BackgroundCOVID-19 is an international global health emergency and has posed a great challenge to mental well-being and resilience. Little is known about the mental health impact of COVID-19 among healthcare workers (HCWs) in sub-Saharan Africa or other low-resource settings.MethodsWe conducted a cross-sectional study between August and November 2020 among HCWs recruited from three major hospitals in Kenya. The survey questionnaire consisted of six components: demographic and work title characteristics; information regarding care of patients with COVID-19; and symptoms of depression, anxiety, insomnia, distress and burnout, measured using standardised questionnaires. Multivariable logistic regression analysis was performed to identify factors associated with mental health disorders.ResultsA total of 433 (65.2% response rate) individuals participated in the survey. Median age was 32.75 years, 58.4% were females and 68.8% were front-line workers. Depression, anxiety, insomnia, distress and burnout were reported in 53.6%, 44.3%, 41.1%, 31.0% and 45.8% of all participants, respectively. Front-line HCWs, females and doctors were at higher risk of mental health symptoms. Nearly half of participants reported inadequate resources or training to care for patients with COVID-19, and those in the government hospital were more likely to report mental health symptoms.ConclusionsThis is among the first studies examining mental health outcomes among HCWs during the COVID-19 pandemic in Kenya. Similar to other studies from around the world, HCWs directly involved with patients with COVID-19 reported higher rates of mental health symptoms. Mitigating strategies specific to Kenyan HCWs are urgently needed to help them cope with mental health symptoms during the pandemic.

Background: Vaccine hesitancy, as defined by the WHO, is the reluctance or refusal to vaccinate despite the availability of vaccines and is one of the ten threats to global health in 2019. Vaccine hesitancy remains a complex matter influenced by multiple factors, especially in sub-Saharan Africa. Methods: We conducted a cross-sectional study between November 2021 and January 2022 among the general adult public seeking care at six different healthcare facilities in Kenya. The survey, in English, consisted of questions based on demographics, knowledge, and attitudes, including hesitancy towards the COVID-19 vaccine. Results: Of the 3996 surveys collected, 55.1% were from private, 19.5% from faith-based and 25.3% from government facilities., Approximately 81.0% of all the participants reported it was important to get a vaccine to protect other people from COVID-19, 79.9% reported they would take a vaccine to protect against COVID-19, yet 40.5% reported being hesitant to take the vaccine primarily due to side effects. Most of the variables were associated with receiving a vaccine. Only 52.1% of those seeking care from the government facility and 54.5% of those seeking care from the faith-based facility were vaccinated, compared to 81.5% seeking care from the private facilities (p < 0.001). More participants from private facilities felt that vaccines are safe as compared to those at the faith-based and government facilities (p < 0.001). Conclusion: Vaccine hesitancy in Kenya, even though much lower than reported in other countries, remains a dynamic problem. Mitigating strategies specific to Africa need to be developed to help address vaccine hesitancy in this part of the continent.

Background: Pulmonary hypertension is poorly studied in Africa. The long-term survival rates and prognostic factors associated with mortality in patients with moderate to severe pulmonary hypertension (PH) in Africa are not well described. Objectives:To determine the causes of moderate to severe PH in patients seen in contemporary hospital settings, determine the patients' one-year survival and the factors associated with mortality following standard care. Methods: A retrospective review of patients diagnosed with moderate to severe PH at Aga Khan University Hospital (AKUHN) from August 2014 to July 2017 was carried out. Clinical and outcome data were collected from medical records and the hospital mortality database. Telephone interviews were conducted for patients who died outside the hospital. Survival analysis was done using Kaplan-Meier, and log-rank tests were used to assess differences between subgroups. Cox regression modelling with multivariable adjustment was used to identify factors associated with all-cause mortality. Results: A total of 659 patients with moderate to severe PH were enrolled. Median follow-up time was 626 days. The survival rates of the patients at 1 and 2 years were 73.8% and 65.9%, respectively. The following variables were significantly associated with mortality: diabetes mellitus [adjusted HR 1.52, 95% CI (1.14-2.01)], WHO functional class III/IV [adjusted HR 3.49, 95% CI (2.46-4.95)], atrial fibrillation [adjusted HR 1.53, 95% CI (1.08-2.17)], severe PH [adjusted HR 1.72, 95% CI (1.30-2.27)], right ventricular dysfunction [adjusted HR 2.42, 95% CI (1.76-3.32)] and left ventricular dysfunction [adjusted HR 1.91, 95% CI (1.36-2.69)].Obesity [adjusted HR 0.68, 95% CI (0.50-0.93)] was associated with improved survival. Conclusion: Pulmonary hypertension is associated with poor long-term outcomes in African patients. Identification of prognostic factors associated with high-risk patients will assist in patient management and potentially improved outcomes.