
crucial role in determining its taste, nutritional value and potential health risks hence quality
(freshness) and safety are of paramount importance(Osei Mensah et al., 2022). One way to assess
the freshness of meat is through inspection. Meat’s shelf life will vary depending on how it was
processed or how it is stored. There is need for strict inspection measures since consumption of
spoiled or adulterated beef has serious implications on consumers’ health. In Kenya, as meat
consumption is high, beef inspection becomes very essential for food safety and quality.
In Kenya, annual red meat production is estimated at 362,815 Metric Tonnes (MT) of which beef
constitutes about 286,000 MT(Aklilu et al., 2002). Although there are around 2500 export
slaughterhouses available, only about 500 meat inspectors have been certified thus leaving a
massive inspection capacity gap (KEPSA 2019) posing a challenge to meat inspection. Kenyan
law as provided for in Kenya Meat Control Act (Cap 356) prescribes that meat inspection should
be performed exclusively by veterinarians. The process of Meat Inspection is clearly outlined in
the Kenya Meat Control Act (Cap 356) (1972). A thorough journey, which begins a day before the
animal is killed and ends at the market where meat ends up, involves inspections at the export
slaughter house, ante mortem checks, detailed post mortems and life at the shelves.
All these processes are supposed to be done by qualified meat inspectors who unfortunately are in
short supply. It is this shortage of personnel that results into a situation where inspecting officers
find themselves overstretched and as a result, they tend to focus on inspections at the slaughter
houses and cannot effectively concentrate on ensuring freshness of meat stocked on shelves. This
condition strains already existing workers and calls into question the efficiency of meat inspection
protocols as well as consumer confidence in beef safety and quality.

MIRERC 047/2025: Clustering-Based Client Selection Technique for Federated Learning in Heterogeneous Environments

Anthony Njina, Prof. Makau Mutua, Dr. Mary Mwadulo — Fri, 04 Jul 2025 00:00:00 +0000

Federated Learning (FL) enables decentralized intelligence by allowing multiple clients to collaboratively train models while preserving data privacy. However, the diversity inherent in heterogeneous environments, ranging from varied data distributions and computational capabilities to fluctuating network conditions, proposes significant challenges to achieving efficient and accurate model convergence. This thesis proposes a clustering-based client selection technique aimed at addressing these challenges. The proposed framework groups clients based on key performance indicators and data characteristics, ensuring that only subsets of clients with similar profiles participate in each training round. The clustering mechanism optimizes the selection process by identifying groups where the aggregated local model updates are most beneficial to global convergence. This not only minimizes communication overhead by reducing redundant or misaligned updates but also mitigates the adverse effects of data and system heterogeneity. The technique dynamically adjusts to the evolving environment, re-clustering and reassigning clients as necessary to maintain optimal learning conditions throughout the training process. Simulation-based experiments and real-world data validations will be used to validate this framework. Evaluation metrics such as model accuracy, convergence speed, and communication cost will be used to benchmark the performance improvements over traditional client selection techniques.

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

Grace Eliud — Thu, 05 Jun 2025 00:00:00 +0000

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 049/2025: An Assessment of The Enabling Environment for Inclusive Urban Sanitation In Nakuru City; Policies, Institutions, Financing, and Service Delivery

Emmah Mwende, Dr Joy Nyawira Riungu,, Dr Kirimi Lilian Mukiri — Fri, 18 Jul 2025 00:00:00 +0000

