Assessment of knowledge on neonatal resuscitation amongst health care providers in Kenya

Introduction: Competence in neonatal resuscitation, which represents the most urgent pediatric clinical situation, is critical in delivery rooms to ensure safety and health of newly born infants. The challenges experienced by health care providers during this procedure are unique due to different causes of cardio respiratory arrest. This study aimed at assessing the knowledge of health providers on neonatal resuscitation. Methods: Data were gathered among 192 health providers drawn from all counties of Kenya. The clinicians were asked to complete questionnaires which were in two parts as; demographic information and assessment of their knowledge by different scenarios which were formatted in the multiple choice questions. Data were analyzed using SPSS version 15.0 for windows. The results are presented using tables. Results: All the participants were aged 23 years and above with at least a certificate training. Most medical providers had heard of neonatal resuscitation (85.4%) with only 23 receiving formal training. The average duration of neonatal training was 3 hours with 50% having missed out on practical exposure. When asked on steps of resuscitation, only 68 (35.4%) of the participants scored above 85%. More than 70% of them considered their knowledge about neonatal resuscitation inadequate and blamed it on inadequate medical training programs. Conclusion: Health providers, as the key personnel in the management of neonatal resuscitation, in this survey seem to have inadequate training and knowledge on this subject. Increasing the duration and quality of formal training should be considered during the pre-service medical education to ensure acceptable neonatal outcome

Hepatitis A Antibody Seroprevalence in a Selected Kenyan Pediatric Population

The incidence of infection by Hepatitis A virus shows regional variation being highest in developing countries. Determination of age specific Hepatitis A virus (HAV) seroprevalence and the associated risk factors would help better plan for national preventive strategies including vaccination. We carried out a cross-sectional study on 300 children from Nairobi city, Kenya during the years 2003-2004. The age range of the children was 2 - 14 years and were from low and high socioeconomic status (SES) families. The indicators of SES included employment status, residence, number of children per patient’s household, parents’ level of education and source of drinking water. SES was encoded and analysed using Statistical Program for Social Sciences (SSPS) version 16.0. Seroprevalence increased significantly with advancing age. Seropositivity of HAV antibodies was significantly higher among children of low SES, 77.6% by the age of 14 years compared to children of high SES, 38.9% by the same age. Crowded household and parental education were significantly associated with high seropositivity and seronegativity respectively. There is significant rate of seronegativity amongst the studied population especially those from richer backgrounds making them more susceptible to severe infection in future with concomitant complications. We propose that revision of national vaccination program should be considered to include Hepatitis A vaccination

Not just surveys and indicators: narratives capture what really matters for health system strengthening

Health system strengthening remains elusive and challenging. Health systems in many countries in sub-Saharan Africa are frequently characterised as weak, with inadequate management and accountability mechanisms, and poor human and financial resources. Putting patients and staff at the heart of health systems is an essential step towards strengthening them. As one of the three pillars of quality in health care, understanding patient experiences is key to moving towards people-centred care. Yet patient experiences are not a singular concept. Patient narratives can convey individual experiences of illness and health care, which complement and augment epidemiological and public health evidence. These narratives, gathered with rigorous, interview-based research and shared with digital tools (audio and video), can generate persuasive evidence. This evidence has important potential for influencing policy and practice, and for supporting people-centred care, but has not been tested systematically in low-income countries. In the Kenyan context of newborn health, work under way is generating evidence to show the transformative potential of patient narratives

Prevalence and missed cases of respiratory distress syndrome disease amongst neonatal deaths enrolled in the Kenya Child Health and Mortality Prevention Surveillance Network (CHAMPS) program between 2017 and 2021

Objectives: To describe RDS in neonatal deaths at the CHAMPS-Kenya site between 2017 and 2021. Methods: We included 165 neonatal deaths whose their Causes of death (COD) were determined by a panel of experts using data from post-mortem conducted through minimally invasive tissue specimen testing, clinical records, and verbal autopsy. Results: Twenty-six percent (43/165) of neonatal deaths were attributable to RDS. Most cases occurred in low birthweight and preterm neonates. From these cases, less than half of the hospitalizations were diagnosed with RDS before death, and essential diagnostic tests were not performed in most cases. Most cases received suboptimal levels of supplemental oxygen, and critical interventions like surfactant replacement therapy and mechanical ventilation were not adequately utilized when available. Conclusion: The study highlights the urgent need for improved diagnosis and management of RDS, emphasizing the importance of increasing clinical suspicion and enhancing training in its clinical management to reduce mortality rates

Child deaths caused by Klebsiella pneumoniae in sub-Saharan Africa and south Asia: a secondary analysis of Child Health and Mortality Prevention Surveillance (CHAMPS) data

