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Amref Institutional Repository
Welcome to the Amref Institutional Repository (IR) — a digital platform dedicated to collecting, preserving, and sharing Amref’s rich body of knowledge and research outputs. The Repository serves as a vital tool for safeguarding the organization’s intellectual legacy, ensuring long-term digital preservation, and promoting open access to scholarly communication across the public health and development community.
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Reconfiguring retention: a qualitative exploration of the lived experiences of female nurses in an arid rural setting in Turkana County, Kenya
(Glob Health Action, 2026-05-21) Sif Sofie Vange; Micah Matiang'i; Mathilde Vraa-Jensen
Background: Retention is especially critical in rural and underserved areas of East Africa, such as Turkana County in Kenya, where resource limitations, harsh conditions, and a lack of professional development opportunities deter nurses from staying. In addition, female nurses face unique challenges shaped by systemic inequities and gendered expectations, influencing their retention.
Objective: The aim of this study was to explore factors influencing retention of female nurses in Turkana and to offer new perspectives on the concept of retention from underserved regions in East Africa.
Methods: This quasi-ethnographic study was conducted in an arid rural setting in Turkana, in 2024. Data were collected through semi-structured interviews with 21 female nurses and 8 local health administrators and through participant observations at 4 health facilities. We used thematic network analysis guided by an abductive approach.
Results: Female nurses in Turkana navigate a paradox of staff shortages alongside high unemployment, leaving many feeling stuck in occupational limbo or permanent liminality, hoping, and working toward better opportunities for themselves and their families. Although the motivation to work as nurses persists, challenging working conditions lead many to aspire to migrate abroad.
Conclusion: This study demonstrates the complex interplay of local and global dynamics driving retention of female nurses in Turkana. Perceived workforce stability is largely due to immobility caused by limited alternatives and systemic constraints. This immobility masks dissatisfaction, making the healthcare system in Turkana vulnerable to outmigration. Findings highlight the need for holistic, gender-sensitive policies that enhance rural career pathways for female nurses.
Feasibility of mainstreaming schistosomiasis and soil transmitted helminthiasis mass drug administration into primary healthcare: a baseline survey for a community case study in Western Kenya
(BMC Health Services Research, 2026-05-16) Josphat Martin Muchangi; Meshack Ndirangu; Gilbert Wangalwa; Yvonne Opanga
Background: Mass drug administration campaigns have enabled great progress in the prevention and control of schistosomiasis and soil transmitted helminthiasis. However, the persistence of these infections continues to challenge public health systems despite decades of control efforts. This study was commissioned to evaluate the feasibility of a transition from periodic mass drug administration campaigns to a sustainable, facility- and community-based delivery model in Western Kenya.
Methods: The study is part of a non-randomized, controlled before-and-after study using a mixed-methods approach. Data were collected from 1,229 households, 24 health facilities (12 control, 12 intervention), focus group discussions, and key informant interviews. The analysis focused on six domains of mainstreaming feasibility: perception of mainstreaming among key stakeholders, processes, infrastructure and system readiness, acceptability and trust for primary healthcare-led treatment, facilitators, and barriers. Finally, we calculated a composite readiness index to grade facility readiness.
Results: Generally, community perceptions to schistosomiasis and soil-transmitted helminthiasis treatment benefits were found to be high in both the control and intervention groups. Qualitative data showed enhanced trust in the integrated model by virtue of the credibility and professional nature of health facility staff. An overwhelming majority of community members received treatment through household visits (95.5%) implying reliance on periodic MDA at baseline. Community Health Promoters remain a critical source of information on treatment opportunities for low-literacy populations, while media and health facilities are increasingly important among more educated groups. We also found high infrastructural and systemic readiness for treatment mainstreaming with respect to stock availability and data reporting systems. However, stock outs were reported among the facilities. High variability in health worker training coverage suggests a critical challenge in workforce preparedness.
Conclusion: The findings point to a strong foundation for mainstreaming but underscore the need for a structured implementation package. Priority actions should include standardized operating procedures, supply chain and digital system strengthening, and expanded Community Health Promoter-led outreach activities to improve consistency, access, and sustainability of deworming services within primary healthcare platforms.
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(AMREF International University Library, 2026-05) Musembi , Emily