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Implementation of psbi activities in kenya where are we now (30.4.2019)
1. ADDRESSING POSSIBLE SERIOUS
BACTERIAL INFECTION AMONG SICK
YOUNG INFANTS IN KENYA WHERE
REFERRAL IS NOT FEASIBLE:
WHERE ARE WE NOW?
Jesse Gitaka –Mount Kenya University
Wilson Liambila and Timothy Abuya-Population
Council
Fred Were and Kezia K’Oduol- KEPRECON
2. Kenya has high NNM rate (22 per 1000 live births) with sepsis
contributing up to 20% of deaths
Poor care seeking, dysfunctional referral pathways and
negative cultural beliefs worsen situation
Reducing this burden requires timely case identification &
initiation of suitable antibiotic treatment
Clinical trials of simplified treatment regimens in Asia
and Africa (2011-2013) showed:
high refusal rates for referral by caregivers (Kenya 89%)
simplified antibiotic regimens for SYIs provided at PHC level when
referral is not feasible are effective and can save lives.
6. Revision of concept
and full proposal
development
August-October 2017
Addis Ababa advocacy
meeting
Jan 2018
Co creation workshop
Jan 2017 Update of IMNCI and
newborn protocols
Jan-may 2018
Formative phase
June-July 2018
Dissemination
and revision of
work county plans
Sept-Oct 2018
Development of job
aids/pamphlets
Jan-March 2019
IMNCI Induction
Jan-March 2019
Dissemination of Job
aids/follow up forms
March 2019
Provider induction on
IMNCI/PSBI
Six monthly follow
up
Quarterly follow up &
tracking
2 3 4 5 6 7 8 9 10 11 12 131
National level
advocacy
Oct 2017
7. • Create foundation for learning
• Generate evidence for action
• Develop a measurement
framework through periodic
monitoring of performance or
implementation activities
8. Formative assessment in
project sites, June – July 2018
Technical Advisory Group
meeting, August 2018
Establishment of Community
of Practice (CoP), October
2018.
Join CoP at:
psbi@communities.harpnet.org
Ongoing establishment of local
CoP.
Quarterly monitoring system
9. Formative assessment activity Sample Sizes
Capacity assessment with CHMTs 4
Capacity assessment with SCHMTs 8
Health facility assessment 48
Partner mapping 8
IDI young mothers (15-18 yrs) 11
IDI young mothers 19-24 yrs 12
IDI with providers & facility managers 14
FGD young mothers (15-18 yrs) 7
FGD young mothers (19-24 yrs) 12
FGD Older mothers (25-45 yrs) 6
FGD married men (>35 yrs) 7
FGD with active CHVs 7
10. RESULTS OF THE FORMATIVE ASSESSMENT:
ORGANIZATIONAL CAPACITY INDEX (OCI)
SCORES BY HEALTH SYSTEM DOMAINS
OCI Bungoma Turkana Mombasa Kilifi
Health Policy and Financing 69.5 64.8 68.6 66.7
Leadership and Governance 53.8 53.8 54.5 61.3
Human Resource for Health 54.5 48.5 57.6 60.6
Health Products and Technologies 61.1 41.7 55.6 62.5
Service delivery 67.1 71.3 74.3 70.7
Infrastructure 65 51.1 53.3 53.3
HMIS 70 72.5 80 70
M&E 40 49.1 50.9 54.5
Key Status Score Action needed
<=50 Red Poor Extensive support
51-69 Amber Average Medium level support
>=70 Green Good Minimal support
12. Cultural practices
Infants rejecting the allocated names
Witchcraft or sorcery
Bad omen
Bad/ evil eye or
Statements made about the infant
Presence of an owl in the homestead
Myths and misconceptions
Infants born out of wedlock
Use of family planning
Eating foods such as wild fruits
Overworking during pregnancy
Mother sleeping outdoors during
pregnancy
Harmful practices
• Delayed breastfeeding while waiting for naming ceremony (religious or cultural)
• Placing exposed young infant outside the home to prevent them from dying like
other siblings
• Use of cultural practices to protect against the evil eye
13. • Germs from people and dirty
surroundings
- Failing to observe hygiene
(unwashed hands, unclean
breast)
- Exposing umbilical cord to
dirty razor, string, grass,
ash, dung, soot
- Cutting baby’s skin and
applying herbs or other
traditional treatment
• Exposing the young infant to
cold
• Complications during
childbirth
• Some birth defects or
abnormalities
• Delaying
breastfeeding
• Giving other foods
other than BF
• Missing
immunization
• Delivery outside a
health facility
• Delivery by unskilled
persons
• Poor diet during or
after pregnancy
14. Poor
breastfeeding,
sunken eyes & eye
discharges
Changes in body
temperature ,
convulsions &
change of skin
color
Excessive crying,
inability to pass
urine or fecal
matter, not
sleeping well, and
or restlessness
Difficulty in
breathing,
diarrhea and
vomiting
Care seeking is
preceded by
seeking a second
opinion due to
persistence of the
condition or
severity then the
action is taken
based on
understanding of
cause of illness
15. Bungoma
Perception that referral may mean severity of illness and thus
possible deaths
Transportation costs and logistics of referral
Lack of funds for in patient care esp. money for food/drugs
Social roles in supporting family at home & Lack of support from
spouses to provide money
Timing of referral
16. CHVs across all counties create
awareness, educate the community on
newborn care, link the community to the
health facilities, serve as referral agents.
