Family and provider perceptions of quality of care in the management of sick young infants in primary healthcare settings in four counties of Kenya

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Study Justification:
– Understanding the perceptions of quality of care given to sick young infants in primary healthcare settings is crucial for developing effective strategies for the management of severe bacterial infections.
– The purpose of this study is to assess the perceptions of families and healthcare providers regarding the care given to sick young infants in primary healthcare facilities in four counties in Kenya.
Study Highlights:
– The study used a cross-sectional qualitative design, involving in-depth interviews and focus group discussions with caregivers of young infants and key informant interviews with healthcare providers.
– The findings of the study highlighted six domains of the WHO framework for the quality of maternal and newborn healthcare, including evidence-based practices, functional referral systems, effective communication, respect and preservation of dignity, availability of competent human resources, and availability of physical resources.
– The study found that challenges in the care of sick young infants included stockouts of essential drugs, limited infrastructure, lack of a functional referral system, delays in receiving treatment, inadequate provider skills, and poor provider attitudes.
– Despite these challenges, motivation and teamwork among healthcare providers were identified as key factors in the provision of care.
Recommendations:
– Prioritize improving the quality of care for sick young infants in primary healthcare settings.
– Build the capacity of healthcare providers through training.
– Ensure a continuous supply of essential medicines and equipment.
– Improve infrastructure, including referral systems.
Key Role Players:
– County Health Management Teams
– Village elders or Community Health Volunteers (CHVs)
– Research assistants
– Facility managers
– Healthcare providers
Cost Items for Planning Recommendations:
– Training programs for healthcare providers
– Procurement and supply of essential medicines and equipment
– Infrastructure improvement, including referral systems
Please note that the provided information is based on the description and findings of the study.

The strength of evidence for this abstract is 8 out of 10.
The evidence in the abstract is based on a cross-sectional qualitative study design with a relatively small sample size. The study collected data through in-depth interviews, focus group discussions, and key informant interviews. The data were analyzed using a thematic framework approach. The findings highlight the perceptions of quality of care given to sick young infants in primary healthcare settings in four counties in Kenya. The study identifies six domains of quality of care and discusses the challenges faced in providing care. The conclusions emphasize the need to prioritize improving the quality of sick young infant services through capacity building, continuous supply of essential medicines and equipment, and infrastructure improvement. To improve the evidence, future studies could consider using a larger sample size and incorporating quantitative data to complement the qualitative findings.

Background Understanding the perceptions of quality of care given to sick young infants in primary healthcare settings is key for developing strategies for effective uptake and utilisation of possible severe bacterial infection guidelines. The purpose of this study is to assess families and providers’ perceptions of care given to sick young infants at primary healthcare facilities in four diverse counties in Kenya. Methods A cross-sectional qualitative design involving 37 in-depth interviews and 39 focus group discussions with very young (15-18 years), young (19-24 years) and older (25-45 years) caregivers of young infants aged 0-59 days; and key informant interviews with community-based and facility-based front-line health providers (14) in primary healthcare facilities. Qualitative data were captured using audio tapes and field notes, transcribed, translated and exported into QSR NVivo V.12 for analysis. A thematic framework approach was adopted to classify and analyse data. Results Perceived care given to sick young infants was described around six domains of the WHO framework for the quality of maternal and newborn healthcare: evidence-based practices for routine and emergency care; functional referral systems; effective communication; respect and preservation of dignity; availability of competent, motivated human resources; and availability of physical resources. Views of caregivers and providers regarding sick young infant care in primary healthcare settings were similar across the four sites. Main hindrance to sick young infant care includes stockout of essential drugs, limited infrastructure, lack of functional referral system, inadequate providers which led to delays in receiving treatment, inadequate provider skills and poor provider attitudes. Despite these challenges, motivation and teamwork of health providers were key tenets in care provision. Conclusion The findings underscore the need to prioritise improving quality of sick young infant services at primary healthcare settings by building capacity of providers through training, ensuring continuous supply of essential medicines and equipment and improving infrastructure including referral.