Despite great progress in improving global sanitation, billions of people still lack access to safe sanitation. In 2022, only 17 countries were on track to achieve universal access by 2030, 84 countries were progressing too slowly and coverage in 24 countries was decreasing. This underscores the persistent challenge in achieving Sustainable Development goal 6.2, which is highlights the importance of safely managed sanitation. In Kenya, urban areas and cities like Nakuru City face critical gaps in sanitation infrastructure and enabling environments necessary for sustainable service delivery. Therefore, this research addresses these challenges by undertaking an assessment of the enabling environment for inclusive urban sanitation service delivery a case of Nakuru City The study is guided by four objectives which are to; examine the influence of the policy framework on inclusive urban sanitation service delivery in Nakuru City; assess the influence of institutional framework on inclusive urban sanitation service delivery in Nakuru City; describe the influence of financial models on inclusive urban sanitation service delivery in Nakuru City; assess the influence of service delivery approaches on inclusive urban sanitation service delivery in Nakuru City. A descriptive cross-sectional research design that proposes to integrate quantitative and qualitative methods of data collection and analysis will be adopted. The population is 110 participants consisting of county government staff, water utility staff, national agency and ministry staff, non-governmental organisations (NGOs), service providers, finance institutions, private sector actors, and community leaders. Out of which 86 respondents will be recruited into the sample using stratified random sampling method. Thereafter, non-probability methods including purposive and convenience techniques along with snowball sampling will be used to recruit the key informants. The inclusion of these diverse respondents is justified by their direct involvement in sanitation service delivery, policy-making, and implementation within Nakuru City. Data will be collected through questionnaires, document analysis, observation, and key informant interviews. Quantitative data from the questionnaire and structured observation checklist will be analyzed by the statistical package for the social sciences (SPSS) version 26 and this will consist of count and frequency distributions, mean, and standard deviation. Qualitative data from key informant interviews will be analysed by thematic analysis while content analysis will be done for observation and document data. Quantitative findings will be presented in tables, while qualitative data will be summarized narratively.

MIRERC 050/2025: ASSESSMENT OF THE RELATIONSHIP BETWEEN SANITATION PRACTICES AND QUALITY OF DRINKING WATER IN RURAL HOUSEHOLDS OF KAJIADO WEST SUB-COUNTY, KENYA

BERNADETT NJOROGE, Dr. Cynthia Mugo, Dr. Vitalis Too — Mon, 23 Jun 2025 00:00:00 +0000

The current research seeks to assess the influence of sanitation practices on bacteriological water quality for drinking in rural households in Kajiado West Sub-County, Kenya. Kajiado County is marked by its semi-arid nature and low levels of improved sanitation, with primary issues of waterborne diseases like diarrhea, typhoid, and cholera, which are likely to be blamed on poor sanitation and contaminated drinking water. The general objective of the study is to analyze how sanitation practices, more precisely waste disposal, handwashing, and water storage vessel handling, influence drinking water quality in this region. Specifically, the research will analyze both bacteriological and physical indicators of water quality, including total coliform levels, E. coli, turbidity and pH, at the point of collection and in household storage containers. The research will utilize a cross-sectional survey design, and the sample size will be 100 households, which will be chosen randomly throughout Kajiado West Sub-County. Data will be collected through structured household surveys. Sampled water will be sent to the lab for microbiological analysis. Statistical analyses will be conducted using R software, to identify significant differences in water quality parameters based on sanitation practices. The research is expected to yield critical insights into the impact of sanitation practices on drinking water quality and provide evidence-based recommendations for improving water safety and public health interventions in rural communities. Findings from this study will contribute to the achievement of the Sustainable Development Goal (SDG) 6, aiming to ensure access to clean water and sanitation for all, particularly in rural and marginalized areas of Kenya.

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

Antony Mutwiri, Kevin Arcenaux, Caleb Gichuhi — Thu, 05 Jun 2025 00:00:00 +0000

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 030/2025 Adaptive Concept Drift Detection Technique for Glucose Monitoring in Diabetic Patients.

