scholarly journals ‘it Is Beyond Our Reach’: Policies and Infrastructure Influencing Postpartum Care in Rural Kenya

2021 ◽  
Author(s):  
Janet Kemei ◽  
Josephine Etowa
Keyword(s):  
Healthcare Providers ◽  
Postpartum Care ◽  
Sub Saharan Africa ◽  
Financial Barriers ◽  
Recruitment And Retention ◽  
Maternity Services ◽  
Low Middle Income Countries ◽  
Rural Kenya ◽  
Nurses And Midwives ◽  
Skilled Health

Abstract BackgroundMaternal mortality in low middle-income countries is still high. Like most countries in Sub-Saharan Africa, the progress towards reducing maternal mortalities in Kenya is slow. Approximately 488 women out of every 100,000 live births die during the childbearing process. Kenya has put in place several strategies to mitigate maternal mortalities. For instance, Kenya introduced free maternity services in 2013 to remove financial barriers to skilled health services for mothers and children under five years old. Hence, it is necessary to explore how the policies and infrastructure intersect with other socioeconomic factors to influence postpartum care in rural Kenya to mitigate maternal and infant deaths.MethodsThis qualitative research conducted in-depth focused ethnographic (FE) interviews with 23 nurses and midwives working in nine health centres and the County Hospital in Nandi County, Kenya, between July 2017 and February 2018. We used thematic analysis approach as described by Braun and Clarke to analyze the data. Lincoln and Guba criteria for establishing the trustworthiness of data was used. ResultsThe analysis of data generated six themes. The findings from the theme, Policies and Infrastructure Influencing Postpartum Care will be discussed in this paper. The findings will be discussed under three sub-themes 1) Free maternity services, 2) Adherence to perinatal care guidelines, and 3) Recruitment and retention of nurses and midwives. Facilities lacked the essential equipment and supplies required to provide these services, recruitment and retention of staff, demotivation of healthcare providers, lack of regular training and supervision of staff, and lack of adherence to postpartum guidelines. These issues intersected to determine the quality of skilled postpartum services provided to childbearing women and their families as well as women and infants’ overall perinatal health outcomes. ConclusionThe findings have underscored the importance of having a functional healthcare system that supports both the clinical and emotional aspects of the women and healthcare providers. Efforts should be directed into addressing the negative factors influencing care provision at the facility level. Suboptimal care could cause women not to attend skilled health care and sabotage the global goals of eliminating maternal and infant mortalities. This can be achieved by creating policies that considers the diverse causes and power-relations withing the healthcare organization.

scholarly journals Connected diagnostics to improve accurate diagnosis, treatment, and conditional payment of malaria services in Kenya

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Shannen M. C. van Duijn ◽  
Angela K. Siteyi ◽  
Sherzel Smith ◽  
Emmanuel Milimo ◽  
Leon Stijvers ◽  
...  
Keyword(s):  
Clinical Performance ◽  
Healthcare Providers ◽  
Malaria Treatment ◽  
Sub Saharan Africa ◽  
Structured Interviews ◽  
National Guidelines ◽  
Private Providers ◽  
Provider Perspectives ◽  
Treatment Data ◽  
Sub Saharan

Abstract Background In sub-Saharan Africa, the material and human capacity to diagnose patients reporting with fever to healthcare providers is largely insufficient. Febrile patients are typically treated presumptively with antimalarials and/or antibiotics. Such over-prescription can lead to drug resistance and involves unnecessary costs to the health system. International funding for malaria is currently not sufficient to control malaria. Transition to domestic funding is challenged by UHC efforts and recent COVID-19 outbreak. Herewith we present a digital approach to improve efficiencies in diagnosis and treatment of malaria in endemic Kisumu, Kenya: Connected Diagnostics. The objective of this study is to evaluate the feasibility, user experience and clinical performance of this approach in Kisumu. Methods Our intervention was performed Oct 2017–Dec 2018 across five private providers in Kisumu. Patients were enrolled on M-TIBA platform, diagnostic test results digitized, and only positive patients were digitally entitled to malaria treatment. Data on socio-demographics, healthcare transactions and medical outcomes were analysed using standard descriptive quantitative statistics. Provider perspectives were gathered by 19 semi-structured interviews. Results In total 11,689 febrile patients were digitally tested through five private providers. Malaria positivity ranged from 7.4 to 30.2% between providers, significantly more amongst the poor (p < 0.05). Prescription of antimalarials was substantially aberrant from National Guidelines, with 28% over-prescription (4.6–63.3% per provider) and prescription of branded versus generic antimalarials differing amongst facilities and correlating with the socioeconomic status of clients. Challenges were encountered transitioning from microscopy to RDT. Conclusion We provide full proof-of-concept of innovative Connected Diagnostics to use digitized malaria diagnostics to earmark digital entitlements for correct malaria treatment of patients. This approach has large cost-saving and quality improvement potential.

