scholarly journals Feasibility of Implementing Recommendations to Improve Neglected Tropical Diseases Surveillance and Response in Kenya: A Modified Delphi Study

2021 ◽  
Author(s):  
Arthur Ng'etich ◽  
Kuku Voyi ◽  
Clifford Mutero
Keyword(s):  
Data Analysis ◽  
Delphi Study ◽  
Surveillance System ◽  
Response Rate ◽  
Health Workers ◽  
Neglected Tropical Diseases ◽  
Tropical Diseases ◽  
Case Detection ◽  
Effective Response ◽  
Surveillance And Response

Abstract Background: Effective health information systems are critical towards achieving timely response to preventive chemotherapy targeted neglected tropical diseases (PC-NTDs) and eventual elimination. Endemic countries should initiate disease control programmes coupled with strengthened health systems that enable prompt case detection and effective response to halt disease transmission and prevent probable outbreaks. This study aimed to assess the importance and feasibility of implementing recommendations for improving surveillance core, support and attribute functions concerning PC-NTDs in Kenya.Methods: A descriptive web-based Delphi process comprising of two survey rounds was used to achieve group consensus. In the first round, participants were enrolled to complete a five-point likert-type self-administered electronic questionnaire comprising of 60 statements across 12 sub-domains on the importance of recommendations. In the second round, participants reappraised their responses following completion of a questionnaire with rephrased statements on feasibility of implementing the recommendations to improve PC-NTDs surveillance and response. Data from both rounds were analysed using descriptive statistics and thematic analysis performed for the open-ended responses. Results: Sixty-two key stakeholders actively involved in surveillance and response activities in seven PC-NTDs endemic counties in Kenya were invited to participate. Of these, 50/62 completed the first round (81% response rate) and 45/50 completed the second round (90% response rate). Consensus was achieved (defined as >70% agreement) on the importance (93%) of recommendation statements and feasibility (77%) of implementing the recommendations. Stakeholders agreed on the importance and feasibility of specific recommendations across the 12 sub-domains: case detection and registration, reporting, data analysis, feedback, epidemic preparedness and response, supervision, training, resources, simplicity, acceptability, stability and flexibility. However, there was lack of consensus on the practicability of availing case registers specific for PC-NTDs (42%), confirming all cases (29%), conducting routine data analysis (31%), increasing supervisory visits (22%), involving all health workers in surveillance training (16%), retaining trained surveillance staff (27%) and increasing the number of designated surveillance personnel (38%). Conclusion: Consensus among surveillance system stakeholders on implementation of the forty-six practical recommendations will inform development of a logical framework to guide decisions on strengthening specific surveillance components within the existing surveillance system in view of PC-NTDs in Kenya.

scholarly journals Feasibility of implementing recommendations to improve neglected tropical diseases surveillance and response in Kenya: a modified Delphi study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Arthur K. S. Ng’etich ◽  
Kuku Voyi ◽  
Clifford M. Mutero
Keyword(s):  
Data Analysis ◽  
Disease Transmission ◽  
Delphi Study ◽  
Response Rate ◽  
Neglected Tropical Diseases ◽  
Tropical Diseases ◽  
Case Detection ◽  
Support Functions ◽  
Effective Response ◽  
Surveillance And Response

