Charlotte Warren, Timothy Abuya and Wilson Liambila (Population Council); Kezia K’Oduol (KPA/KEPRECON); and Jesse Gitaka (Mount Kenya University)
The treatment of possible serious bacterial infection (PSBI) in young infants is a challenge in rural areas where families with sick infants have poor access to care.
The World Health Organization’s (WHO) recommendation for managing newborn and young infant infection is referral to a hospital for treatment with a seven- or ten-day course of two injectable antibiotics– penicillin or ampicillin plus gentamicin. However, in light of research showing that many young infants with signs of serious infection do not receive the recommended inpatient treatment because such treatment is not accessible, acceptable or affordable to families, WHO developed a recommendation for use in resource-limited settings where referral is not feasible. These guidelines also provide recommendations on the role of community health workers and home visits to identify signs of serious infections in young infants. These revised guidelines are based on new research in both Africa (DRC, Kenya, and Nigeria) and Asia (Bangladesh, Pakistan).
Population Council is leading a consortium (comprised of Mount Kenya University and the Kenya Paediatric Association) to implement Ponya Mtoto (treat the baby in Kiswahili) to understand how to introduce and sustain these new guidelines in primary health care facilities and in outpatient departments of hospitals.
Population Council is undertaking formative research to assess county readiness to manage possible serious bacterial infections (PSBI) in young infants. Ponya Mtoto, in consultation with the Kenya Ministry of Health, is implementing the study activities in four counties that have a range of geographic and socio-cultural dynamics (see study counties and characteristics). Since geographic coverage and access to services is challenging in each county, Ponya Mtoto researchers are assessing where PSBI management can be embedded within the health system to improve coverage and access to health services, particularly for the management of newborn and young infant infections.
Study Counties and Characteristics
- Located in the Northern region; semi-arid
- Nomadic population
- Geographical challenges when accessing services (e.g. distance to a health facility)
- Displays socio-cultural challenges affecting urban Kenya
In June and July 2018, Ponya Mtoto conducted fieldwork in the four counties to assess the feasibility, acceptability, and sustainability of introducing and implementing the new WHO PSBI guidelines in a range of Kenyan settings where referral is not feasible. The aim was to find out whether PSBI management was possible at the primary health care level if linked to the community level. Additionally, the project aims to understand the best mechanism to ensure PSBI management is embedded into existing service delivery systems and how those systems could be scaled up.
Surveys, feasibility assessments, focus group discussions, and in-depth interviews were used to obtain health facility data and diverse opinions from key demographic groups. Researchers first conducted a facility readiness assessment which consisted of a checklist and survey. This was followed up with qualitative interviews with mothers and providers. Interviews with healthcare providers focused on understanding their perspective regarding the strengths and limitations of the current health system. Further probing also identified healthcare providers’ treatment regimens and their thoughts on the standard treatment guidelines. Researchers asked mothers similar questions to gain their perspective of health services, the treatment their newborn received, and their overall thoughts on the treatment their provider selected.
County and sub-county facility comparisons furthered understanding of the capacity to implement PSBI management in line with WHO recommended Integrated Management of Newborn and Childhood Illness (IMNCI) guidelines. Researchers assessed eight areas of the health system and provided 3 scores: green (above 70%); amber (50-69%); and, red (below 50%). The color-coded scoring system is a simple and effective way of presenting data to policymakers. Researchers also conducted partner mapping analyses to assess activities and support from other implementing partners in the same health facilities. This helped to identify existing programs where IMNCI guidelines could be embedded.
Finally, several key themes emerged during the interviews with mothers and fathers with infants. These themes uncovered the challenges of infant care, and reasons affecting care-seeking behavior – including, the decision-making process, barriers, and referral processes.
These findings will support implementation research by using results to inform and revise intended activities in each county. They will help Ponya Mtoto and the Ministry of Health design activities to ensure more sick babies can get the medicine they need – even when they live far from health facilities. For example, policy briefs will be created for each of the 4 counties that participated in the formative research. Implementers will also create IMNCI materials for caregivers and providers, further promoting advocacy and knowledge exchange.
Key results from the assessment will be shared with the counties, sub-counties, and facilities, who plan to embed the revised guidelines in their respective systems as routine care. After six months Ponya Mtoto will repeat a mini-assessment in each county to review how well the guidelines are integrated. As a result of this formative research, continued progress is expected in adopting IMNCI guidelines within county health systems to manage PSBI in young infants.