scholarly journals Assessing trauma care systems in low-income and middle-income countries: a systematic review and evidence synthesis mapping the Three Delays framework to injury health system assessments

2021 ◽  
Vol 6 (5) ◽  
pp. e004324
Author(s):  
John Whitaker ◽  
Nollaig O'Donohoe ◽  
Max Denning ◽  
Dan Poenaru ◽  
Elena Guadagno ◽  
...  
Keyword(s):  
Systematic Review ◽  
Health System ◽  
Evidence Synthesis ◽  
Rapid Assessment ◽  
Sub Saharan Africa ◽  
Trauma Systems ◽  
Middle Income ◽  
Middle Income Countries ◽  
Low Middle Income Countries ◽  
Three Delays

BackgroundThe large burden of injuries falls disproportionately on low/middle-income countries (LMICs). Health system interventions improve outcomes in high-income countries. Assessing LMIC trauma systems supports their improvement. Evaluating systems using a Three Delays framework, considering barriers to seeking (Delay 1), reaching (Delay 2) and receiving care (Delay 3), has aided maternal health gains. Rapid assessments allow timely appraisal within resource and logistically constrained settings. We systematically reviewed existing literature on the assessment of LMIC trauma systems, applying the Three Delays framework and rapid assessment principles.MethodsWe conducted a systematic review and narrative synthesis of articles assessing LMIC trauma systems. We searched seven databases and grey literature for studies and reports published until October 2018. Inclusion criteria were an injury care focus and assessment of at least one defined system aspect. We mapped each study to the Three Delays framework and judged its suitability for rapid assessment.ResultsOf 14 677 articles identified, 111 studies and 8 documents were included. Sub-Saharan Africa was the most commonly included region (44.1%). Delay 3, either alone or in combination, was most commonly assessed (79.3%) followed by Delay 2 (46.8%) and Delay 1 (10.8%). Facility assessment was the most common method of assessment (36.0%). Only 2.7% of studies assessed all Three Delays. We judged 62.6% of study methodologies potentially suitable for rapid assessment.ConclusionsWhole health system injury research is needed as facility capacity assessments dominate. Future studies should consider novel or combined methods to study Delays 1 and 2, alongside care processes and outcomes.

scholarly journals Akwenda intervention programme for children and youth with cerebral palsy in a low-resource setting in sub-Saharan Africa: protocol for a quasi-randomised controlled study

BMJ Open ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. e047634
Author(s):  
Gillian Saloojee ◽  
Francis Ekwan ◽  
Carin Andrews ◽  
Diane L Damiano ◽  
Angelina Kakooza-Mwesige ◽  
...  
Keyword(s):  
Cerebral Palsy ◽  
Sub Saharan Africa ◽  
Children And Youth ◽  
Controlled Study ◽  
Motor Disorder ◽  
National Council ◽  
Low Resource ◽  
Resource Setting ◽  
Low Middle Income Countries ◽  
Randomised Controlled

