Community health worker interventions are key to optimal infant immunization coverage, evidence from a pretest-posttest experiment in Mwingi, Kenya

Introduction: Immunization is a powerful and cost-effective health intervention which averts an estimated 2 to 3 million deaths every year. Kenya has a high infant and under five mortality and morbidity rates. Increasing routine child immunization coverage is one way of reducing child morbidity and mortality rates in Kenya. Community Health Workers (CHWs) have emerged as critical human resources for health in developing countries. The Community Strategy (CS) is one of the CHW led interventions promoting Maternal and Child Health (MCH) in Kenya. This studysought to establish the effect of CS on infant vaccination Coverage (IVC) in Mwingi west sub-county; Kenya. Methods: This was a pretest - posttest experimental study design with 1 pretest and 2 post-test surveys conducted in intervention and control sites. Mwingi west and Mwingi north sub-counties where intervention and control sites respectively. Sample size in each survey was 422 households. Women with a child aged 9-12 months were main respondents.Results: intervention site end-term evaluation indicated that; the CS increased IVC by 10.1% (Z =6.0241, P <0.0001), from a suboptimal level of 88.7% at baseline survey to optimal level of 98.8% at end term survey. Infants in intervention site were 2.5 times more likely to receive all recommended immunizations within their first year of life [(crude OR= 2.475, P<0.0001; 95%CI: 1.794-3.414) (adj. OR=2.516, P<0.0001; 95%CI: 1.796-3.5240)].Conclusion: CS increased IVC in intervention site to optimal level (98.8%). To improve child health outcomes through immunization coverage, Kenya needs to fast-track nationwide implementation of the CS intervention. Key words: Community health workers, maternal and child health, vaccination coverag

Quality Assurance for Occupational Health and Safety Administration (OSHA) In the Morgue: The Impact of SOP Domestication on Implementation and Practice of Universal Safety Precautions in Kenya

The growing need for mortuary services in sub-Saharan Africa amid competing priorities poses occupational health and Safety (OHS) challenges to industry stakeholders.  OHS Administration (OSHA) in the healthcare sector in sub-Saharan Africa has not only been overlooked on the assumption that the sector is a ‘safe zone’ given that “health” is its core mandate, but morgues have been sidelined in resource allocation losing out to presumed priority areas like maternal and child health. Quality implementation of universal safety precautions is however critical in such risky work environments as the morgues. While deliberate morgue safety quality assurance (QA) efforts have been made, emerging data raises an alarm.  In over 2.3 million fatalities reported annually in hospital environment related accidents and diseases, morgues are a contributor.  However there is lack of information on OHS exposures among mortuary workers in the light of rapid expansions.  This study investigated the quality assurance for OSHA in morgues specifically the impact of standard operating procedures (SOP) domestication on practice of universal safety precautions in government mortuaries in Kenya. This was a cross-sectional survey targeting a saturated sample of 39 facilities out of a population of 97 randomly sampled from 3,448 government health facilities.  A research model instrument, the Morgue OHS-Hazard Identification Risk Assessment and Control (HIRAC) survey comprising 30 variables developed from the principles of universal mortuary safety precautions was used to collect data.  100% (39) response rate was achieved.  The tool tested the presence and implementation of the universal precautions in a scale of 1-5 and the variables used for stratification to identify factors that correlate with major constructs and relationships between factors determined by Spearman’s rank correlation analyses.  The result shows cases of “Universal Precautions fully in Place” at 9.8%, “Universal Precautions Partially (Certain Elements) in Place” 27.8%, while cases of “No Universal Precautions in Place” at 62.4%.  In addition, a correlation was observed between the presence of SOPs and the practice of universal precautions in the morgues (P£0.05).  Regression analysis revealed approximately 70% (r=0.7) of variance in presence of SOPs as the determinant factor and the practice of individual elements of universal precautions namely; staff protection through vaccination (P=0.502**) Appropriate ventilation systems (P=0.535**) provision of appropriate equipment e.g. power-saws (P=0.658**); Use of additional PPE when gross contamination is anticipated (P=0.664**) and Respiratory protection measures at (P=0.726**) among others. This study confirms an empirical relationship between SOP domestication and the practice of universal precautions in government owned morgues in Kenya. Results show that morgues which had SOPs were largely compliant with universal safety precautions as opposed to those without SOPs.  The findings are significant in improving quality assurance for OHSA in the mortuaries and healthcare sector in Kenya. Keywords: Practice, Occupational Safety and Health (OHS), Universal Precautions, Mortuary/Morgue, Workers, Public Health Facilities