Abstract Background Effective health information systems (HIS) are critical towards achieving timely response to preventive chemotherapy neglected tropical diseases (PC-NTDs) and their eventual elimination. Strengthened HIS enable prompt case detection and effective response to halt disease transmission and prevent probable outbreaks. This study aimed to assess the importance and feasibility of implementing recommendations for improving surveillance core functions, support functions and surveillance attributes concerning PC-NTDs in Kenya. Methods A descriptive web-based Delphi process comprising of two survey rounds was used to achieve group consensus on the importance of recommended actions and feasibility of their implementation. In the first round, participants were enrolled to complete a five-point likert-type self-administered electronic questionnaire comprising of 60 statements across 12 sub-domains on the importance of recommendations. In the second round, participants reappraised their responses following completion of a questionnaire with 56 rephrased statements on feasibility of implementing the recommendations to improve PC-NTDs surveillance and response. Data from both rounds were analysed using descriptive statistics and thematic analysis performed for the open-ended responses. Results Sixty-two key stakeholders actively involved in surveillance and response activities in seven PC-NTDs endemic counties in Kenya were invited to participate. Of these, 50/62 completed the first round (81 % response rate) and 45/50 completed the second round (90 % response rate). Consensus was achieved (defined as > 70 % agreement) on the importance (93 %) of recommendation statements and feasibility (82 %) of implementing the important recommendations. Stakeholders agreed on the importance and feasibility of specific recommendations across the 12 sub-domains: case detection and registration, reporting, data analysis, feedback, epidemic preparedness and response, supervision, training, resources, simplicity, acceptability, stability and flexibility. However, there was lack of consensus on the feasibility of conducting routine data analysis, increasing supervision of surveillance activities at lower levels and retaining trained surveillance staff across all levels. Conclusions Consensus among health stakeholders on implementation of the important and feasible recommendations will inform relevant strategies for strengthening specific surveillance system functions in view of PC-NTDs in Kenya.

scholarly journals Assessment of surveillance core and support functions regarding neglected tropical diseases in Kenya

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Arthur K. S. Ng’etich ◽  
Kuku Voyi ◽  
Clifford M. Mutero
Keyword(s):  
Data Analysis ◽  
Surveillance System ◽  
Qualitative Data ◽  
Neglected Tropical Diseases ◽  
National Level ◽  
World Health ◽  
Tropical Diseases ◽  
Support Functions ◽  
Specimen Handling ◽  
Surveillance And Response

Abstract Background Effective surveillance and response systems are vital to achievement of disease control and elimination goals. Kenya adopted the revised guidelines of the integrated disease surveillance and response system in 2012. Previous assessments of surveillance system core and support functions in Africa are limited to notifiable diseases with minimal attention given to neglected tropical diseases amenable to preventive chemotherapy (PC-NTDs). The study aimed to assess surveillance system core and support functions relating to PC-NTDs in Kenya. Methods A mixed method cross-sectional survey was adapted involving 192 health facility workers, 50 community-level health workers and 44 sub-national level health personnel. Data was collected using modified World Health Organization generic questionnaires, observation checklists and interview schedules. Descriptive summaries, tests of associations using Pearson’s Chi-square or Fisher’s exact tests and mixed effects regression models were used to analyse quantitative data. Qualitative data derived from interviews with study participants were coded and analysed thematically. Results Surveillance core and support functions in relation to PC-NTDs were assessed in comparison to an indicator performance target of 80%. Optimal performance reported on specimen handling (84%; 100%), reports submission (100%; 100%) and data analysis (84%; 80%) at the sub-county and county levels respectively. Facilities achieved the threshold on reports submission (84%), reporting deadlines (88%) and feedback (80%). However, low performance reported on case definitions availability (60%), case registers (19%), functional laboratories (52%) and data analysis (58%). Having well-equipped laboratories (3.07, 95% CI: 1.36, 6.94), PC-NTDs provision in reporting forms (3.20, 95% CI: 1.44, 7.10) and surveillance training (4.15, 95% CI: 2.30, 7.48) were associated with higher odds of functional surveillance systems. Challenges facing surveillance activities implementation revealed through qualitative data were in relation to surveillance guidelines and reporting tools, data analysis, feedback, supervisory activities, training and resource provision. Conclusion There was evidence of low-performing surveillance functions regarding PC-NTDs especially at the peripheral surveillance levels. Case detection, registration and confirmation, reporting, data analysis and feedback performed sub-optimally at the facility and community levels. Additionally, support functions including standards and guidelines, supervision, training and resources were particularly weak at the sub-national level. Improved PC-NTDs surveillance performance sub-nationally requires strengthened capacities.

scholarly journals Assessment of surveillance core and support functions regarding neglected tropical diseases in Kenya