IntroductionCerebral palsy (CP) is the most common childhood-onset motor disorder accompanied by associated impairments, placing a heavy burden on families and health systems. Most children with CP live in low/middle-income countries with little access to rehabilitation services. This study will evaluate the Akwenda CP programme, a multidimensional intervention designed for low-resource settings and aiming at improving: (1) participation, motor function and daily activities for children with CP; (2) quality of life, stress and knowledge for caregivers; and (3) knowledge and attitudes towards children with CP in the communities.MethodsThis quasi-randomised controlled clinical study will recruit children and youth with CP aged 2–23 years in a rural area of Uganda. Children will be allocated to one of two groups with at least 44 children in each group. Groups will be matched for age, sex and motor impairment. The intervention arm will receive a comprehensive, multidimensional programme over a period of 11 months comprising (1) caregiver-led training workshops, (2) therapist-led practical group sessions, (3) provision of technical assistive devices, (4) goal-directed training and (5) community communication and advocacy. The other group will receive usual care. The outcome of the intervention will be assessed before and after the intervention and will be measured at three levels: (1) child, (2) caregiver and (3) community. Standard analysis methods for randomised controlled trial will be used to compare groups. Retention of effects will be examined at 12-month follow-up.Ethics and disseminationThe study has been approved by the Uganda National Council for Science and Technology (SS 5173) and registered in accordance with WHO and ICMJE standards. Written informed consent will be obtained from caregivers. Results will be disseminated among participants and stakeholders through public engagement events, scientific reports and conference presentations.Trial registration numberPan African Clinical Trials Registry (PACTR202011738099314) Pre-results.

scholarly journals Understanding cause of stillbirth: a prospective observational multi-country study from sub-Saharan Africa

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Mamuda Aminu ◽  
Sarah Bar-Zeev ◽  
Sarah White ◽  
Matthews Mathai ◽  
Nynke van den Broek
Keyword(s):  
Sierra Leone ◽  
Cause Of Death ◽  
Expert Panel ◽  
Healthcare Providers ◽  
Sub Saharan Africa ◽  
Primary Data ◽  
Middle Income ◽  
Computer Based ◽  
Sub Saharan ◽  
Low And Middle Income

Abstract Background Every year, an estimated 2.6 million stillbirths occur worldwide, with up to 98% occurring in low- and middle-income countries (LMIC). There is a paucity of primary data on cause of stillbirth from LMIC, and particularly from sub-Saharan Africa to inform effective interventions. This study aimed to identify the cause of stillbirths in low- and middle-income settings and compare methods of assessment. Methods This was a prospective, observational study in 12 hospitals in Kenya, Malawi, Sierra Leone and Zimbabwe. Stillbirths (28 weeks or more) were reviewed to assign the cause of death by healthcare providers, an expert panel and by using computer-based algorithms. Agreement between the three methods was compared using Kappa (κ) analysis. Cause of stillbirth and level of agreement between the methods used to assign cause of death. Results One thousand five hundred sixty-three stillbirths were studied. The stillbirth rate (per 1000 births) was 20.3 in Malawi, 34.7 in Zimbabwe, 38.8 in Kenya and 118.1 in Sierra Leone. Half (50.7%) of all stillbirths occurred during the intrapartum period. Cause of death (range) overall varied by method of assessment and included: asphyxia (18.5–37.4%), placental disorders (8.4–15.1%), maternal hypertensive disorders (5.1–13.6%), infections (4.3–9.0%), cord problems (3.3–6.5%), and ruptured uterus due to obstructed labour (2.6–6.1%). Cause of stillbirth was unknown in 17.9–26.0% of cases. Moderate agreement was observed for cause of stillbirth as assigned by the expert panel and by hospital-based healthcare providers who conducted perinatal death review (κ = 0.69; p < 0.0005). There was only minimal agreement between expert panel review or healthcare provider review and computer-based algorithms (κ = 0.34; 0.31 respectively p < 0.0005). Conclusions For the majority of stillbirths, an underlying likely cause of death could be determined despite limited diagnostic capacity. In these settings, more diagnostic information is, however, needed to establish a more specific cause of death for the majority of stillbirths. Existing computer-based algorithms used to assign cause of death require revision.

scholarly journals Quality of care in the free maternal healthcare era in sub-Saharan Africa: a scoping review of providers’ and managers’ perceptions

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Monica Ansu-Mensah ◽  
Frederick Inkum Danquah ◽  
Vitalis Bawontuo ◽  
Peter Ansu-Mensah ◽  
Tahiru Mohammed ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Research Question ◽  
Healthcare Providers ◽  
Poor Quality ◽  
Sub Saharan Africa ◽  
Healthcare Financing ◽  
Maternal Healthcare ◽  
Sub Saharan ◽  
The Impact

