Mortality of sick children after outpatient treatment at first-level health facilities in rural western Kenya

Background: Early Infant Male Circumcision (EIMC) is part of sustainable HIV prevention strategies in Kenya. The goals of the national EIMC program are to circumcise at least 40% of all newborn male infants delivered at hospitals offering the service and keep the rate of moderate and adverse events below 2%. Objectives: To determine the proportion of early male infants (age less than 60 days) born at hospitals in four counties of western Kenya who got circumcised and document the prevalence of adverse events (AEs) among those circumcised. Methods: A retrospective descriptive study involving all records for EIMC from 1st March 2014 through 31st March 2018 in four counties of western Kenya. Data analysis was done using EXEL to document proportion of facilities offering EIMC and compare EIMC uptake and outcomes in the four counties against the national goals for the program. Results: A mean of 4.3% of total health facilities offer EIMC in the region. Siaya had the highest proportion of facilities offering EIMC while Migori had the lowest proportion. Uptake of EIMC was low at 17.4% for all male infants born, far less than the anticipated target of 40%. Average adverse event rates were 0.3%. Conclusion: EIMC uptake remains low in this region of Kenya due to small number of health facilities offering the service. The proportion of circumcised early male infants born at the target health facilities is below the national target of 40% even though the rate of adverse events among those circumcised is acceptable. Keywords: Adverse event; circumcision; early male infant; uptake; western Kenya.

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Malaria micro-stratification using routine surveillance data in Western Kenya

10.21203/rs.3.rs-53969/v3 ◽

2020 ◽

Author(s):

Victor A Alegana ◽

Laurissa Suiyanka ◽

Peter M Macharia ◽

Grace Ikahu-Muchangi ◽

Robert W Snow

Keyword(s):

Spatial Resolution ◽

Population Distribution ◽

Indoor Residual Spraying ◽

Routine Data ◽

Malaria Risk ◽

Health Facilities ◽

Exceedance Probability ◽

Future Research ◽

Small Scale ◽

Western Kenya

Abstract Background There is an increasing need for finer spatial resolution data on malaria risk to provide micro-stratification to guide sub-national strategic plans. Here, spatial-statistical techniques are used to exploit routine data to depict sub-national heterogeneities in test positivity rate (TPR) for malaria among patients attending health facilities in Kenya. Methods Routine data from health facilities (n=1,804) representing all ages over 24 months (2018-2019) were assembled across 8 counties (62 sub-counties) in Western Kenya. Statistical model-based approaches were used to quantify heterogeneities in TPR and uncertainty at fine spatial resolution adjusting for missingness, population distribution, spatial data structure, month, and type of health facility. Results The overall monthly reporting rate was 78.7% (IQR 75.0-100.0) and public-based health facilities were more likely than private facilities to report ≥12 months (OR 5.7, 95% CI 4.3-7.5). There was marked heterogeneity in population-weighted TPR with sub-counties in the north of the lake-endemic region exhibiting the highest rates (exceedance probability >70% with 90% certainty) where approximately 2.7 million (28.5%) people reside. At micro-level the lowest rates were in 14 sub-counties (exceedance probability <30% with 90% certainty) where approximately 2.2 million (23.1%) people lived and indoor residual spraying had been conducted since 2017.Conclusion The value of routine health data on TPR can be enhanced when adjusting for underlying population and spatial structures of the data, highlighting small-scale heterogeneities in malaria risk often masked in broad national stratifications. Future research should aim at relating these heterogeneities in TPR with traditional community-level prevalence to improve tailoring malaria control activities at sub-national levels.

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Intermittent screening and treatment with dihydroartemisinin-piperaquine for the prevention of malaria in pregnancy: implementation feasibility in a routine healthcare system setting in western Kenya

Malaria Journal ◽

10.1186/s12936-020-03505-0 ◽

2020 ◽

Vol 19 (1) ◽

Author(s):

Jenny Hill ◽

Peter Ouma ◽

Seth Oluoch ◽

Jane Bruce ◽

Simon Kariuki ◽

...