We used a cross-sectional qualitative study design with 37 in-depth interviews and 39 focus group discussions in four counties. The study draws on data from a formative assessment that is part of implementation research (IR) aimed at guiding the operationalisation of PSBI guidelines in Kenya. The formative assessment refers to the initial baseline survey conducted in the development and institution of public health interventions to inform learning in research and practice. Data were collected in four purposively sampled counties. These sites are representative of a mix of varying contexts characterised by rural and urban slum disadvantage, nomadic pastoralist and agrarian settings that impact access to healthcare. The four settings have higher NMRs ranging from 26 to 60 deaths per 1000 live births in each of the counties compared with the national mean of 22 deaths per 1000 live births with many other deaths in the community going unreported.24 Two subcounties in each county were selected in consultation with respective County Health Management Teams. Six facilities in each subcounty were subsequently purposively selected as implementation sites. For purposes of presenting the results, we anonymised the sites using symbols as County A, B, C and D. Caregivers were selected based on age; residency in the project site and with newborns or young infants aged 0–59 days. They were recruited with the help of village elders or community health volunteers (CHVs). The interviews were conducted in Kiswahili or local languages by research assistants with training in qualitative data collection using an interview guide. Health providers were interviewed to examine the facility-level perceptions of quality of care for SYIs and challenges faced during service delivery among other aspects. Table 1 outlines the type and number of qualitative interviews conducted. Distribution of qualitative data collection by site CHV, community health volunteer; FGD, focus group discussion; IDI, in-depth interview. In-depth interviews were held with very young mothers (15–18 years) and young mothers (19–24 years) to provide deeper context of the quality of care provided to SYIs in each study site. The in-depth interviews with providers and facility managers in turn provided health system-related reflections of the quality of care. The focus groups were critical in illuminating community perceptions on the quality of care and the different factors affecting the care of young infants. The qualitative interviews in each county and participant category outlined in table 1 were arrived at in consideration of the number of community units attached to each health facility which in turn informed the population coverage of the facility to ensure qualitative data saturation. To address the contextual convergent relationship between the research team and the participants, the researchers employed a combination of three mechanisms in each study site: (1) a detailed research log with details on date, time, place, participants and type of qualitative data method used, (2) field notes providing an account of all aspects discussed and observed during the interaction, and (3) a research journal with the researcher’s questions, thoughts and notes to self well outlined. The data from these notes helped enrich the correspondent thematic area in the Results and Discussion sections. Qualitative data were captured via audio tapes and field notes, translated, transcribed and exported into QSR NVivo V.12 for analysis. Ten members of the research team used an iterative analysis process to develop a coding framework and later a thematic framework to classify and organise data into emergent themes. A team of research assistants conducted a second iteration of analysis using the frameworks developed by the research team. Analysis charts were developed for each theme and categorised across participants and sites in accordance with WHO’s standard for improving quality of maternal and newborn care in health facilities.25 Community and public engagement activities included community advisory forums and community education days in which sensitisation, understanding and dialogue around research priorities were fostered. Community advisory forums entailed public meetings with the communities organised in collaboration with local leaders and the CHVs. Health providers in the facility serving the community played the crucial role of child health champions to ensure community ownership and leadership in implementation. Through these forums, the findings were shared and discussed, in form of posters, provider and caregiver pamphlets translated to local languages, continuously to ensure community and public participation.

Based on the provided description, here are some potential innovations that could be recommended to improve access to maternal health:

1. Strengthening supply chain management: Address the issue of stockouts of essential drugs by implementing a robust supply chain management system. This could include regular monitoring of drug availability, forecasting and procurement based on demand, and efficient distribution to primary healthcare facilities.

2. Infrastructure improvement: Invest in improving the infrastructure of primary healthcare facilities to ensure they have adequate space, equipment, and facilities to provide quality care to sick young infants. This could involve renovating existing facilities, constructing new facilities where needed, and ensuring the availability of essential medical equipment.

3. Training and capacity building: Develop comprehensive training programs for healthcare providers to enhance their skills and knowledge in managing sick young infants. This could include training on evidence-based practices for routine and emergency care, effective communication, and respectful and dignified care. Continuous professional development programs can also be implemented to ensure providers stay updated with the latest guidelines and best practices.

4. Strengthening referral systems: Establish functional referral systems between primary healthcare facilities and higher-level healthcare facilities to ensure timely and appropriate care for sick young infants. This could involve improving communication channels, developing clear referral protocols, and providing training to healthcare providers on the referral process.

5. Community engagement and education: Conduct community engagement activities to raise awareness about the importance of maternal and newborn healthcare and promote utilization of primary healthcare services. This could include community advisory forums, education sessions, and the dissemination of informational materials in local languages.

6. Continuous monitoring and evaluation: Implement a robust monitoring and evaluation system to regularly assess the quality of care provided to sick young infants in primary healthcare settings. This could involve conducting regular audits, collecting feedback from caregivers and providers, and using the data to identify areas for improvement and track progress over time.