Abstract Background Free maternal healthcare financing schemes play an essential role in the quality of services rendered to clients during antenatal care in sub-Saharan Africa (SSA). However, healthcare managers’ and providers’ perceptions of the healthcare financing scheme may influence the quality of care. This scoping review mapped evidence on managers’ and providers’ perspectives of free maternal healthcare and the quality of care in SSA. Methods We used Askey and O’Malley’s framework as a guide to conduct this review. To address the research question, we searched PubMed, CINAHL through EBSCOhost, ScienceDirect, Web of Science, and Google Scholar with no date limitation to May 2019 using keywords, Boolean terms, and Medical Subject Heading terms to retrieve relevant articles. Both abstract and full articles screening were conducted independently by two reviewers using the inclusion and exclusion criteria as a guide. All significant data were extracted, organized into themes, and a summary of the findings reported narratively. Results In all, 15 out of 390 articles met the inclusion criteria. These 15 studies were conducted in nine countries. That is, Ghana (4), Kenya (3), and Nigeria (2), Burkina Faso (1), Burundi (1), Niger (1), Sierra Leone (1), Tanzania (1), and Uganda (1). Of the 15 included studies, 14 reported poor quality of maternal healthcare from managers’ and providers’ perspectives. Factors contributing to the perception of poor maternal healthcare included: late reimbursement of funds, heavy workload of providers, lack of essential drugs and stock-out of medical supplies, lack of policy definition, out-of-pocket payment, and inequitable distribution of staff. Conclusion This study established evidence of existing literature on the quality of care based on healthcare providers’ and managers’ perspectives though very limited. This study indicates healthcare providers and managers perceive the quality of maternal healthcare under the free financing policy as poor. Nonetheless, the free maternal care policy is very much needed towards achieving universal health, and all efforts to sustain and improve the quality of care under it must be encouraged. Therefore, more research is needed to better understand the impact of their perceived poor quality of care on maternal health outcomes.

scholarly journals Understanding patient health-seeking behaviour to optimise the uptake of cataract surgery in rural Kenya, Zambia and Uganda: findings from a multisite qualitative study

2021 ◽  
Author(s):  
Stevens Bechange ◽  
Emma Jolley ◽  
Patrick Tobi ◽  
Eunice Mailu ◽  
Juliet Sentongo ◽  
...  
Keyword(s):  
Cataract Surgery ◽  
Visual Impairment ◽  
Healthcare Delivery ◽  
Healthcare Providers ◽  
Health Seeking ◽  
Healthcare Delivery System ◽  
Group Discussions ◽  
Patient Health ◽  
Rural Kenya ◽  
Rural Zambia

Abstract Background Cataract is a major cause of visual impairment globally, affecting 15.2 million people who are blind, and another 78.8 million who have moderate or severe visual impairment. This study was designed to explore factors that influence the uptake of surgery offered to patients with operable cataract in a free-of-charge, community-based eye health programme. Methods Focus group discussions and in-depth interviews were conducted with patients and healthcare providers in rural Zambia, Kenya and Uganda during 2018–2019. We identified participants using purposive sampling. Thematic analysis was conducted using a combination of an inductive and deductive team-based approach. Results Participants consisted of 131 healthcare providers and 294 patients. Two-thirds of patients had been operated on for cataract. Two major themes emerged: (1) surgery enablers, including a desire to regain control of their lives, the positive testimonies of others, family support, as well as free surgery, medication and food; and (2) barriers to surgery, including cultural and social factors, as well as the inadequacies of the healthcare delivery system. Conclusions Cultural, social and health system realities impact decisions made by patients about cataract surgery uptake. This study highlights the importance of demand segmentation and improving the quality of services, based on patients’ expectations and needs, as strategies for increasing cataract surgery uptake.

scholarly journals Lack of autonomy in facility-based births makes women become absentees of maternity services in Somaliland fragile contexts - a qualitative study