2021 ◽  
Author(s):  
Arthur Kipkemoi Saitabau Ng'etich ◽  
Kuku Voyi ◽  
Clifford Maina Mutero
Keyword(s):  
Data Analysis ◽  
Surveillance System ◽  
Qualitative Data ◽  
Neglected Tropical Diseases ◽  
National Level ◽  
World Health ◽  
Tropical Diseases ◽  
Support Functions ◽  
Specimen Handling ◽  
Surveillance And Response

Abstract Background: Effective surveillance and response systems are vital to achievement of disease control and elimination goals. Kenya adopted the revised guidelines of the integrated disease surveillance and response system in 2012. Previous assessments of surveillance system core and support functions in Africa are limited to notifiable diseases with minimal attention given to neglected tropical diseases amenable to preventive chemotherapy (PC-NTDs). The study aimed to assess surveillance system core and support functions relating to PC-NTDs in Kenya.Methods: A mixed method cross-sectional survey was adapted involving 192 health facility workers, 50 community-level health workers and 44 sub-national level health personnel. Data was collected using modified World Health Organization generic questionnaires, observation checklists and interview schedules. Descriptive summaries, tests of associations using Pearson’s Chi-square or Fisher’s exact tests and mixed effects regression models were used to analyse quantitative data. Qualitative data derived from interviews with study participants were coded and analysed thematically.Results: Surveillance core and support functions in relation to PC-NTDs were assessed in comparison to an indicator performance target of 80%. Optimal performance reported on specimen handling (84%; 100%), reports submission (100%; 100%) and data analysis (84%; 80%) at the sub-county and county levels respectively. Facilities achieved the threshold on reports submission (84%), reporting deadlines (88%) and feedback (80%). However, low performance reported on case definitions availability (60%), case registers (19%), functional laboratories (52%) and data analysis (58%). Having well-equipped laboratories (3.07, 95% CI: 1.36, 6.94), PC-NTDs provision in reporting forms (3.20, 95% CI: 1.44, 7.10) and surveillance training (4.15, 95% CI: 2.30, 7.48) were associated with higher odds of functional surveillance systems. Challenges facing surveillance activities implementation revealed through qualitative data were in relation to surveillance guidelines and reporting tools, data analysis, feedback, supervisory activities, training and resource provision.Conclusion: There was evidence of low-performing surveillance functions regarding PC-NTDs especially at the peripheral surveillance levels. Case detection, registration and confirmation, reporting, data analysis and feedback performed sub-optimally at the facility and community levels. Additionally, support functions including standards and guidelines, supervision, training and resources were particularly weak at the sub-national level. Improved PC-NTDs surveillance performance sub-nationally requires strengthened capacities.

scholarly journals Assessment of surveillance core and support functions regarding neglected tropical diseases in Kenya

2020 ◽  
Author(s):  
Arthur Kipkemoi Saitabau Ng'etich ◽  
Kuku Voyi ◽  
Clifford Maina Mutero
Keyword(s):  
Data Analysis ◽  
Surveillance System ◽  
Qualitative Data ◽  
Neglected Tropical Diseases ◽  
National Level ◽  
World Health ◽  
Meeting Report ◽  
Tropical Diseases ◽  
Support Functions ◽  
Surveillance And Response