“P: When we get into the house that we visit, there are a few
things that we normally ask. Like if there is a sick person or if
there is an expectant mother who has not yet started clinic, or if
there are those who started the clinic and defaulted, then I teach
them and refer them to go to the hospital. And if there is a sick
person, we check on the symptoms and if there is a sign of malaria,
…and if not malaria I refer them to the hospital to be treated”
Bungoma FGD CHVs.
Inadequate number of CHVs, capacity
gaps makes it hard for them to reach
newborns and mothers
Transport and logistics affect service
delivery at community level
23. IMNCI training materials
have been revised/ updated
to incorporate PSBI
In Bungoma-IMNCI
training for TOTs has just
been completed and plans
are underway to train the
providers
24. Quarterly routine monitoring.
Project team working with County, Sub-county and
Facility quality improvement teams to assess the quality
of care.
25. IR data collection cycles involve
conducting case narratives with
women who use PSBI and those
referred from the community by
CHVs, and in-depth interviews
with active CHVs and frontline
providers.
Project team will continuously
document the number of PSBI
cases seen and the treatment given
as well as referral practices for
purposes of generating additional
evidence to guide scale up and
future revisions of national
IMNCI/PSBI guidelines.
26. Population
Council
Wilson Liambila
Timothy Abuya
Charity Ndwiga
George Odwe
Charlotte Warren
Institutions
• Newborn, Child & Adolescent Health Unit - MOH
• County and Sub-County Health Management Teams –
Bungoma
• Health Facility Management Teams – Project Counties
• USAID-for providing financial resources
Kenya Paediatric
Research
Consortium
• Fred Were
• David Githanga
• Joe Mbuthia
• Doris Kinuthia
• Kezia K’Oduol
Mount Kenya
University
• Jesse Gitaka
• Alice Natecho
• Samuel Mungai
• Peter Mwaura
• Jackline Nyaberi
Editor's Notes
Project Goal & PartnershipsGoal: To contribute to reductions in young infant deaths from PSBI, through revision of national IMNCI guidelines
Sites: Bungoma, Turkana, Mombasa and Kilifi counties
Partnership:
Population Council
KEPRECON
MKU
MOH HQ (NCAHU)
Bacterial infections - a leading cause of newborn deaths
Implementation teams
County and sub-County Health Management Teams
Health facility management teams
Implementing partners working in the area of MNH
Implementation approach
Use Implementation Research to identify service delivery and programmatic barriers that prevent SYIs with PSBI from accessing care
Generating localized solutions in partnership with local health teams
Documenting effects of approaches used and lessons learnt
We conducted the formative assessment as a key step in building the foundation for learning base lay in project sites, June – July 2018
The highest score was in HMIS with an average score of 70% across counties and service delivery domain where Turkana, Mombasa and Kilifi scored a green but Bungoma scored an amber of 65%. The lowest scores were M&E where Bungoma and Turkana scored a red while the rest scored amber. Counties scored relatively low scores in Human resource for health and health products and commodities with Turkana scoring a red for both areas while the rest scored an amber. The rest of the domains scored an amber of between 51-65%.
The OCI is calculated by adding average scores under each capacity area against the total possible scores and generating a percentage. For ease of interpretation, the overall grading score was green if the counties scored 70% and above based on the OCI, amber for scores between 50-69% and red below 50%. Figure shows the overall OCI for the four counties. All counties scored an amber with Bungoma and Turkana scoring 61%, Mombasa and Kilifi scored 64%.
NB: Correct practices or perspectives are emphasized or reinforced by health providers
This slide illustrates the type of infrastructure available in primary health care facilities. As expected, hospitals (Not shown) were better equipped than HCs and dispensaries (not shown).
During the formative assessment-Bungoma County had not started training in IMNCI/PSBI. The training of TOTs in Bungoma took place in March 2019.
This has been developed to demystify causes of infant illnesses and strengthen care seeking dynamics including prompt action for treatment.
To build confidence of providers, we have developed a follow up form and flow chart to support in the management of PSBI using the simplified treatment regimen.
.
Working with other partners advocated for IMNCI induction