2021 ◽  
Author(s):  
Jama Ali Egal ◽  
Amina Essa ◽  
Rahma Yusuf ◽  
Fadumo Osman ◽  
Marie Klingberg- Allvin ◽  
...  
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Qualitative Study ◽  
Healthcare Providers ◽  
Medical Knowledge ◽  
Care Seeking ◽  
Place Of Birth ◽  
Maternity Services ◽  
Risk Pregnancy ◽  
Respectful Care

Abstract ObjectiveSomaliland has high levels of both maternal and infant mortality. This has been attributed, in part, to the fact that nearly 80% of births in the country take place at home, with women assisted by Traditional Birth Attendants (TBA) who have limited medical knowledge when it comes to obstetric complications. In this study we aim to capture multipara women’s decision-making when choosing the place of birth, illuminated by their experiences of maternity services in SomalilandDesignAn explorative qualitative approach using individual interviews conducted in Somaliland with 25 multiparous women who had experience of both a home and facility-based birth within the last three years.FindingsThe main finding of this study was the description of how valuable autonomy and respectful care were for Somaliland women. Respectful care and the cost of maternity services were vital parts of women’s autonomous decision-making when choosing a place of birth. Disrespectful care in maternity services made low-risk pregnancy women chose homebirth instead of a health facility birth. Women who had previous high-risk pregnancies that suggested they should be returnees to facility-based antenatal care, were still planning for a homebirth as their first choice.Key conclusionThis qualitative study was conducted in the fragile context of Somaliland and suggest a need to transform maternal and child health clinics into midwifery-led birthing centers that promote natural birth. It is further important to create new roles and responsibilities for TBAs that link them to the formal health system assuring timely health care seeking during pregnancy and in relation to delivery. There is a need to conduct a country-wide study on the availability and distribution of healthcare providers and to construct a long-term sustainable plan to assure quality and equal access to maternal health care in the country.

Barriers and facilitators of completing the steps in the PMTCT cascade at Midwife Obstetric Units in Gauteng - Healthcare Provider and Patient's views

2020 ◽  
Author(s):  
Constance Mongwenyana ◽  
Nelly Jinga ◽  
Given Mohomi ◽  
Sindisiwe Buthelezi ◽  
Nancy Nkopane ◽  
...  
Keyword(s):  
Primary Healthcare ◽  
Healthcare Providers ◽  
Turnaround Time ◽  
Postpartum Care ◽  
Barriers And Facilitators ◽  
Hiv Status ◽  
Hiv Diagnosis ◽  
Hiv Test ◽  
Increase Risk ◽  
Pmtct Cascade

Abstract Background: The implementation of Prevention of Mother to Child Transmission (PMTCT) programmes at midwifes obstetric units (MOU) involves the confirmation of HIV diagnosis during labour, early infant HIV diagnosis (EID), initiation/continuation of antiretroviral therapy (ART) for mother and baby as appropriate and counselling for postpartum care. Objectives: The aim of this study was to explore the barriers and facilitators to completing the steps in the PMTCT cascade at MOUs as defined by healthcare providers and recently postpartum women. Methods: We conducted 10 in-depth interviews with healthcare providers, and 24 HIV positive and HIV negative women at the four MOUs and Primary Healthcare Centres (PHC’s) in Gauteng South Africa (SA). Results: The implementation of PMTCT at MOU is impeded by maternal denial of HIV status (both new diagnoses and ANC diagnoses). Challenges with acceptance and disclosure of HIV status were thought to compromise patient commitment to EID tests and postpartum adherence to infant ART. Newly diagnosed (during labour) patients have limited time to process new HIV diagnosis and clinics have limited nurse/counsellor capacity for further one on one counselling. Additional challenges include communication challenges with foreign women and turnaround time for birth HIV tests. Results are often not available at postnatal visit and unclear processes for referral to Primary Healthcare Centre (PHC) for postpartum care increase risk of postpartum loss to follow up. Conclusion: We need to strengthen MOU capacity to prepare women for postpartum PMTCT requirements and facilitate access to EID results. Patient referral processes, including communication of infant HIV test results to the referral PHC, needs improvement.

scholarly journals Using research to prepare for outbreaks of severe acute respiratory infection

