Knowledge, attitudes, and perceptions of Kenyan healthcare workers regarding pediatric discharge from hospital.

Shadae Paul,Sarah Martin,Benson Singa,Chris Oduol,Scott Ickes,Donna M. Denno,Ednah Ojee,Kirkby D. Tickell,Filipe Prazeres

doi:10.1371/journal.pone.0249569

Abstract

ObjectiveTo assess attitudes, perceptions, and practices of healthcare workers regarding hospital discharge and follow-up care for children under age five in Migori and Homa Bay, Kenya.MethodsThis mixed-methods study included surveys and semi-structured telephone interviews with healthcare workers delivering inpatient pediatric care at eight hospitals between November 2017 and December 2018.ResultsThe survey was completed by 111 (85%) eligible HCWs. Ninety-seven of the surveyed HCWs were invited for interviews and 39 (40%) participated. Discharge tasks were reported to be “very important” to patient outcomes by over 80% of respondents, but only 37 (33%) perceived their hospital to deliver this care “very well” and 23 (21%) believed their facility provides sufficient resources for its provision. The vast majority (97%) of participants underestimated the risk of pediatric post-discharge mortality. Inadequate training, understaffing, stock-outs of take-home therapeutics, and user fees were commonly reported health systems barriers to adequate discharge care while poverty was seen as limiting caregiver adherence to discharge and follow-up care. Respondents endorsed the importance of follow-up care, but reported supportive mechanisms to be lacking. They requested enhanced guidelines on discharge and follow-up care.ConclusionKenyan healthcare workers substantially underestimated the risk of pediatric post-discharge mortality. Pre- and in-service training should incorporate instruction on discharge and follow-up care. Improved post-discharge deaths tracking–e.g., through vital registry systems, child mortality surveillance studies, and community health worker feedback loops–is needed, alongside dissemination which could leverage platforms such as routine hospital-based mortality reports. Finally, further interventional trials are needed to assess the efficacy and cost-effectiveness of novel packages to improve discharge and follow-up care.

Highlights

Most low- and middle-income countries (LMICs) did not achieve Millennium Development Goal 4 to reduce child mortality by two-thirds between 1990 and 2015 [1]
Ninety-seven of the surveyed healthcare workers’ (HCWs) were invited for interviews and 39 (40%) participated
Kenyan healthcare workers substantially underestimated the risk of pediatric post-discharge mortality

Summary

Introduction

Most low- and middle-income countries (LMICs) did not achieve Millennium Development Goal 4 to reduce child mortality by two-thirds between 1990 and 2015 [1]. Evidence from Kenya and other LMICs have identified the period following hospital discharge as a high-risk period, in which children are often readmitted and experience a fatality rate eight-times higher than -aged community peers [3,4,5,6]. Despite mounting evidence about this vulnerable period, little is known about healthcare workers’ (HCWs) understanding of poor post-discharge outcomes, opinions on the importance, barriers and facilitators of discharge and follow-up care, and use of related guidelines. Attitudes, and reported practices regarding pediatric discharge and follow-up care among HCWs who provide pediatric inpatient and discharge services at eight hospitals in Homa Bay and Migori counties, Kenya.

Results

Discussion

Conclusion