Abstract Background: Effective surveillance and response systems are vital to achievement of disease control and elimination goals. Kenya adopted the revised guidelines of the integrated disease surveillance and response system in 2012. Previous assessments of surveillance system core and support functions in Africa are limited to notifiable diseases with minimal attention given to neglected tropical diseases amenable to preventive chemotherapy (PC-NTDs). The study aimed to assess surveillance system core and support functions relating to PC-NTDs in Kenya. Methods: A mixed method cross-sectional survey was adapted involving 192 health facility workers, 50 community-level health workers and 44 sub-national level health personnel. Data was collected using modified World Health Organization generic questionnaires, observation checklists and interview schedules. Descriptive summaries, tests of associations using Pearson’s Chi-square or Fisher’s exact tests and mixed effects regression models were used to analyse quantitative data. Qualitative data derived from interviews with study participants were coded and analysed thematically. Results: Performance of surveillance core and support functions in relation to PC-NTDs was assessed in comparison to an indicator performance target of 80%. Optimal level of performance was achieved on specimen handling capacity (84%; 100%), reports submission (100%; 100%), meeting report deadlines (84%; 80%) and data analysis (84%; 80%) at the sub-county and county levels respectively. Health facilities achieved the target threshold on reports submission (84%), meeting report deadlines (88%) and providing feedback (80%). Presence of well-equipped laboratories (3.07, 95% CI: 1.36, 6.94), provision for PC-NTDs in reporting forms (3.20, 95% CI: 1.44, 7.10) and training of personnel on surveillance (4.15, 95% CI: 2.30, 7.48) were associated with higher odds of a functional surveillance system. Challenges facing surveillance activities implementation revealed through qualitative data were in relation to surveillance guidelines and reporting tools, data analysis, feedback, supervisory activities, training and resource provision. Conclusion: There was evidence of low-performing surveillance functions regarding PC-NTDs in Kenya. Case detection, registration and confirmation, reporting, data analysis and feedback performed sub-optimally at the facility and community levels. Additionally, support functions including standards and guidelines, supervision, training and resources were particularly weak at the sub-national level. Improved PC-NTDs surveillance performance sub-nationally requires strengthened capacities.

scholarly journals Assessment of surveillance core and support functions regarding neglected tropical diseases in Kenya

2020 ◽  
Author(s):  
Arthur Kipkemoi Saitabau Ng'etich ◽  
Kuku Voyi ◽  
Clifford Maina Mutero
Keyword(s):  
Data Analysis ◽  
Surveillance System ◽  
Qualitative Data ◽  
Neglected Tropical Diseases ◽  
National Level ◽  
World Health ◽  
Tropical Diseases ◽  
Support Functions ◽  
Standard Case ◽  
Surveillance And Response

Abstract Background: Effective surveillance and response systems are vital to achievement of disease control and elimination goals. Kenya adopted the revised guidelines of the integrated disease surveillance and response system in 2012. Previous assessments of surveillance system core and support functions in Africa are limited to notifiable diseases with minimal attention given to neglected tropical diseases amenable to preventive chemotherapy (PC-NTDs). The study aimed to assess surveillance system core and support functions relating to PC-NTDs in Kenya. Methods: A mixed method cross-sectional survey was adapted involving 192 health facility workers, 50 community-level health workers and 44 sub-national level health personnel. Data was collected using modified World Health Organization generic questionnaires, observation checklists and interview schedules. Descriptive summaries, tests of associations using Pearson’s Chi-square or Fisher’s exact tests and mixed effects regression models were used to analyse quantitative data. Qualitative data derived from interviews with study participants were coded and analysed thematically. Results: Detection of PC-NTDs was minimal at the peripheral level with limited (60%) use of standard case definitions. Case registration and confirmation capacities were suboptimal at the lower levels with 52% of facilities having functional laboratories. Presence of well-equipped laboratories (p = 0.007), provision for PC-NTDs in reporting forms (p = 0.004) and training of personnel on surveillance (p<0.001) were associated with higher odds of having a functional surveillance system. Lower levels lacked sufficient action thresholds and feedback was limited across all surveillance levels. Supervisory visits frequency at the community (73%) and facility (53%) levels were minimal. Challenges facing PC-NTDs surveillance activities implementation revealed through qualitative data included lack of surveillance guidelines and reporting tools, minimal data analysis, inconsistent feedback, limited supervisory activities, minimal training and low resource provision. Conclusions: Sufficient milestones have been achieved towards improving performance of surveillance functions in Kenya. However, challenges exist relating to PC-NTDs. Core functions including case detection, registration and confirmation, reporting, data analysis and feedback perform sub-optimally at the facility and community levels. Additionally, support functions including standards and guidelines, supervision, training and resources are particularly weak at the sub-national level. Improved PC-NTDs surveillance performance sub-nationally requires strengthened capacities.

