Public Health Facilities In Kenya Research Articles

Effects of Communicable Diseases on Maternity services in selected MNCH priority counties’ Public Health facilities in Kenya: A Case of COVID-19.

Covid-19 is a rapidly evolving pandemic which has affected both developed and developing countries. Maternity services in low resource countries are adapting to provide antenatal and postnatal care midst a rapidly shifting health system environment due to the COVID-19 pandemic. Over the years there has been progress in reducing maternal and new-born mortality and stillbirths in Kenya and the globe. However, in the wake of covid-19 pandemic, perinatal women and their frontline health services providers especially nurses and midwives have been cited to bear the brunt of the pandemic. This has largely been linked to the limited access to Personal Protective Equipment (PPE) requirements and the fear of contracting the disease within health services delivery points. There have been adverse effects of maternal and new-born care outcomes due to coronavirus disease. The objective of this study was to determine the effect of coronavirus disease (COVID 19) to maternity services in selected levels III and IV public health facilities within five (5) Counties in Kenya. The five MNCH priority counties selected included Nairobi, Migori, Kilifi, Isiolo and Garissa. A two-stage sampling approach was used to select health facilities in the 5 MNCH priority counties with the sampling frame comprising all MNCH priority counties in Kenya. The study employed cross-sectional and observational retrospective approaches. Data was collected from the midwifery managers and maternity registers in a total of 28 levels III and IV facilities. Open Data Kit (ODK) formatted tools were used to collect data from maternity services facility managers and maternity registers in the selected facilities. Data collected from maternity registers covered the period of four months before covid-19 pandemic and four months during the covid-19 pandemic. A two-days training programme comprising of introduction to study objectives and instruments as well as review of the instruments, practice interviews and data collection was conducted. Data was analysed using STATA Version 15. Descriptive statistics and measures of central tendencies were used to analyse the demographic details of the respondents and health related variables of interests. Chi-square test and fishers exact test were used to find association between facilities that had diagnosed COVID-19 cases and their demographic characteristics. For all tests, a p-value < 0.05 was taken as statistically significant. A total of 31 midwifery managers were interviewed and a total of 801 maternity records (400 before COVID and 401 during COVID-19 pandemic) were obtained from levels 3 III (66%) and IV (34%) facilities across 5 MNCH priority counties in Kenya [Nairobi (27%), Garissa (10%), Isiolo (20%), Kilifi (23%) and Migori (20%)]. On Overall representation, Level III facilities were slightly over half (51.6%) and level IV facilities had 48.4% representation. Most of the maternity services managers interviewed (48.4%) had worked for less than 3 years in their respective stations and the majority (67.7%) had a diploma in either Nursing or midwifery as their highest level of professional education. Overall, the managers indicated that ANC visits had reduced (67.9%), referrals of mothers with complications got delayed (29%), mothers feared delivering in hospitals (64.5%) and possibly some mothers were delivering with the assistance of TBAs (45.2%). The managers reported that New-born care services were the most affected by the pandemic (54.8%) followed by ANC services (45.2%). Immunization services were the least affected (35.5%). The managers (41.9%) reported reduced uptake of FP commodities and a reduction in exclusive breastfeeding (12.9%). Majority (51.6%) of the managers confirmed there was an increase of unplanned pregnancies (90.4) during the pandemic period with limited opportunity to educate ANC clients (74.2%). It was observed that 48% of the facilities surveyed had diagnosed a covid-19 case yet only 61.3% and 54.8% of the facilities had access to masks and hand sanitizers respectively. Facility records indicated a 19% higher ANC attendance before COVID than during COVID-19 pandemic period. Neonatal deaths increased significantly during Covid-19 period ((P=0.010) by 38%. Live births significantly increased by 15% during the pandemic (p<0.0001). Other significant increases were observed in mothers with labour complications (p=0.0003) and number of mothers that underwent caesarean sections(p<0.001) during the pandemic period. There was no sufficient statistical evidence on whether the uptake of FP commodities, post-partum complications, immunizations and maternal mortalities were affected by the covid-19 pandemic. The Covid-19 pandemic caught maternity service providers and the local health systems unaware. The fear of the pandemic had a cross-cutting effect on utilisation of maternity services. Continuous training of health services providers on emergency response to pandemics and health system preparedness is vital in order to have resilient service delivery points.

Patterns of PrEP continuation and coverage in the first year of use: a latent class analysis of a programmatic PrEP trial in Kenya.