2019 ◽  
Vol 4 (1) ◽  
pp. e001061 ◽  
Author(s):  
Keyword(s):  
Critical Care ◽  
North America ◽  
Data Collection ◽  
East Asia ◽  
Case Fatality ◽  
Sub Saharan Africa ◽  
Hospital Length Of Stay ◽  
Low Middle Income Countries ◽  
Severe Acute Respiratory Infection ◽  
Short Period

Severe acute respiratory infections (SARI) remain one of the leading causes of mortality around the world in all age groups. There is large global variation in epidemiology, clinical management and outcomes, including mortality. We performed a short period observational data collection in critical care units distributed globally during regional peak SARI seasons from 1 January 2016 until 31 August 2017, using standardised data collection tools. Data were collected for 1 week on all admitted patients who met the inclusion criteria for SARI, with follow-up to hospital discharge. Proportions of patients across regions were compared for microbiology, management strategies and outcomes. Regions were divided geographically and economically according to World Bank definitions. Data were collected for 682 patients from 95 hospitals and 23 countries. The overall mortality was 9.5%. Of the patients, 21.7% were children, with case fatality proportions of 1% for those less than 5 years. The highest mortality was in those above 60 years, at 18.6%. Case fatality varied by region: East Asia and Pacific 10.2% (21 of 206), Sub-Saharan Africa 4.3% (8 of 188), South Asia 0% (0 of 35), North America 13.6% (25 of 184), and Europe and Central Asia 14.3% (9 of 63). Mortality in low-income and low-middle-income countries combined was 4% as compared with 14% in high-income countries. Organ dysfunction scores calculated on presentation in 560 patients where full data were available revealed Sequential Organ Failure Assessment (SOFA) scores on presentation were significantly associated with mortality and hospital length of stay. Patients in East Asia and Pacific (48%) and North America (24%) had the highest SOFA scores of >12. Multivariable analysis demonstrated that initial SOFA score and age were independent predictors of hospital survival. There was variability across regions and income groupings for the critical care management and outcomes of SARI. Intensive care unit-specific factors, geography and management features were less reliable than baseline severity for predicting ultimate outcome. These findings may help in planning future outbreak severity assessments, but more globally representative data are required.

scholarly journals Provider-perceived barriers to diagnosis and treatment of acute coronary syndrome in Tanzania: a qualitative study

2019 ◽  
Vol 12 (2) ◽  
pp. 148-154 ◽  
Author(s):  
Julian T Hertz ◽  
Godfrey L Kweka ◽  
Preeti Manavalan ◽  
Melissa H Watt ◽  
Francis M Sakita
Keyword(s):  
Acute Coronary Syndrome ◽  
Healthcare Providers ◽  
Care Patient ◽  
Cost Of Care ◽  
Sub Saharan Africa ◽  
Coronary Syndrome ◽  
Provider Perspectives ◽  
Northern Tanzania ◽  
Sub Saharan ◽  
Clinical Officers

Abstract Background The incidence of acute coronary syndrome (ACS) is growing across sub-Saharan Africa and many healthcare systems are ill-equipped for this growing burden. Evidence suggests that healthcare providers may be underdiagnosing and undertreating ACS, leading to poor health outcomes. The goal of this study was to examine provider perspectives on barriers to ACS care in Tanzania in order to identify opportunities for interventions to improve care. Methods Semistructured in-depth interviews were conducted with physicians and clinical officers from emergency departments and outpatient departments in northern Tanzania. Thematic analysis was conducted using an iterative cycle of coding and consensus building. Results The 11 participants included six physicians and five clinical officers from health centers, community hospitals and one referral hospital. Providers identified barriers related to providers, systems and patients. Provider-related barriers included inadequate training regarding ACS and poor application of textbook-based knowledge. System-related barriers included lack of diagnostic equipment, unavailability of treatments, referral system delays, lack of data regarding disease burden, absence of locally relevant guidelines and cost of care. Patient-related barriers included inadequate ACS knowledge, inappropriate healthcare-seeking behavior and non-adherence. Conclusions This study identified actionable barriers to ACS care in northern Tanzania. Multifaceted interventions are urgently needed to improve care.

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