David Mwangi, Dr. Amos Chege, Dr. Mary Mwadulo — Mon, 23 Jun 2025 00:00:00 +0000

Effective diabetes management depends on accurate glucose monitoring. However, this process is complicated by the dynamic nature of glucose levels, which fluctuate due to factors such as diet, medication, and individual metabolic responses. These fluctuations contribute to concept drift, a phenomenon in which the relationship between input variables—such as glucose levels, dietary habits, and medication—and outcomes like blood sugar control and complications evolve. As a patient’s condition, lifestyle, or treatment response changes, historical data becomes less reliable for predicting future trends. Consequently, failing to account for these shifts can lead to inaccurate insulin dosage recommendations or misclassification of risks, underscoring the need for continuous monitoring and adaptive predictive models. Several existing techniques are employed for glucose
monitoring and drift detection, yet each has notable limitations. Threshold- based methods rely on fixed glucose level thresholds to detect abnormalities. While simple and widely used, these methods struggle to adapt to gradual changes and individual patient variations. Statistical Process Control (SPC) techniques, such as Shewhart charts and CUSUM (Cumulative Sum), excel at detecting abrupt fluctuations but are less effective in identifying slow, evolving trends. Machine learning models, increasingly used for glucose prediction, often assume that past patterns remain valid, making them susceptible to accuracy degradation as concept drift occurs. Similarly,moving average techniques help smooth glucose variations but fail to actively detect shifts in the underlying data distribution, leading to delayed responses to critical changes. To address these challenges, this research introduces a novel adaptive concept drift detection technique tailored for glucose monitoring in diabetic patients. By building upon advanced principles from existing methods such as ADWIN (Adaptive Windowing) and the Drift Detection Method (DDM), this study aims to develop an innovative approach specifically designed to detect subtle shifts in glucose patterns. This study employs a quasi-experimental design using existing CGM datasets to develop an adaptive concept drift detection technique. Purposive sampling selects datasets with drift patterns, and machine learning algorithms are applied for data preprocessing, noise reduction, and drift detection. Data analysis involves statistical and performance evaluation metrics, including accuracy, precision, recall, and F1-score, to compare the developed technique with existing methods. The findings aim to enhance glucose monitoring by
improving drift detection and adaptation accuracy.

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

Antony Mutwiri, Dr. Sakshi Ghai — Thu, 05 Jun 2025 00:00:00 +0000

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 051/2025: PRODUCT DESIGN

Rahab Kariuki, Raya Shatry, Jackline Chemtai, Antony Mutwiri — Fri, 18 Jul 2025 00:00:00 +0000

Executive Summary
In times of crises, particularly during climate-caused risks, women in Africa grapple
with heightened vulnerabilities, due to their limited control over assets and
decision-making, even as they bear the critical responsibility for household sustenance
amid declining agricultural productivity. To address these challenges, savings and
loaning groups present a valuable opportunity to serve as a platform for building
resilience to such shocks. By enhancing financial literacy and encouraging the use of
insurance products, these groups can help protect members against emergencies and
improve overall risk management within their communities.
However, there is a concerning decline in the use of insurance products in Kenya, as
evidenced by a drop in National Health Insurance Fund (NHIF) participation even before
the transition to the Social Health Agency (SHA). The lack of effective insurance within
these groups leaves members exposed to emergencies and a cycle of debt.
In a previous study conducted by Busara, we find that women in savings groups do not
have an insurance mechanism to protect them from financial shocks during risk.
Furthermore, the nature of savings groups’ risk management mechanism is largely
centered around ad-hoc payments for members during financial crises - similar to a
harambee. Due to the suddenness of shocks, many members are left grappling for
finances to contribute - leaving them in vulnerable financial situations such as added
debt. Planned to act as a method of financial empowerment, village savings groups in
cases of risk management may cause more financial strain on members.
Busara, along with Mercycorps Agrifin and AB Entheos proposed a mutual - a form of
self insurance for the members of savings groups to ensure that risks are covered in a
systematic manner that does not leave members open to financial vulnerabilities. Our
study found that the majority of members are open to an insurance mutual with
conditions that they are involved in the co-creation of it as well as in the cover designs.
This study aims to understand how members would like to structure an insurance
mutual, what covers would be beneficial to them and what their major concerns would
be in the establishment of such a mutual.