Background: Klebsiella pneumoniae is an important cause of nosocomial and community-acquired pneumonia and sepsis in children, and antibiotic-resistant K pneumoniae is a growing public health threat. We aimed to characterise child mortality associated with this pathogen in seven high-mortality settings. Methods: We analysed Child Health and Mortality Prevention Surveillance (CHAMPS) data on the causes of deaths in children younger than 5 years and stillbirths in sites located in seven countries across sub-Saharan Africa (Ethiopia, Kenya, Mali, Mozambique, Sierra Leone, and South Africa) and south Asia (Bangladesh) from Dec 9, 2016, to Dec 31, 2021. CHAMPS sites conduct active surveillance for deaths in catchment populations and following reporting of an eligible death or stillbirth seek consent for minimally invasive tissue sampling followed by extensive aetiological testing (microbiological, molecular, and pathological); cases are reviewed by expert panels to assign immediate, intermediate, and underlying causes of death. We reported on susceptibility to antibiotics for which at least 30 isolates had been tested, and excluded data on antibiotics for which susceptibility testing is not recommended for Klebsiella spp due to lack of clinical activity (eg, penicillin and ampicillin). Findings: Among 2352 child deaths with cause of death assigned, 497 (21%, 95% CI 20–23) had K pneumoniae in the causal chain of death; 100 (20%, 17–24) had K pneumoniae as the underlying cause. The frequency of K pneumoniae in the causal chain was highest in children aged 1–11 months (30%, 95% CI 26–34; 144 of 485 deaths) and 12–23 months (28%, 22–34; 63 of 225 deaths); frequency by site ranged from 6% (95% CI 3–11; 11 of 184 deaths) in Bangladesh to 52% (44–61; 71 of 136 deaths) in Ethiopia. K pneumoniae was in the causal chain for 450 (22%, 95% CI 20–24) of 2023 deaths that occurred in health facilities and 47 (14%, 11–19) of 329 deaths in the community. The most common clinical syndromes among deaths with K pneumoniae in the causal chain were sepsis (44%, 95% CI 40–49; 221 of 2352 deaths), sepsis in conjunction with pneumonia (19%, 16–23; 94 of 2352 deaths), and pneumonia (16%, 13–20; 80 of 2352 deaths). Among K pneumoniae isolates tested, 121 (84%) of 144 were resistant to ceftriaxone and 80 (75%) of 106 to gentamicin. Interpretation: K pneumoniae substantially contributed to deaths in the first 2 years of life across multiple high-mortality settings, and resistance to antibiotics used for sepsis treatment was common. Improved strategies are needed to rapidly identify and appropriately treat children who might be infected with this pathogen. These data suggest a potential impact of developing and using effective K pneumoniae vaccines in reducing neonatal, infant, and child deaths globally

Iron deficiency anaemia in children of a peri-urban health facility

Objective: To ascertain the prevalence of iron deficiency anaemia(IDA) and its risk factors. Design: A cross -sectional survey. Setting: A peri-urban health centre in Nairobi, Kenya. Subjects: Four hundred and three children, aged six months to six years. Intervention: Demographic data were obtained and each child examined for signs of iron deficiency anaemia. Blood was drawn for haemoglobin determination. Main outcome measure: The diagnosis of iron deficiency anaemia was made using a pre-defined criteria. Results: Iron deficiency anaemia had a prevalence of 7.4% (95% CI=4.8-10.0) and was predominantly mild (93.6%). Age was found to be significantly associated with iron deficiency anaemia with a prevalence of (14.6%) in infants. No association was found between IDA and sex, birthweight, weaning age and weaning diet, sanitation, water source or mother\u27s education. Conclusion: The prevalence of iron deficiency anaemia in this health facility was relatively low and was predominantly mild

A survey of barriers and facilitators to caffeine use for apnoea of prematurity in low- and middle-income countries

Background: Despite its associated benefits which include better long-term pulmonary and neurodevelopmental outcome, the use of caffeine for apnoea of prematurity (AoP) has been limited in low- and middle-income countries (LMIC) Aim: To better understand current caffeine use, the barriers and facilitators to its use and perceptions and practices in LMIC which have a disproportionately high burden of prematurity. Methods: An anonymous online global survey was conducted, targeting healthcare providers working and training in paediatrics and/or neonatology in LMIC. Results: A total of 181 respondents in 16 LMIC were included in the analysis; most were physicians working in publicly-funded urban tertiary hospitals. Most had received training in the use of caffeine for AoP (77%), reported expertise (70%) and confidence (96%) in its use, and had access to caffeine (65%). Caffeine availability was reported to be the greatest barrier (48%) and the greatest facilitator (37%). Other common barriers included cost (31%), access (7%) and policies or guidelines on caffeine use (7%); other common facilitators included policies or guidelines on caffeine use (11%), access (10%), staff/other providers’ acceptance of caffeine as an appropriate treatment (9%) and the availability of staff to administer caffeine (8%). Most (79%) noted that access to caffeine was important, 92% agreed that caffeine improves quality of care, and 95% agreed that caffeine improves patient outcome. Conclusion: Improving availability and access to low-cost caffeine will be key to increasing caffeine use in LMIC