These innovations, if implemented effectively, have the potential to improve access to maternal health and enhance the quality of care provided to sick young infants in primary healthcare settings.
AI Innovations Description
Based on the description provided, the following recommendation can be developed into an innovation to improve access to maternal health:

1. Strengthening Capacity of Healthcare Providers: Provide training and continuous education programs for healthcare providers in primary healthcare settings to improve their skills and knowledge in providing quality care to sick young infants. This can include training on evidence-based practices for routine and emergency care, effective communication, and respectful and dignified care.

2. Ensuring Availability of Essential Medicines and Equipment: Address the issue of stockouts of essential drugs and limited infrastructure by implementing a robust supply chain management system. This can involve regular monitoring of stock levels, timely procurement of medicines and equipment, and improving storage and distribution systems.

3. Improving Referral Systems: Establish functional referral systems between primary healthcare facilities and higher-level healthcare facilities to ensure timely and appropriate care for sick young infants. This can include developing clear referral protocols, strengthening communication channels between facilities, and providing training to healthcare providers on the referral process.

4. Enhancing Infrastructure: Invest in improving the infrastructure of primary healthcare facilities, including the availability of physical resources such as adequate space, equipment, and facilities for maternal and newborn care. This can involve renovating existing facilities, constructing new facilities where needed, and ensuring the availability of basic amenities like clean water and electricity.

5. Community Engagement and Education: Conduct community engagement activities to raise awareness and educate caregivers about the importance of seeking timely and appropriate care for sick young infants. This can include community advisory forums, community education days, and the dissemination of educational materials in local languages.

By implementing these recommendations, access to maternal health can be improved, leading to better outcomes for both mothers and infants.
AI Innovations Methodology
Based on the provided description, the study aims to assess the perceptions of quality of care given to sick young infants in primary healthcare settings in four counties in Kenya. The methodology used is a cross-sectional qualitative design involving in-depth interviews, focus group discussions, and key informant interviews with caregivers and health providers. The data collected were analyzed using a thematic framework approach.

To improve access to maternal health, here are some potential recommendations:

1. Strengthening healthcare infrastructure: Improve the physical resources and infrastructure in primary healthcare facilities to ensure they are adequately equipped to provide quality care to sick young infants. This includes ensuring the availability of essential medicines and equipment.

2. Enhancing provider capacity: Provide training and continuous education programs for healthcare providers to improve their skills and knowledge in managing sick young infants. This can include training on evidence-based practices for routine and emergency care.

3. Establishing functional referral systems: Develop and implement effective referral systems between primary healthcare facilities and higher-level healthcare facilities to ensure timely and appropriate care for sick young infants. This can help address delays in receiving treatment.

4. Improving communication: Enhance communication between healthcare providers and caregivers to ensure effective and clear communication regarding the care of sick young infants. This can include providing information on treatment plans, follow-up care, and preventive measures.

5. Promoting respectful and dignified care: Emphasize the importance of respecting and preserving the dignity of caregivers and sick young infants during healthcare interactions. This can contribute to a positive care experience and encourage caregivers to seek healthcare services.

To simulate the impact of these recommendations on improving access to maternal health, a methodology could include the following steps:

1. Define the indicators: Identify specific indicators that can measure the impact of the recommendations on improving access to maternal health. For example, indicators could include the percentage of facilities with adequate infrastructure, the percentage of healthcare providers trained in managing sick young infants, or the percentage of successful referrals.

2. Collect baseline data: Gather baseline data on the identified indicators before implementing the recommendations. This can involve conducting surveys, interviews, or reviewing existing data sources.

3. Implement the recommendations: Introduce the recommended interventions in primary healthcare settings. This can include providing training programs, improving infrastructure, establishing referral systems, and promoting respectful care.

4. Monitor and evaluate: Continuously monitor and evaluate the implementation of the recommendations. Collect data on the indicators identified in step 1 to assess the impact of the interventions on improving access to maternal health.

5. Analyze the data: Analyze the collected data to determine the extent to which the recommendations have improved access to maternal health. This can involve comparing the baseline data with the data collected after implementing the interventions.

6. Draw conclusions and make recommendations: Based on the analysis of the data, draw conclusions about the impact of the recommendations on improving access to maternal health. Identify any gaps or areas for further improvement and make recommendations for future interventions.

By following this methodology, it is possible to simulate the impact of the recommendations on improving access to maternal health and make evidence-based decisions for further interventions.

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