Keyword(s):

Intermittent Preventive Treatment ◽

Preventive Treatment ◽

Standard Of Care ◽

Health Facilities ◽

Malaria In Pregnancy ◽

Sub Saharan Africa ◽

Directly Observed Therapy ◽

Western Kenya ◽

Sub Saharan ◽

In Pregnancy

Abstract Background Intermittent preventive treatment in pregnancy (IPTp) with sulfadoxine-pyrimethamine (SP) is recommended for preventing malaria in pregnancy in areas of moderate-to-high transmission in sub-Saharan Africa. However, due to increasing parasite resistance to SP, research on alternative strategies is a priority. The study assessed the implementation feasibility of intermittent screening and treatment (ISTp) in the second and third trimester at antenatal care (ANC) with malaria rapid diagnostic tests (RDTs) and treatment of positive cases with dihydroartemisinin-piperaquine (DP) compared to IPTp-SP in western Kenya. Methods A 10-month implementation study was conducted in 12 government health facilities in four sub-counties. Six health facilities were assigned to either ISTp-DP or IPTp-SP. Evaluation comprised of facility audits, ANC observations, and exit interviews. Intermediate and cumulative effectiveness analyses were performed on all processes involved in delivery of ISTp-DP including RDT proficiency and IPTp-SP ± directly observed therapy (DOT, standard of care). Logistic regression was used to identify predictors of receiving each intervention. Results A total of 388 and 389 women were recruited in the ISTp-DP and IPTp-SP arms, respectively. For ISTp-DP, 90% (289/320) of eligible women received an RDT. Of 11% (32/289) who tested positive, 71% received the correct dose of DP and 31% the first dose by DOT, and only 6% were counselled on subsequent doses. Women making a sick visit and being tested in a facility with a resident microscopist were more likely to receive ISTp-DP (AOR 1.78, 95% CI 1.31, 2.41; and AOR 3.75, 95% CI 1.31, 2.40, respectively). For IPTp-SP, only 57% received a dose of SP by DOT. Payment for a laboratory test was independently associated with receipt of SP by DOT (AOR 6.43, 95% CI 2.07, 19.98). Conclusions The findings indicate that the systems effectiveness of ANC clinics to deliver ISTp-DP under routine conditions was poor in comparison to IPTp-SP. Several challenges to integration of ISTp with ANC were identified that may need to be considered by countries that have introduced screening at first ANC visit and, potentially, for future adoption of ISTp with more sensitive RDTs. Understanding the effectiveness of ISTp-DP will require additional research on pregnant women’s adherence to ACT.

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Expanded eligibility for HIV testing increases HIV diagnoses—A cross-sectional study in seven health facilities in western Kenya

PLoS ONE ◽

10.1371/journal.pone.0225877 ◽

2019 ◽

Vol 14 (12) ◽

pp. e0225877 ◽

Cited By ~ 1

Author(s):

Rachael H. Joseph ◽

Paul Musingila ◽

Fredrick Miruka ◽

Stella Wanjohi ◽

Caroline Dande ◽

...

Keyword(s):

Hiv Testing ◽

Cross Sectional Study ◽

Health Facilities ◽

Sectional Study ◽

Cross Sectional ◽

Western Kenya

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Evaluation of the impact of a simple hand-washing and water-treatment intervention in rural health facilities on hygiene knowledge and reported behaviours of health workers and their clients, Nyanza Province, Kenya, 2008

Epidemiology and Infection ◽

10.1017/s095026881400082x ◽

2014 ◽

Vol 143 (4) ◽

pp. 873-880 ◽

Cited By ~ 9

Author(s):

N. SREENIVASAN ◽

S. A. GOTESTRAND ◽

S. OMBEKI ◽

G. OLUOCH ◽

T. K. FISCHER ◽

...

Keyword(s):

Drinking Water ◽

Water Treatment ◽

Rural Health ◽

Health Workers ◽

Health Facilities ◽

Hand Washing ◽

Treatment Intervention ◽

Treatment Procedure ◽

Western Kenya ◽

The Impact

SUMMARYMany clinics in rural western Kenya lack access to safe water and hand-washing facilities. To address this problem, in 2005 a programme was initiated to install water stations for hand washing and drinking water in 109 health facilities, train health workers on water treatment and hygiene, and motivate clients to adopt these practices. In 2008, we evaluated this intervention's impact by conducting observations at facilities, and interviewing staff and clients about water treatment and hygiene. Of 30 randomly selected facilities, 97% had water stations in use. Chlorine residuals were detectable in at least one container at 59% of facilities. Of 164 interviewed staff, 79% knew the recommended water-treatment procedure. Of 298 clients, 45% had received training on water treatment at a facility; of these, 68% knew the recommended water-treatment procedure. Use of water stations, water treatment, and client training were sustained in some facilities for up to 3 years.

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Increases in correct administration of chloroquine in the home and referral of sick children to health facilities through a community-based intervention in Bougouni District, Mali

Transactions of the Royal Society of Tropical Medicine and Hygiene ◽

10.1016/s0035-9203(03)80001-9 ◽

2003 ◽

Vol 97 (5) ◽

pp. 481-490 ◽

Cited By ~ 24

Author(s):

P.J. Winch ◽

A. Bagayoko ◽

A. Diawara ◽

M. Kané ◽

F. Thiéro ◽

...

