Early indirect impact of COVID-19 pandemic on utilisation and outcomes of reproductive, maternal, newborn, child and adolescent health services in Kenya: A cross-sectional study

The paper determined the initial impact of COVID-19 pandemic on reproductive, maternal, newborn, child and adolescent health (RMNCAH) services in Kenya. Hospital data for the first four months (March-June 2020) of the pandemic and the equivalent period in 2019 were compared using two-sample test of proportions. Despite the global projections for worse indicators, there were no differences in monthly mean (±SD) attendance between March-June 2019 vs 2020 for antenatal care (400,191.2±12,700.0 vs 384,697.3±20,838.6), hospital births (98,713.0±4,117.0 vs 99,634.5±3,215.5), family planning attendance (431,930.5±19,059.9 vs 448,168.3±31,559.8), post-abortion care (3,206.5±111.7 vs 448,168.3±31,559.8) and pentavalent 1 immunisation (114,701.0±3,701.1 vs 110,915.8±7,209.4), p>0.05. However, there were significant increases in FP utilisation among young people (25.7% to 27.0%), injectable (short-term) FP method uptake (58.2% to 62.3%), caesarean section rate (14.6% to 15.8%), adolescent maternal deaths (6.2% to 10.9%) and fresh stillbirths (0.9% to 1.0%) with a reduction in implants (long-term) uptake (16.5% to 13.0%) (p<0.05). With uncertainty around the duration of the pandemic, strategies to mitigate against catastrophic indirect maternal health outcomes are urgently needed. (Afr J Reprod Health 2021; 25[6]: 76-87)

Practice and outcomes of neonatal resuscitation for newborns with birth asphyxia at Kakamega County General Hospital, Kenya: a direct observation study

Abstract Background About three – quarters of all neonatal deaths occur during the first week of life, with over half of these occurring within the first 24 h after birth. The first minutes after birth are critical to reducing neonatal mortality. Successful neonatal resuscitation (NR) has the potential to prevent these perinatal mortalities related to birth asphyxia. This study described the practice of NR and outcomes of newborns with birth asphyxia in a busy referral hospital. Methods Direct observations of 138 NRs by 28 healthcare providers (HCPs) were conducted using a predetermined checklist adapted from the national pediatric resuscitation protocol. Descriptive statistics were computed and chi – square tests were used to test associations between the newborn outcome at 1 h and the NR processes for the observed newborns. Logistic regression models assessed the relationship between the survival status at 1 h versus the NR processes and newborn characteristics. Results Nurses performed 72.5% of the NRs. A warm environment was maintained in 71% of the resuscitations. Airway was checked for almost all newborns (98%) who did not initiate spontaneous breathing after stimulation. However, only 40% of newborns were correctly cared for in case of meconium presence in airway. Bag and mask ventilation (BMV) was initiated in 100% of newborns who did not respond to stimulation and airway maintenance. About 86.2% of resuscitated newborns survived after 1 h. Removing wet cloth (P = 0.035, OR = 2.90, CI = 1.08–7.76), keeping baby warm (P = 0.018, OR = 3.30, CI = 1.22–8.88), meconium in airway (P = 0.042, OR = 0.34, CI = 0.12–0.96) and gestation age (P = 0.007, OR = 1.38, CI = 1.10–1.75) were associated with newborn outcome at 1 h. Conclusions Mentorship and regular cost – effective NR trainings with focus on maintaining the warm chain during NR, airway maintenance in meconium presence, BMV and care for premature babies are needed for HCPs providing NR

Educators’ perceptions of the early impact of COVID-19 on midwifery training in Kenya: a cross-sectional survey

Background This paper presents a descriptive analysis of the perceptions of Kenyan midwifery educators regarding the early impact of coronavirus disease 2019 (COVID-19) on the continuity of midwifery education. Methods A cross-sectional online survey was conducted among 51 midwifery/clinical medicine educators from 35 diploma training colleges from all eight regions of Kenya. Educators’ concerns and satisfaction regarding the delivery of training during the early phases of the pandemic were expressed as proportions on a three-point Likert scale. Results Of the educators, 76% were extremely concerned about face-to-face teaching during the pandemic; 96% of educators had started delivering virtual teaching (VT), with only 41% being extremely confident in facilitating VT; and 97% were unsatisfied with the measures in place in their institutions to continue face-to-face teaching. Conclusion To minimise the impact of COVID-19 on midwifery education in Kenya, capacity building for VT and mitigation measures for safe in-person training are urgently needed