Retinopathy of prematurity in Kenya: prevalence and risk factors in a hospital with advanced neonatal care

Introduction: Increased survival of preterm babies in sub-saharan Africa has held to an increasing prevalence of Retinopathy of prematurity (ROP). This study was done to determine the ROP prevalence in a hospital with advanced neonatal care in urban Kenya. Methods: A hospitalbased retrospective review of the records of premature infants screened for ROP between January 2010 and December 2015. Records of all premature infants screened for ROP in the neonatal unit and outpatient eye clinic were extracted. Information on Birth weights, Gestational age, Maternal risk factors (mode of delivery, pre-eclampsia/eclampsia) and Neonatal risk factors (neonatal sepsis, days on oxygen, blood transfusion) was recorded in a questionnaire then analysed. Results: 103 infants were included in the study. Mean gestational age was 29.9 ± 2.2 weeks and the mean birth weight was 1280.1 ± 333.0 grams. Forty-three infants were diagnosed with ROP, a prevalence of 41.7%. Majority of these had Stage 1 or 2 ROP in Zone II, which spontaneously regressed with follow up. Nine infants were diagnosed with vision-threatening ROP (any Zone I disease or Stage 2/3 disease in Zone II with plus disease), a prevalence of 20.9%. All of these underwent laser treatment in the neonatal unit. The most significant risk factor was low gestational age. Other risk factors identified were: low birth weight and blood transfusions. Conclusion: ROP prevalence in sub-saharan Africa will match those in middle-income and high income countries in neonatal units with advanced care and low mortality

A survey of barriers and facilitators to caffeine use for apnoea of prematurity in low- and middle-income countries

Despite its associated benefits which include better long-term pulmonary and neurodevelopmental outcome, the use of caffeine for apnoea of prematurity (AoP) has been limited in low- and middle-income countries (LMIC). To better understand current caffeine use, the barriers and facilitators to its use and perceptions and practices in LMIC which have a disproportionately high burden of prematurity. An anonymous online global survey was conducted, targeting healthcare providers working and training in paediatrics and/or neonatology in LMIC. A total of 181 respondents in 16 LMIC were included in the analysis; most were physicians working in publicly-funded urban tertiary hospitals. Most had received training in the use of caffeine for AoP (77%), reported expertise (70%) and confidence (96%) in its use, and had access to caffeine (65%). Caffeine availability was reported to be the greatest barrier (48%) and the greatest facilitator (37%). Other common barriers included cost (31%), access (7%) and policies or guidelines on caffeine use (7%); other common facilitators included policies or guidelines on caffeine use (11%), access (10%), staff/other providers’ acceptance of caffeine as an appropriate treatment (9%) and the availability of staff to administer caffeine (8%). Most (79%) noted that access to caffeine was important, 92% agreed that caffeine improves quality of care, and 95% agreed that caffeine improves patient outcome. Improving availability and access to low-cost caffeine will be key to increasing caffeine use in LMIC. AoP: Apnoea of Prematurity; LMIC: low- and middle-Income countries; REDCap: Research Electronic Data Capture.</p

‘Sometimes you are forced to play God…’: a qualitative study of healthcare worker experiences of using continuous positive airway pressure in newborn care in Kenya

​Objective: To explore the experiences of using continuous positive airway pressure (CPAP) in newborn care among healthcare workers in Kenya, and to identify factors that would promote successful scale-up. ​Design and setting: A qualitative study using key informant interviews and focus group discussions, based at secondary and tertiary level hospitals in Kenya. ​Participants: Healthcare workers in the newborn units providing CPAP. ​Primary and secondary outcome measure: Facilitators and barriers of CPAP use in newborn care in Kenya. ​Results: 16 key informant interviews and 15 focus group discussions were conducted across 19 hospitals from September 2017 to February 2018. Main barriers reported were: (1) inadequate infrastructure to support the effective delivery of CPAP, (2) shortage of skilled staff rendering it difficult for the available staff to initiate or monitor infants on CPAP and (3) inadequate knowledge and training of staff that inhibited the safe care of infants on CPAP. Key facilitators reported were positive patient outcomes after CPAP use that increased staff confidence and partnership with caregivers in the management of newborns on CPAP. Healthcare workers in private/mission hospitals had more positive experiences of using CPAP in newborn care as the relevant support and infrastructure were available. ​Conclusion: CPAP use in newborn care is valued by healthcare workers in Kenya. However, we identified key challenges that threaten its safe use and sustainability. Further scale-up of CPAP in newborn care should ensure that staff members have ready access to optimal training on CPAP and that there are enough resources and infrastructure to support its use. Ethics: This study was approved through the appropriate ethics committees in Kenya and the UK (see in text) with written informed consent for each participant