Keyword(s):

Health Facilities ◽

Community Based ◽

Sick Children

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Malaria micro-stratification using routine surveillance data in Western Kenya

Malaria Journal ◽

10.1186/s12936-020-03529-6 ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Victor A. Alegana ◽

Laurissa Suiyanka ◽

Peter M. Macharia ◽

Grace Ikahu-Muchangi ◽

Robert W. Snow

Keyword(s):

Spatial Resolution ◽

Population Distribution ◽

Indoor Residual Spraying ◽

Routine Data ◽

Malaria Risk ◽

Health Facilities ◽

Exceedance Probability ◽

Future Research ◽

Small Scale ◽

Western Kenya

Abstract Background There is an increasing need for finer spatial resolution data on malaria risk to provide micro-stratification to guide sub-national strategic plans. Here, spatial-statistical techniques are used to exploit routine data to depict sub-national heterogeneities in test positivity rate (TPR) for malaria among patients attending health facilities in Kenya. Methods Routine data from health facilities (n = 1804) representing all ages over 24 months (2018–2019) were assembled across 8 counties (62 sub-counties) in Western Kenya. Statistical model-based approaches were used to quantify heterogeneities in TPR and uncertainty at fine spatial resolution adjusting for missingness, population distribution, spatial data structure, month, and type of health facility. Results The overall monthly reporting rate was 78.7% (IQR 75.0–100.0) and public-based health facilities were more likely than private facilities to report ≥ 12 months (OR 5.7, 95% CI 4.3–7.5). There was marked heterogeneity in population-weighted TPR with sub-counties in the north of the lake-endemic region exhibiting the highest rates (exceedance probability > 70% with 90% certainty) where approximately 2.7 million (28.5%) people reside. At micro-level the lowest rates were in 14 sub-counties (exceedance probability < 30% with 90% certainty) where approximately 2.2 million (23.1%) people lived and indoor residual spraying had been conducted since 2017. Conclusion The value of routine health data on TPR can be enhanced when adjusting for underlying population and spatial structures of the data, highlighting small-scale heterogeneities in malaria risk often masked in broad national stratifications. Future research should aim at relating these heterogeneities in TPR with traditional community-level prevalence to improve tailoring malaria control activities at sub-national levels.

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Perspectives of stakeholders of the free maternity services for economicaly constrained mothers in western kenya, lessons for universal health coverage

10.21203/rs.3.rs-833489/v1 ◽

2021 ◽

Author(s):

Beverly Ochieng ◽

Margaret Kaseje ◽

Dan Kaseje ◽

Kevin Oria ◽

Monica Magadi

Keyword(s):

Health Services ◽

Universal Health Coverage ◽

Social Protection ◽

Service Providers ◽

Health Facilities ◽

Child Health Services ◽

Health Coverage ◽

Financial Risk Protection ◽

Western Kenya ◽

Universal Health

Abstract The strategic aim of universal health coverage (UHC) is to ensure that everyone can use health services they need without risk of financial impoverishment. Linda mama (Taking care of the mother) initiative focuses on the most vulnerable women, newborns and infants in offering free health services. Financial risk protection is one element in the package of measures that provides overall social protection, as well as protection against severe financial difficulties in the event of pregnancy, childbirth, neonatal and perinatal health care for mothers and their children. Purpose of study was to find out the extent of awareness, and involvement among managers, service providers and consumers of “Linda mama” supported services and benefits of the initiative from the perspectives of consumers, providers and managers Methods We carried out cross sectional study in four sub counties in western Kenya: Rachuonyo East, Nyando, Nyakach, and Alego Usonga. We used qualitative techniques to collect data from purposively selected knowledge rich individuals, managers, service providers and service consumers. Findings From the perspectives of managers, service providers and consumers of the “Linda Mama” scheme emerge concepts, principles and pathways of successful health interventions. Managers and service providers were well aware of the initiative and were involved in it. Participation in “Linda Mama” seemed to be more prominent among managers and service providers. Routine household visits by community health volunteers to sensitize mothers and community engagement was core to the initiative. The managers and providers of services displayed profound awareness of how requiring identification cards and telephone numbers had the potential to undermine equity by excluding those in greater need of care such as under-age pregnant adolescents.Maternity and mother child health services improved as a result of the funds received by health facilities. “Linda Mama” reimbursements helped to purchase drug and reduced workload in the facility by hiring extra hands. Conclusion The initiative seems to have influenced attitudes on health facility delivery through: Partnership among key stakeholders and highlighting the need for enhanced partnership with the communities. It enhanced the capacity of health facilities to deliver high quality comprehensive, essential care package and easing economic burden.

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