A system approach to improving maternal and child health care delivery in Kenyan communities and primary care facilities: baseline survey on maternal health

Background: Maternal, fetal and neonatal mortality are 10 to 100 fold higher in many low-income compared to high-income countries. Reasons for these discrepancies include limited antenatal care and delivery outside health facilities.Objectives: The study aimed at conducting a baseline survey to assess the current levels of maternal health indicators in six counties in Western Kenya.Methods: This was a cross sectional study conducted targeting women residing in Uasin-Gishu, ElgeyoMarakwet, TransNzoia, Bungoma, Busia and Kakamega counties who had given birth five years prior to the interview. Socio-demographic and maternal indicators were collected using forms adopted from KDHS 2009. Interviews were conducted in the homesteads between December 2015 and June 2016.Results: A total of 6257 women participated in the study, median age 27 years IQR 23-32. Majority of the women had post-primary level of education, were married and 40% were members of an income-generating activity. 56.8% were using modern family planning method, 49% attended WHO recommended four plus antenatal clinic visits and only 20% attended in the first trimester. Majority, 85% had their most recent delivery in a health facility.Conclusion: Findings suggest that women are not attending recommended four plus antenatal clinic visits and even those that attend are few are during the first trimester.Keywords: System approach, maternal and child health care, Kenyan communities

A consensus on malnutrition in Africa: A report from the micronutrient deficiency awareness forum (Nairobi 2017)

While most forms of malnutrition are easy to identify at an early age, micronutrient deficiency also manifests in form of “Hidden Hunger”, where children could seem to be well fed, but still suffer from deficiencies due to lack of key micronutrients in their diets whose absence is hard to detect. While the symptoms of micronutrient deficiency may not be obvious in the short-term, they translate into cognitive deficiencies in the longterm that negatively affect the economic productivity of these infants when they become adults, perpetuating the malnutrition cycle. The Micronutrient Deficiency Awareness Forum was held in April 2017 in Nairobi Kenya, comprising seven specialties from across sub-Saharan Africa. The forum was convened to discuss how to increase awareness of conditions associated with micronutrient deficiencies developing from early childhood, especially those impacting brain development, identify sections of the population that were at high risk of micronutrient deficiencies, outline available guidelines on diagnostic tools, assessment and management of deficiencies, and develop a consensus on best practices in diagnosing, managing, and preventing micronutrient deficiency and malnutrition. It is estimated that 40% of the children in sub-Saharan Africa are affected by stunting, which is the most prevalent form of malnutrition, and an estimated 69-82% of malnutrition cases are not properly treated. This phenomenon is not without a cost, as malnutrition greatly undermines cognitive development, and ultimately economic productivity. A 2014 study revealed that Ethiopia lost the equivalent of 12% of its GDP to malnutrition in 2009. Studies in different countries across the world have shown that focused interventions work. For instance, early childhood macronutrient intervention led to a 46% higher wage in adult years in Guatemala. The Micronutrient Deficiency Awareness Forum 2017 Consensus Report provides suggestions on policy design and implementation strategies that may lead to early detection, treatment, and ultimately prevalence reduction of malnutrition across the region

Characterising Kenyan hospitals' suitability for medical officer internship training: a secondary data analysis of a cross-sectional study

Objective To characterise the capacity of Kenya internship hospitals to understand whether they are suitable to provide internship training for medical doctors. Design A secondary data analysis of a cross-sectional health facility assessment (Kenya Harmonized Health Facility Assessment (KHFA) 2018). Setting and population We analysed 61 out of all 74 Kenyan hospitals that provide internship training for medical doctors. Outcome measures Comparing against the minimum requirement outlined in the national guidelines for medical officer interns, we filtered and identified 166 indicators from the KHFA survey questionnaire and grouped them into 12 domains. An overall capacity index was calculated as the mean of 12 domain-specific scores for each facility. Results The average overall capacity index is 69% (95% CI 66% to 72%) for all internship training centres. Hospitals have moderate capacity (over 60%) for most of the general domains, although there is huge variation between hospitals and only 29 out of 61 hospitals have five or more specialists assigned, employed, seconded or part-time-as required by the national guideline. Quality and safety score was low across all hospitals with an average score of 40%. As for major specialties, all hospitals have good capacity for surgery and obstetrics-gynaecology, while mental health was poorest in comparison. Level 5 and 6 facilities (provincial and national hospitals) have higher capacity scores in all domains when compared with level 4 hospitals (equivalent to district hospitals). Conclusion Major gaps exist in staffing, equipment and service availability of Kenya internship hospitals. Level 4 hospitals (equivalent to district hospitals) are more likely to have a lower capacity index, leading to low quality of care, and should be reviewed and improved to provide appropriate and well-resourced training for interns and to use appropriate resources to avoid improvising

Teachers’ Perception on Implementing the Revised Lower Secondary Curriculum in Selected Schools in Uganda: A Focus on Emerging Issues and Coping Strategies

This study explored teachers’ perception on the implementation of Comptency-based Curriculum (CBC) in lower secondary schools in Uganda that was rolled out in 2020. The shift from the Knowledge-Based Curriculum (KBC) to CBC caused a cultural shock to those who had been nurtured in a purely teacher-centred curriculum! Teachers got challenged over their authority and autonomy in the delivery of instruction. Discussion was centred on teachers’ readiness to implement; pedagogical competences to plan, facilitate and assess CBC. In this phenomenological study, data was collected from 12 randomly selected secondary schools in urban, semi-urban and rural areas of Uganda. The population comprised teachers of Lower Secondary, Directors of Studies and Headteachers. Data was analyzed qualitatively through codes and themes and reported thematically, backed with verbatim quotations and statements from participants. Majority of the teachers were struggling with gaps in planning and content delivery, CBC stimulated hands-on-learning, teachers’ preparedness was considerably low due to lack of prior training, ICT integration was still an uphill task, majority of teachers were still stuck to traditional methodologies. CBC is too demanding and ambitious! NCDC should, therefore, design retooling packages for continuous capacity building, schools should promote peer mentorship, collaboration and Network initiatives

