Student thesis: Doctoral ThesisDoctor of Philosophy


This thesis explores the role of leadership in understanding the recurrence of malnutrition amongst women living with HIV/AIDS (WLWHA) who have been treated through nutrition-based interventions in Kakamega and Homa Bay counties in Kenya. The thesis examines why despite nutrition-based interventions being given to People Living with HIV/AIDS (PLWHA) women continue to be malnourished and to suffer relapse once a nutrition intervention programme stops. The thesis establishes that despite an existing human rights policy that emphasizes food security, access to food was not guaranteed to WLWHA due to structural factors. It explores the role leadership plays in mitigating or sustaining this relapse, and how a different leadership perspective might enhance the effectiveness of nutrition-based interventions to curb malnutrition. By analysing the lived experiences of WLWHA, the thesis documents different leadership relationships that shape the outcomes of nutrition-based intervention, using a process-based leadership analytical framework. This is a mixed methods research design. The study was conducted in two phases: Researcher-administered questionnaires were used during the survey conducted in 18 primary health facilities and hospitals chosen at random in Kakamega and Homa Bay Counties specifically Mumias and Ndhiwa sub-counties followed by key informant/elite interviews with policy decision makers relevant to the issues revealed in the survey. The study sampled 270 women living with HIV/AIDS, 18 county officials and 43 health professionals. Survey data was analysed using the statistical package for social sciences (SPSS) statistics software version 26. Qualitative data was analysed using N-vivo 12. The findings show that more than 60% of the patients received the therapeutic foods in both counties indicating that they had experienced malnutrition during their treatment due to being food insecure and had been enrolled on a food programme. 176 out of 270 women were identified as malnourished during their treatment. They were given nutrition-based interventions for periods ranging from 1 week to 1 year with improvement recorded. However, 148 (84.09%) of the 176 women in both counties who received the nutrition-based interventions relapsed and had to be given nutrition-based interventions once or several more times. This thesis sheds light on how the relationships between WLWHA and those leading the response to the needs of people living with HIV/AIDS shaped the treatment outcomes for the women in this study.
Date of Award1 Feb 2023
Original languageEnglish
Awarding Institution
  • King's College London
SupervisorFunmi Olonisakin (Supervisor) & Ekaette Ikpe (Supervisor)

Cite this