Effective PrEP use is critical for impact, but data are limited on common patterns of continuation and coverage among persons using PrEP in real-world settings. Data are from the Partners Scale-Up Project, a programmatic stepped-wedge cluster-randomized trial to integrate PrEP delivery in 25 Kenyan public health facilities conducted between February 2017 and December 2021. We evaluated PrEP continuation using visit attendance and pharmacy refill records, and computed medication possession ratio to define coverage during the first year of use. Latent class mixture models were used to identify and characterize membership to different PrEP continuation patterns. Multinomial logistic regression was used to examine the association between group trajectories and demographic and behaviour characteristics. Overall, 4898 persons initiated PrEP, 54% (2640) were female, mean age was 33 years (standard deviation 11) and 84% (4092) had partners living with HIV. PrEP continuation was 57%, 44%, and 34% at 1, 3, and 6 months, respectively. Four unique trajectories of PrEP coverage were identified: (1) one-fourth (1154) exhibited consistent high coverage throughout the year with 93%, 94%, 96%, and 67% continuing PrEP at months 1, 3, 6, and 12, respectively; (2) 13% (682) showed high coverage trajectory throughout 6 months but coverage rapidly declined thereafter (94%, 93%, 63%, and 10% continued at months 1, 3, 6, and 12, respectively); (3) 18.9% (918) exhibited moderate coverage trajectory with 91% of clients refilling PrEP at month 1 but nearly all dropped-off thereafter (37%, 5%, and 4% continued at months 3, 6, and 12, respectively); and (4) 43.8% (2144) exhibited immediate discontinuation trajectory, in which nearly all did not have any subsequent PrEP refill. Overall, being female, older age, having partners living with HIV or of unknown HIV status were statistically associated with better PrEP continuation trajectories compared to the immediate discontinuation trajectory (p <0.05 for all). In this analysis of a real-world PrEP implementation programme in Kenya, we found four distinct patterns of PrEP continuation, with one-third of users exhibiting consistent high continuation throughout 12 months and two-fifths with immediate discontinuation patterns. These data may help guide tailored interventions to support PrEP continuation in this setting.

Assessing the Readiness to Provide Integrated Management of Cardiovascular Diseases and Type 2 Diabetes in Kenya: Results from a National Survey.

Integrated chronic disease management is the desired core function of a responsive healthcare system. However, many challenges surround its implementation in Sub-Saharan Africa. The current study assessed the readiness of healthcare facilities to provide integrated management of cardiovascular diseases (CVDs) and type 2 diabetes in Kenya. We used data from a nationally representative cross-sectional survey of 258 public and private health facilities conducted in Kenya between 2019 and 2020. Data were collected using a standardised facility assessment questionnaire and observation checklists modified from the World Health Organization Package of Essential Non-communicable Diseases. The primary outcome was the readiness to provide integrated care for CVDs and diabetes-defined as the mean availability of tracer items comprising trained staff and clinical guidelines, diagnostic equipment, essential medicines, diagnosis, treatment and follow-up. A cut-off threshold of ≥70% was used to classify facilities as 'ready'. Gardner-Altman plots and modified Poisson regression were used to examine the facility characteristics associated with care integration readiness. Of the surveyed facilities, only a quarter (24.1%) were ready to provide integrated care for CVDs and type 2 diabetes. Care integration readiness was lower in public versus private facilities [aPR = 0.6; 95% CI 0.4 to 0.9], and primary healthcare facilities were less likely to be ready compared to hospitals [aPR = 0.2; 95% CI 0.1 to 0.4]. Facilities located in Central Kenya [aPR = 0.3; 95% CI 0.1 to 0.9], and the Rift Valley region [aPR = 0.4; 95% CI 0.1 to 0.9], were less likely to be ready compared to the capital Nairobi. There are gaps in the readiness of healthcare facilities particularly primary healthcare facilities in Kenya to provide integrated care services for CVDs and diabetes. Our findings inform the review of current supply-side interventions for integrated management of CVDs and type 2 diabetes, especially in lower-level public health facilities in Kenya.

Can a quality improvement intervention improve person-centred maternity care in Kenya?