Automatic identification of informative regions with epigenomic changes associated to hematopoiesis

Hematopoiesis is one of the best characterized biological systems but the connection between chromatin changes and lineage differentiation is not yet well understood. We have developed a bioinformatic workflow to generate a chromatin space that allows to classify 42 human healthy blood epigenomes from the BLUEPRINT, NIH ROADMAP and ENCODE consortia by their cell type. This approach let us to distinguish different cells types based on their epigenomic profiles, thus recapitulating important aspects of human hematopoiesis. The analysis of the orthogonal dimension of the chromatin space identify 32,662 chromatin determinant regions (CDRs), genomic regions with different epigenetic characteristics between the cell types. Functional analysis revealed that these regions are linked with cell identities. The inclusion of leukemia epigenomes in the healthy hematological chromatin sample space gives us insights on the healthy cell types that are more epigenetically similar to the disease samples. Further analysis of tumoral epigenetic alterations in hematopoietic CDRs points to sets of genes that are tightly regulated in leukemic transformations and commonly mutated in other tumors. Our method provides an analytical approach to study the relationship between epigenomic changes and cell lineage differentiation. Method availability: https://github.com/david-juan/ChromDet.European Union’s Seventh Framework Programme [FP7/2007–2013, 282510 (BLUEPRINT)]; Spanish Ministry of Economy, Industry and Competitiveness and European Regional Development Fund [Project Retos BFU2015–71241-R]. Funding for open access charge: Project Retos BFU2015–71241-R (to A.V.).Peer ReviewedPostprint (published version

Building Learning Health Systems to Accelerate Research and Improve Outcomes of Clinical Care in Low- and Middle-Income Countries.

Mike English and colleagues argue that as efforts are made towards achieving universal health coverage it is also important to build capacity to develop regionally relevant evidence to improve healthcare

Assessment of neonatal care in clinical training facilities in Kenya.

OBJECTIVE: An audit of neonatal care services provided by clinical training centres was undertaken to identify areas requiring improvement as part of wider efforts to improve newborn survival in Kenya. DESIGN: Cross-sectional study using indicators based on prior work in Kenya. Statistical analyses were descriptive with adjustment for clustering of data. SETTING: Neonatal units of 22 public hospitals. PATIENTS: Neonates aged 20% in prescriptions for penicillin (11.6%, 95% CI 3.4% to 32.8%) and gentamicin (18.5%, 95% CI 13.4% to 25%), respectively. CONCLUSIONS: Basic resources are generally available, but there are deficiencies in key areas. Poor documentation limits the use of routine data for quality improvement. Significant opportunities exist for improvement in service delivery and adherence to guidelines in hospitals providing professional training

A system approach to improving maternal and child health care delivery in Kenyan communities and primary care facilities: baseline survey on maternal health

Background: Maternal, fetal and neonatal mortality are 10 to 100 fold higher in many low-income compared to high-income countries. Reasons for these discrepancies include limited antenatal care and delivery outside health facilities. Objectives: The study aimed at conducting a baseline survey to assess the current levels of maternal health indicators in six counties in Western Kenya. Methods: This was a cross sectional study conducted targeting women residing in Uasin-Gishu, ElgeyoMarakwet, TransNzoia, Bungoma, Busia and Kakamega counties who had given birth five years prior to the interview. Socio-demographic and maternal indicators were collected using forms adopted from KDHS 2009. Interviews were conducted in the homesteads between December 2015 and June 2016. Results: A total of 6257 women participated in the study, median age 27 years IQR 23-32. Majority of the women had post-primary level of education, were married and 40% were members of an income-generating activity. 56.8% were using modern family planning method, 49% attended WHO recommended four plus antenatal clinic visits and only 20% attended in the first trimester. Majority, 85% had their most recent delivery in a health facility. Conclusion: Findings suggest that women are not attending recommended four plus antenatal clinic visits and even those that attend are few are during the first trimester. DOI: https://dx.doi.org/10.4314/ahs.v19i2.6 Cite as: Mwangi A, Nangami M, Tabu J, Ayuku D, Were E, Fabian E. A system approach to improving maternal and child health care delivery in Kenyan communities and primary care facilities: Baseline Survey on Maternal Health. Afri Health Sci.2019;19(2): 1841-1848. https://dx.doi. org/10.4314/ahs.v19i2.

How to do no harm: empowering local leaders to make care safer in low-resource settings.

In a companion paper, we showed how local hospital leaders could assess systems and identify key safety concerns and targets for system improvement. In the present paper, we consider how these leaders might implement practical, low-cost interventions to improve safety. Our focus is on making immediate safety improvements both to directly improve patient care and as a foundation for advancing care in the longer-term. We describe a 'portfolio' approach to safety improvement in four broad categories: prioritising critical processes, such as checking drug doses; strengthening the overall system of care, for example, by introducing multiprofessional handovers; control of known risks, such as only using continuous positive airway pressure when appropriate conditions are met; and enhancing detection and response to hazardous situations, such as introducing brief team meetings to identify and respond to immediate threats and challenges. Local clinical leaders and managers face numerous challenges in delivering safe care but, if given sufficient support, they are nevertheless in a position to bring about major improvements. Skills in improving safety and quality should be recognised as equivalent to any other form of (sub)specialty training and as an essential element of any senior clinical or management role. National professional organisations need to promote appropriate education and provide coaching, mentorship and support to local leaders