MIRERC 052/2025: Beyond Demographics

Rahab Kariuki, Edel Koki, Mercy Kiptai, Ruth Wambua, Antony Mutwiri — Fri, 18 Jul 2025 00:00:00 +0000

Executive summary
Despite growing access to insurance in low- and middle-income countries, a significant portion
of the population remains uninsured, even when affordable products are available. Traditional
targeting approaches based on demographic, occupational, or income-related indicators have
proven insufficient in explaining or predicting insurance uptake. These methods often fail to
account for the behavioral and psychological processes individuals navigate when making
decisions about whether to insure against future risk.
This proposal outlines a study that takes a behavioral approach to understanding insurance
uptake. It focuses on how individuals perceive risk, plan for uncertainty, and allocate financial
and social resources when facing potential loss. The study hypothesizes that insurance decisions
are deeply shaped by behavioral traits such as risk aversion, trust, locus of control, and emotional
responses to past shocks rather than just economic ability or demographic profile.
The study will use a lab-in-field experiment, in which 400 participants from diverse urban,
peri-urban, and rural settings in Kenya will engage in a simulated insurance decision-making
game followed by a psychometric survey. Participants will face a series of structured choices
involving real monetary stakes to reveal their willingness to transfer risk under different
conditions. These game-based decisions will be combined with survey data to identify behavioral
segments that share similar attitudes and patterns. Once we conduct the lab experiment, we will
carry out a follow-up qualitative study which will help us describe the segments.
The aim is to move beyond conventional segmentation and instead identify individuals who are
behaviorally “insurance ready.” The findings will generate actionable insights into the behavioral
drivers of insurance uptake and enable more effective design, targeting, and delivery of insurance
products and outreach strategies especially among underserved or mischaracterized groups.

MIRERC 059/2025: Tackling Psychological Barriers to Job Search and Employment in Kenya

Tue, 22 Jul 2025 00:00:00 +0000

Executive Summary
Young jobseekers in developing countries often struggle to get on the career ladder. One reason could be that finding and then keeping a new job is psychologically challenging. The stress of rejection and uncertainty may discourage jobseekers from applying ‘enough’, and anxiety about work may affect performance in interviews or when starting work. Yet the economic benefits of.
psychological interventions to help jobseekers cope with work- and job search-related anxiety have been little studied in developing countries.

In Nairobi, Kenya we first aim to evaluate, in a randomized controlled trial (RCT), whether a psychological intervention, aimed at reducing fear of rejection and work-related anxiety, can improve job-finding rates, particularly for those who start less resilient to job-search stress.

Second, we propose to study how the same psychological intervention affects downstream labour market outcomes- in particular, on-the-job performance. We will measure the productivity (performance) of some job seekers in simple tasks that they will do in our study office. Participants will be invited to our lab to complete 6-weeks of work, primarily revolving around data entry and a customer service training task with virtual customers. They will have additional opportunities to work in teams, present what they have learnt, and negotiate terms of pay. We will measure how they perform in each of these set-ups.

Third, we will also measure how our intervention affects performance on a mock job-application, where we will collect participant CV , Cover Letter, and have them complete skill-assessments commonly used by employers. Participants will also complete a mock video interview. We will measure job application “performance” based on how a set of Kenya-based recruiters perceive participants’ application materials.

Collectively, our study of the effects of these interventions will seek to evaluate the effect of alleviating psychological constraints, stemming from depression, anxiety and stress, at three distinct stages of an individual’s labour market activity (job search, individual work performance and work-in-teams). Our results will provide us with a rich picture of how labour markets can be used as a tool for poverty alleviation amongst those vulnerable.

MIRERC 065/2025; Field Market Experiment

Tue, 12 Aug 2025 00:00:00 +0000

Executive Summary
This research proposal supports the broader objectives of evidence-based rural development and innovative agricultural sales strategies in sub-Saharan Africa. Despite increasing efforts to reach smallholder farmers with high-quality agricultural products, a lack of rigorous evidence on effective sales approaches continues to hinder the scale-up and optimization of last-mile distribution models. In particular, questions remain about the added value of deploying trained sales agents versus lower-cost enumerators in driving product uptake.

This experimental study aims to generate practical, actionable insights on farmer purchasing behavior in response to different seller types and sales incentives. Conducted within a controlled yet realistic simulated marketplace, the experiment will compare the sales effectiveness of trained agents and enumerators, and assess which offer structures—such as discounts, savings plans, or bundled services—are most effective in promoting product uptake among rural farmers.