scholarly journals Evaluation of health surveillance system attributes: the case of neglected tropical diseases in Kenya

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Arthur K. S. Ng’etich ◽  
Kuku Voyi ◽  
Clifford M. Mutero
Keyword(s):  
Work Experience ◽  
Surveillance System ◽  
Health Workers ◽  
Neglected Tropical Diseases ◽  
Likert Scale ◽  
Quality Data ◽  
Categorical Variables ◽  
Tropical Diseases ◽  
Preventive Chemotherapy ◽  
Cross Sectional

Abstract Background Control of preventive chemotherapy-targeted neglected tropical diseases (PC-NTDs) relies on strengthened health systems. Efficient health information systems provide an impetus to achieving the sustainable development goal aimed at ending PC-NTD epidemics. However, there is limited assessment of surveillance system functions linked to PC-NTDs and hinged on optimum performance of surveillance system attributes. The study aimed to evaluate surveillance system attributes based on healthcare workers’ perceptions in relation to PC-NTDs endemic in Kenya. Methods A cross-sectional health facility survey was used to purposively sample respondents involved in disease surveillance activities. Consenting respondents completed a self-administered questionnaire that assessed their perceptions on surveillance system attributes on a five-point likert scale. Frequency distributions for each point in the likert scale were analysed to determine health workers’ overall perceptions. Data was analysed using descriptive statistics and estimated median values with corresponding interquartile ranges used to summarise reporting rates. Factor analysis identified variables measuring specific latent attributes. Pearson’s chi-square and Fisher’s exact tests examined associations between categorical variables. Thematic analysis was performed for questionnaire open-ended responses. Results Most (88%) respondents worked in public health facilities with 71% stationed in second-tier facilities. Regarding PC-NTDs, respondents perceived the surveillance system to be simple (55%), acceptable (50%), stable (41%), flexible (41%), useful (51%) and to provide quality data (25%). Facility locality, facility type, respondents’ education level and years of work experience were associated with perceived opinion on acceptability (p = 0.046; p = 0.049; p = 0.032 and p = 0.032) and stability (p = 0.030; p = 0.022; p = 0.015 and p = 0.024) respectively. Median monthly reporting timeliness and completeness rates for facilities were 75 (58.3, 83.3) and 83.3 (58.3, 100) respectively. Higher-level facilities met reporting timeliness (p < 0.001) and completeness (p < 0.001) thresholds compared to lower-level facilities. Conclusion Health personnel had lower perceptions on the stability, flexibility and data quality of the surveillance system considering PC-NTDs. Reporting timeliness and completeness rates decreased in 2017 compared to previous surveillance periods. Strengthening all surveillance functions would influence health workers’ perceptions and improve surveillance system overall performance with regard to PC-NTDs.

scholarly journals Evaluation of Health Surveillance System Attributes: The Case of Neglected Tropical Diseases in Kenya

2020 ◽  
Author(s):  
Arthur Kipkemoi Saitabau Ng'etich ◽  
Kuku Voyi ◽  
Clifford Maina Mutero
Keyword(s):  
Work Experience ◽  
Surveillance System ◽  
Health Workers ◽  
Neglected Tropical Diseases ◽  
Likert Scale ◽  
Quality Data ◽  
Categorical Variables ◽  
Tropical Diseases ◽  
Preventive Chemotherapy ◽  
Cross Sectional