Provider knowledge of treatment policy and dosing regimen with artemether-lumefantrine and quinine in malaria-endemic areas of western Kenya

BACKGROUND: Due to widespread anti-malarial drug resistance in many countries, Kenya included, artemisinin-based Combination Therapy (ACT) has been adopted as the most effective treatment option against malaria. Artemether-lumefantrine (AL) is the first-line ACT for treatment of uncomplicated malaria in Kenya, while quinine is preferred for complicated and severe malaria. Information on the providers’ knowledge and practices prior to or during AL and quinine implementation is scanty. The current study evaluated providers’ knowledge and practices of treatment policy and dosing regimens with AL and quinine in the public, private and not-for-profit drug outlets. METHODS: A cross-sectional survey using three-stage sampling of 288 (126 public, 96 private and 66 not-for-profits) providers in drug outlets was conducted in western Kenya in two Plasmodium falciparum-endemic regions with varying malarial risk. Information on provider in-service training, knowledge (qualification, treatment policy, dosing regimen, recently banned anti-malarials) and on practices (request for written prescription, prescription of AL, selling partial packs and advice given to patients after prescription), was collected. RESULTS: Only 15.6% of providers in private outlets had received any in-service training on AL use. All (100%) in public and majority (98.4%) in not-for-profit outlets mentioned AL as first line-treatment drug. Quinine was mentioned as second-line drug by 47.9% in private outlets. A total of 92.0% in public, 57.3% in private and 78.8% in not-for-profit outlets stated correct AL dose for adults. A total of 85.7% of providers in public, 30.2% in private and 41.0% in not-for-profit outlets were aware that SP recommendations changed from treatment for mild malaria to IPTp in high risk areas. In-service training influenced treatment regimen for uncomplicated malaria (P = 0.039 and P = 0.039) and severe malaria (P < 0.0001 and P = 0.002) in children and adults, respectively. Most (82.3%) of private outlets sell partial packs of AL while 72.4% do not request for written prescription for AL. In-service training influenced request for written prescription (P = 0.001), AL prescription (P < 0.0001) and selling of partial packs (P < 0.0001). CONCLUSION: Public-sector providers have higher knowledge on treatment policy and dosing regimen on recommended anti-malarials. Changes in treatment guidelines should be accompanied by subsequent implementation activities involving all sector players in unbiased strategies

Factors Associated with Choice of Infant Feeding Practices among HIV-1 Positive Post-natal Clinic Attendees in Tharaka Nithi County

Background: Feeding practices for HIV-exposed infants plays a key role in determining the risk of morbidity and mortality. Infected mothers’ choice of infant feeding is influenced by many factors within the community hence challenging their decisions. We sought to determine factors associated with choice of HIV exposed infant feeding practices in the region. Methods: Two hundred and forty nine HIV infected mothers were systematically recruited.  Data on infant HIV status was obtained from facility records. Respondents were interviewed using a semi-structured questionnaire. Focus group discussions and key informant interviews were carried out to support primary data. Analysis was done using SPSS version 16.0. Logistic regression was used to determine association of factors that influenced choice of infant feeding practice. Results: Of the 249 respondents, 98% chose exclusively breastfeeding during prenatal counseling but majority did not sustain beyond 2 months, while replacement feeding was least practiced (2%) postnatal. Major factors that influenced feeding practices were mother’s education (OR 2.637; CI: 1.088-6.388), non-health care workers advise (OR 3.053; CI: 1.706-5.463), not belonging to support groups (OR 2.804; CI: 1.620-4.854) rejection of health care workers support (OR 3.386; CI: 1.937-5.919). Conclusion: Although exclusive breastfeeding was the preferred feeding choice among the respondents immediately after birth, it was not sustained beyond the second month of the infant’s life. Increased contact of HIV positive women with health care workers and professionals through promotion of trust in community health workers, attendance of ANC and delivery in hospital should be promoted.  Education efforts should also target non health care persons who influence feeding practices to reduce stigma among HIV positive mothers. Keywords:  Infant feeding practices; Stigm

Determinants of parents’ intention to vaccinate their children aged 12–17 years against COVID-19 in North Kivu (Democratic Republic of Congo)