The research places strong emphasis on real-world applicability, using genuine financial transactions and locally relevant products to simulate market dynamics. Additionally, the study incorporates farmer profiling and discrete behavioral observation to understand both demand-side drivers and the influence of agent interaction quality on purchasing decisions.

By rigorously testing these elements, the study will contribute valuable insights for implementing organizations, funders, and agricultural input providers looking to optimize rural sales strategies, improve farmer outreach, and enhance the cost-effectiveness of agent deployment models.

MIRERC 069/2025: Marginal Costs, Usage Decisions, And Electric Cooking Adoption study in Nakuru County

Susanna Berkouwer, Joshua Dean, Suleiman Amanela , Antony Mutwiri — Tue, 12 Aug 2025 00:00:00 +0000

EXECUTIVE SUMMARY

This research proposal aims to advance clean energy access and reduce carbon emissions by improving household technology adoption in Kenya. In collaboration with BURN (a cookstove manufacturer), Busara (a local research organization), and nLine (a grid watch startup), the study will evaluate the adoption and usage of electric cookstoves among up to 3,000 individuals in Kenya. Although modern cooking technologies are available, many households continue to rely on polluting fuels such as charcoal and firewood due to high upfront costs, unreliable electricity, and limited access to subsidies.

The study seeks to generate evidence on the factors influencing electric cookstove adoption. Its primary objectives are to estimate household energy expenditures and CO2 emissions, examine the determinants of stove choice, and assess demand for clean cooking solutions under varying stove payment discounts and electricity subsidy levels. The study will also include a decision-aid randomization to evaluate whether suggested calculations or prompts influence participants' ability to estimate stove usage costs. This research will aim to produce actionable insights for policymakers, energy providers, and funders working to promote energy equity, reduce environmental harm, and support the scale-up of clean cooking technologies.

MIRERC 071/2025: Integrated Investment for Vulnerable Children in Kenya

Tue, 12 Aug 2025 00:00:00 +0000

Executive summary

SHOFCO, with support from CIFF, is implementing the Integrated Investment for Vulnerable Children (IIVC) program across 15 urban counties in Kenya to tackle school dropout, gender-based violence (GBV), and inadequate sanitation among girls in informal settlements. To support this, Busara is leading a baseline evaluation in three counties to refine the program’s Monitoring, Evaluation, and Learning (MEL) framework and generate context-specific insights on education, gender, and WASH at the baseline level. The study comprises three phases: updating the MEL framework through workshops and reviews, conducting 72 in-depth interviews across Nairobi, Kilifi, and Kisumu, and analyzing the f indings to inform program design and learning. The evaluation focuses on understanding girls’ lived experiences, establishing baseline indicators, and enhancing SHOFCO’s ability to measure impact over time. Key activities include the development of qualitative tools, training, fieldwork, and reporting. The total estimated budget is $69,500, covering staff time, f ield logistics, transcription, and IRB fees. This evaluation will ensure that IIVC is grounded in evidence and aligned with the realities of the communities it serves.

MIRERC 078/2025: Political Participation Among Youth in Kenya

Dr. Scovia Aweko, Antony Mutwiri — Mon, 22 Sep 2025 00:00:00 +0000

Executive summary

Over the past two decades, leaderless protest movements have gained prominence, effectively mobilizing large numbers of young people across demographic and geographic divides. Commonly referred to as #hashtag protests, these movements are organized primarily through social media and unified by short, memorable hashtags that convey collective grievances and demands. Despite their decentralized nature, they have been met with widespread state repression, ranging from police beatings, arrests, and abductions to the use of live ammunition. The #EndSARS protests in Nigeria illustrate this clearly, as peaceful demonstration against police brutality ended with the army opening fire on protesters at the Lekki Toll Gate following a government-imposed curfew.

While existing scholarship has focused largely on mobilization through formal, hierarchical organizations, less attention has been given to how leaderless movements organize for collective action. This study addresses that gap by examining how mobilizers within hashtag protests interpret pivotal protest events and leverage those meanings to sustain participation. Building on social movement theory and drawing from literature on critical junctures, the research explores the strategies that enable decentralized protests to maintain momentum, shape narratives, and advance collective action despite repression.