Abstract Background: Control of preventive chemotherapy-targeted neglected tropical diseases (PC-NTDs) relies on strengthened health systems. Efficient health information systems provide an impetus to achieving the sustainable development goal aimed at ending PC-NTD epidemics. However, there is limited assessment of surveillance system functions linked to PC-NTDs that is hinged on optimum performance of surveillance system attributes. The study aimed to evaluate surveillance system attributes based on healthcare workers’ perceptions in relation to PC-NTDs endemic in Kenya. Methods: A cross-sectional health facility survey was used to purposively sample respondents involved in surveillance activities. Consenting respondents completed a self-administered questionnaire that assessed their perceptions towards surveillance system attributes on a five-point likert scale. Frequency distribution for each point in the likert scale was analysed to determine health worker’s overall perception. Data was analysed using descriptive statistics and estimated median values with corresponding interquartile ranges used to summarise reporting rates. Factor analysis identified variables measuring specific latent attributes. Pearson’s chi-square and Fisher’s exact tests examined associations between categorical variables. Thematic analysis was performed for the questionnaire open-ended responses.Results: Most (88%) respondents worked in public facilities with 71% in second-tier facilities. Regarding PC-NTDs, 55% of respondents perceived the surveillance system to be simple, 50% to be acceptable, 41% to be stable, 41% to be flexible, 51% to be useful and 25% to providing quality data. Facility locality, facility type, respondents’ education level and years of work experience were associated with perceived opinion on acceptability (p = 0.046; p = 0.049; p = 0.032 and p = 0.032) and stability (p = 0.030; p = 0.022; p = 0.015 and p =0.024) respectively. Median monthly reporting timeliness and completeness rates for facilities were 75 (58.3, 83.3) and 83.3 (58.3, 100) respectively. Higher-level facilities met reporting timeliness (p <0.001) and completeness (p <0.001) thresholds compared to lower-level facilities.Conclusion: Health personnel had lower perceptions on the stability, flexibility and data quality of the surveillance system. Reporting timeliness and completeness rates decreased in 2017 compared to previous surveillance periods. Strengthening all surveillance functions would influence health workers’ perceptions and improve surveillance system overall performance regarding PC-NTDs.

scholarly journals Development and validation of a framework to improve neglected tropical diseases surveillance and response at the sub-national level in Kenya

2021 ◽  
Author(s):  
Arthur Kipkemoi Saitabau Ng'etich ◽  
Kuku Voyi ◽  
Clifford Maina Mutero
Keyword(s):  
Disease Transmission ◽  
Neglected Tropical Diseases ◽  
Methodological Approach ◽  
National Level ◽  
Primary Data ◽  
Second Phase ◽  
Tropical Diseases ◽  
Preventive Chemotherapy ◽  
Response System ◽  
Surveillance And Response

Background Assessment of surveillance and response system functions focusing on notifiable diseases has widely been documented in literature. However, there is limited focus on diseases targeted for elimination or eradication, particularly preventive chemotherapy neglected tropical diseases (PC-NTDs). There are limited strategies to guide strengthening of surveillance and response system functions concerning PC-NTDs. The aim of this study was to develop and validate a framework to improve surveillance and response to PC-NTDs at the sub-national level in Kenya. Methods Framework development adopted a multi-phased approach. The first phase involved a systematic literature review of surveillance assessment studies conducted in Africa to derive generalised recommendations. The second phase utilised primary data surveys to identify disease-specific recommendations to improve PC-NTDs surveillance in Kenya. The third phase utilised a Delphi survey to assess stakeholders consensus on feasible recommendations. The fourth phase drew critical lessons from existing conceptual frameworks. The final validated framework was based on resolutions and inputs from concerned stakeholders. Results Framework components constituted inputs with the first domain combining surveillance tools, equipment and infrastructure while the second domain combined financial, technical and logistical support. Processes were categorised into four sub-domains with activities for strengthening existing surveillance tools, surveillance core, support and attribute functions. The intended results phase comprised of ten distinct outputs with the anticipated outcomes categorised into three sub domains. Lastly, the overall impact alluded to reduced disease burden, halted disease transmission and reduced costs for implementing treatment interventions to achieve PC-NTDs control and elimination. Conclusion In view of the mixed methodological approach used to develop the framework coupled with further inputs and consensus among concerned stakeholders, the validated framework appears to be relevant in guiding decisions by policy makers to strengthen the existing surveillance and response system functions towards achieving PC-NTDs elimination.

Sign in / Sign up

Export Citation Format

Share Document