Parents are facing tremendous stress in relation to the COVID-19 pandemic and the effectiveness of the COVID-19 vaccination program for children. We aimed to investigate parents’ willingness to vaccinate their children against COVID-19 in North Kivu province, (Democratic Republic of Congo). A cross-sectional survey between 1 December 2021 to 20 January 2022 in six health zones (Goma, Karisimbi, Butembo, Beni, Kamango, and Katwa) was conducted in the province of North Kivu. In each health zone, we selected five clusters (Health area) using the method of probabilistic selection proportional to population size. In total, 522 parents participated in our study. Results: Overall, 32.8% of parents intended to vaccinate their children. In the multivariate analysis, a younger age of parents (aOR: 2.40, CI: [1.50–3.83]), a higher level of fear that “a member of my family” could contract COVID-19 (aOR: 2.35, CI: [1.38–4.02]), a higher level of perceived vulnerability to COVID-19 within the family (aOR: 1.70, CI: [1.005–2.2881]), a higher level of perceived susceptibility to COVID-19 within the family (aOR: 3.07, CI: [1.80–5.23]), and a history of vaccination against COVID-19 among parents (aOR: 16.47, CI: [8.39–32.33]), were all significantly associated with the intention of parents to have their children or adolescents vaccinated. According to the different explanatory factors of the will to have their children vaccinated, an emphasis on the health education of parents who are prone to refusal or hesitation of the vaccine, by addressing the common reasons for the refusal of the vaccine and highlight the vaccine’s benefits

Voluntary medical male circumcision scale-up in Nyanza, Kenya: evaluating technical efficiency and productivity of service delivery.

BACKGROUND:Voluntary medical male circumcision (VMMC) service delivery is complex and resource-intensive. In Kenya's context there is still paucity of information on resource use vis-à-vis outputs as programs scale up. Knowledge of technical efficiency, productivity and potential sources of constraints is desirable to improve decision-making. OBJECTIVE:To evaluate technical efficiency and productivity of VMMC service delivery in Nyanza in 2011/2012 using data envelopment analysis. DESIGN:Comparative process evaluation of facilities providing VMMC in Nyanza in 2011/2012 using output orientated data envelopment analysis. RESULTS:Twenty one facilities were evaluated. Only 1 of 7 variables considered (total elapsed operation time) significantly improved from 32.8 minutes (SD 8.8) in 2011 to 30 minutes (SD 6.6) in 2012 (95%CI = 0.0350-5.2488; p = 0.047). Mean scale technical efficiency significantly improved from 91% (SD 19.8) in 2011 to 99% (SD 4.0) in 2012 particularly among outreach compared to fixed service delivery facilities (CI -31.47959-4.698508; p = 0.005). Increase in mean VRS technical efficiency from 84% (SD 25.3) in 2011 and 89% (SD 25.1) in 2012 was not statistically significant. Benchmark facilities were #119 and #125 in 2011 and #103 in 2012. Malmquist Productivity Index (MPI) at fixed facilities declined by 2.5% but gained by 4.9% at outreach ones by 2012. Total factor productivity improved by 83% (p = 0.032) in 2012, largely due to progress in technological efficiency by 79% (p = 0.008). CONCLUSIONS:Significant improvement in scale technical efficiency among outreach facilities in 2012 was attributable to accelerated activities. However, ongoing pure technical inefficiency requires concerted attention. Technological progress was the key driver of service productivity growth in Nyanza. Incorporating service-quality dimensions and using stepwise-multiple criteria in performance evaluation enhances comprehensiveness and validity. These findings highlight site-level resource use and sources of variations in VMMC service productivity, which are important for program planning

Service quality ranking by cases in 2011 and 2012 and by facility in 2012.

<p>Service quality ranking by cases in 2011 and 2012 and by facility in 2012.</p

Scree plot showing distribution of factors by their eigenvalues.

<p>A Scree plot of eigenvalues of the unrotated factors displaying an ‘elbow’ of the plot (shown by the red arrow). This point of the curve represents the threshold chosen for retention of the initial factors extracted from the observed variables and which maximize the variance accounted for. Three factors, each respectively with eigenvalues of 5.78; 4.29; 2.99 were retained. These factors cumulatively accounted for 29.1% of the total variance (12.9%; 9.5%; 6.7%) with final communality estimates being 13.06. The shallow “scree” distal to the arrow demonstrates small extent of variance accounted for by the subsequent minor factors, which were deleted.</p

Table showing model input and output variables and their definitions.

<p>Table showing model input and output variables and their definitions.</p

Overall facility ranking by weighted quality scores.

<p>Overall facility ranking by weighted quality scores.</p