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

Antony Mutwiri, Dr Mareike Schomerus — Thu, 05 Jun 2025 00:00:00 +0000

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

Antony Mutwiri, Diag Davenport — Thu, 05 Jun 2025 00:00:00 +0000

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.

MIRERC 042/2025: Women, Peace and Security Agenda and Male Allyship

Alex Maxwell, Antony Mutwiri, Susanna Campbell — Mon, 23 Jun 2025 00:00:00 +0000

Executive Summary
The WPS is an agenda that was initially underpinned by transformative feminist goals for
gender equality. These underpinnings are being challenged by a shift in Global North politics
where increased conservative, far-right populist and authoritarian governments, largely
linked to an anti-gender agenda are exploiting the mobilising potential of misogyny. The
shifting politics is resulting in increased military spending and a militant rhetoric in a project
of ‘masculine restoration’ (Kandiyoti, 2019). In addition, shrinking civic spaces, Sweden’s
shift from feminist foreign policy to ‘ traditional Swedish values’ (an important development
actor signifying backsliding on gender equality focus), and a global decline in peacebuilding
funding are significantly limiting progress made on gender equality. The WPS however
continues to be mainstreamed by donors to tackle gender inequality despite the increasingly
regressive everyday politics in multilateral/donor spaces.
In view of the challenges outlined, this project seeks to investigate differences in how men
and women promote WPS and gender equality, better understanding how the agenda is
translated through the prism of male allyship. The research broadly asks: How do male allies
make meaning of their promotion of women’s rights, through the WPS for example, in a
context of increasing retrenchment of these rights? Taking an interpretive approach, the
research will analyse how the WPS is interpreted by male advocates and community
members in an urban settlement in Nairobi, Kenya. The research more broadly navigates the
contradictions between delivering WPS goals while operating in a context where there is a
backsliding on women’s rights and a more general retrenchment on gender equality in the
West.

MIRERC 045/2025: Examining How Users Navigate, Select, and Understand Insurance Options: Addressing Information Gaps

Mon, 23 Jun 2025 00:00:00 +0000

3.0 Executive Summary
There is a growing need to enhance public understanding of insurance to increase adoption, improve
financial literacy, and empower individuals to make informed decisions. However, two major
challenges hinder progress:
1. Stakeholders often lack clear insights into the actual knowledge gaps, misconceptions, and
barriers—such as mistrust, complexity, or misinformation—that prevent people from
engaging effectively with insurance products.
2. Educational efforts and materials are rarely tested for their impact on understanding and
behavior change.
This study explores these issues through the lens of Social Health Insurance (SHA) in Kenya, focusing
on how users discover, choose, and interpret insurance options. By examining experiences across
urban, peri-urban, and rural contexts, the research will uncover critical gaps and obstacles in user
understanding.
The insights will go beyond health, offering practical recommendations for insurance design and
education in other sectors like agriculture and education. Using a mixed-methods
approach—combining in-depth interviews, quantitative analysis, and eye-tracking —the study aims to
shape evidence-based, user-centered interventions that improve insurance literacy and empower
better decision-making.

MIRERC 054/2025: Understanding the Impact of Gender, Household Responsibilities and Spousal Involvement on Women’s Decisions to Purchase Insurance

Rahab Kariuki, Antony Mutwiri, Jaspreet Singh, Raya Shatry, Cecile Juma — Mon, 23 Jun 2025 00:00:00 +0000

Executive summary
This study seeks to explore the factors influencing insurance uptake in Kenya, with a specific focus on
how gender, spousal dynamics and household responsibilities shape access to and engagement with
insurance products. Despite the critical role of insurance in building financial resilience, particularly
among vulnerable populations, uptake remains low across much of the country—especially in
low-income, rural, and informal-sector settings.
Women are disproportionately affected by low insurance coverage, often due to economic
constraints, limited financial literacy, lack of tailored products, and cultural norms that shape
decision-making power within households. These challenges are compounded by irregular income
streams and mistrust in financial institutions, which further restrict access to formal financial safety
nets. While innovations such as mobile-based microinsurance and public initiatives like the National
Hospital Insurance Fund (NHIF) have improved access, significant gaps persist—particularly for
women and those with caregiving responsibilities.

This study aims to explore how women make financial decisions at the household level and how
these decisions influence insurance uptake. Specifically, it will examine the impact of household
needs, spousal involvement, and gender dynamics on women’s willingness and ability to purchase
insurance.
The proposed research will be carried out in three counties—Mombasa, Isiolo, and Homa Bay—and
will employ a two-phase design. The first phase consists of a mixed-method household survey aimed
at understanding how women plan financially, prioritize spending, and perceive risk. The second
phase will involve a lab in the field experiment where participants will engage in budget allocation
exercises and insurance product simulations. These activities will help identify how household
responsibilities, spousal involvement, and behavioral factors influence insurance decisions.
Participants will be categorized by gender, marital status, and caregiving responsibilities to allow for
nuanced comparisons. By simulating real-life financial trade-offs and introducing relevant insurance
products under different framings (e.g., child-focused, health-focused), the study aims to test what
product features and messaging strategies most effectively drive uptake—particularly among
women.
Findings from this study will provide critical insights into the behavioral, social, and economic barriers
to insurance adoption in Kenya. The results will inform product design, policy recommendations, and
outreach strategies that support more inclusive financial protection—ultimately contributing to
Kenya’s goals of financial inclusion, gender equity, and improved household resilience.
Proposed activities include research design where we will be designing data collection instruments,training of field
officers,recruitment,data collection(household surveys and lab in the field experiment) analysis and report writing.

MIRERC 075/2025: INFLUENCE OF WATER, SANITATION, AND HYGIENE PRACTICES ON DIARRHOEAL DISEASES IN CHILDREN UNDER FIVE YEARS OF AGE IN WESTLANDS SUB-COUNTY, NAIROBI COUNTY, KENYA

Margaret sunguti — Mon, 22 Sep 2025 00:00:00 +0000

The health and well-being of under-five children are significantly influenced by water, sanitation, and hygiene (WASH) practices. According to the United Nations (2015), Sustainable Development Goals (SDGs) 6.1 and 6.2 aim to ensure universal access to safe drinking water and adequate sanitation by 2030. In its global Strategy for WASH (2016-2030), UNICEF recognizes the scale of the challenge facing the world if it is to succeed in achieving this vision and singles out urban WASH as one of the priority areas for increased engagement, to reach the most vulnerable, wherever they are. Diarrhoeal diseases, a leading cause of morbidity and mortality in this age group, are closely associated with inadequate WASH practices.The study aims to investigate the influence of Water, Sanitation, and Hygiene Practices on diarrhoeal diseases in children under five years of age. A cross-sectional descriptive study design will be employed utilizing a convergent mixed-methods approach. Quantitative data will be collected through structured questionnaires and observational checklists, while qualitative data will be gathered using key informant interviews and focus group discussions. The target population for this study will consist of caregivers of under five children residing in Westlands Sub-County, Nairobi County with a sample size of 375 households. The study will employ a cluster sampling technique. Quantitative data will be analyzed using statistical tools to identify patterns and relationships, whereas qualitative data will be subjected to thematic analysis to provide contextual insights. The study will contribute to the achievement of Sustainable Development Goals (SDGs), particularly SDG 3 (Good Health and Well-being) and SDG 6 (Clean Water and Sanitation). By improving WASH practices, it will also indirectly support SDG 1 (No Poverty) and SDG 4 (Quality Education) by minimizing economic strain and educational disruptions caused by preventable illnesses. Furthermore, the study will provide scientific value by filling existing knowledge gaps and laying the groundwork for future research in the field. Approval by the Institutional Research and Ethics Committee of Meru University, and informed consent from all study participants will be sought.

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

Antony Mutwiri, Rahab Kariuki — Thu, 05 Jun 2025 00:00:00 +0000

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.

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

Tabitha Nekesa Khamala — Thu, 03 Apr 2025 00:00:00 +0000

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.