Few evidence-based interventions exist to improve person-centred maternity care in low-resource settings. This study aimed to understand whether a quality improvement (QI) intervention could improve person-centred maternity care (PCMC) experiences for women delivering in public health facilities in Kenya. A pre–post design was used to examine changes in PCMC scores across three intervention and matched control facilities at baseline (n = 491) and endline (n = 677). A QI intervention, using the Model for Improvement, was implemented in three public health facilities in Nairobi and Kiambu Counties in Kenya. Difference-in-difference analyses using models that included main effects of both treatment group and survey round was conducted to understand the impact of the intervention on PCMC scores. Findings suggest that intervention facilities’ average total PCMC score decreased by 5.3 points post-intervention compared to baseline (95% CI: −8.8, −1.9) and relative to control facilities, holding socio-demographic and facility variables constant. Additionally, the intervention was significantly associated with a 1.8-point decrease in clinical quality index pre–post-intervention (95% CI: −2.9, −0.7), decreased odds of provider visits, and less likelihood to plan to use postpartum family planning. While improving the quality of women’s experiences during childbirth is a critical component to ensure comprehensive, high-quality maternity care experiences and outcomes, further research is required to understand which intervention methods may be most appropriate to improve PCMC in resource-constrained settings.

“They talked to me rudely”. Women perspectives on quality of post-abortion care in public health facilities in Kenya

BackgroundAccess to safe abortion is legally restricted in Kenya. Therefore, majority women seeking abortion services in such restrictive contexts resort to unsafe methods and procedures that result in complications that often require treatment in health facilities. Most women with abortion-related complications end up in public health facilities. Nevertheless, evidence is limited on the quality of care provided to patients with abortion complications in public health facilities in Kenya.MethodsData for this paper are drawn from a qualitative study that included interviews with 66 women who received post-abortion care in a sample of primary, secondary and tertiary public health facilities in Kenya between November 2018 and February 2019. The interviews focused on mechanisms of decision-making while seeking post-abortion care services, care pathways within facilities, and perceptions of patients on quality of care received including respect, privacy, confidentiality, communication and stigma.FindingsThe participants’ perceptions of the quality of care were characterized as either “bad care” or “good care”, with the good care focusing on interpersonal aspects such as friendliness, respect, empathy, short waiting time before receiving services, as well as the physical or functional aspects of care such as resolution of morbidity and absence of death. Majority of participants initially reported that they received “good care” because they left the facility with their medical problem resolved. However, when probed, about half of them reported delays in receiving care despite their condition being an emergency (i.e., severe bleeding and pain). Participants also reported instances of abuse (verbal and sexual) or absence of privacy during care and inadequate involvement in decisions around the nature and type of care they received. Our findings also suggest that healthcare providers treated patients differently based on their attributes (spontaneous versus induced abortion, single versus married, young versus older). For instance, women who experienced miscarriages reported supportive care whereas women suspected to have induced their abortions felt stigmatized.ConclusionThese findings have far reaching implications on efforts to improve uptake of post-abortion care, care seeking behaviors and on how to assess quality of abortion care. There should be emphasis on interventions meant to enhance processes and structural indicators of post-abortion care services meant to improve patients’ experiences throughout the care process. Moreover, more efforts are needed to advance the tools and approaches for assessing women experiences during post-abortion care beyond just the overriding clinical outcomes of care.

EFFECT OF ATTITUDE SURVEY ON JOB SATISFACTION AMONG THE MEDICAL STAFF IN PUBLIC HEALTH FACILITIES IN BOMET COUNTY, KENYA

The public health facilities in Kenya provide diverse health services to its citizens throughout the country. Public health employees across the country have exhibited some dissatisfaction in the recent past which has led to poor service delivery as well strikes. This could be a result of delays in salaries, poor remuneration, poor working conditions, lack of PPEs and non-inclusion of employees in airing their views. These issues and others are indicative of having demotivated and unsatisfied employees. This study, therefore, purposes to establish the effect of the attitude survey strategies on job satisfaction among the medical staff in public health facilities in Bomet County. Specifically, the study seeks to examine whether attitude surveys, upward communication, employee participation and suggestion schemes have an effect on the job satisfaction of employees in public health facilities in Bomet County. The study was guided by the anxiety uncertain theory. A cross-sectional descriptive research design was used. The study targeted 205 medical staff drawn from 3 public health facilities in Bomet County. A stratified random sampling technique was used. A sample size of 136 medical staff was used in the study. A questionnaire was used for data collection. A pilot study was undertaken in Kericho referral hospital. The study made the following conclusions. The study concluded that the attitude survey had a statistically significant influence on job satisfaction levels. The study further found that the unstandardized regression beta stood at 0.597 which indicated that a unit increase in attitude survey would lead to 0.597 change in the job satisfaction.&lt;p&gt; &lt;/p&gt;&lt;p&gt;&lt;strong&gt; Article visualizations:&lt;/strong&gt;&lt;/p&gt;&lt;p&gt;&lt;img src="/-counters-/edu_01/0759/a.php" alt="Hit counter" /&gt;&lt;/p&gt;

Using an on-site modular training approach to amplify prep service delivery in public health facilities in Kenya.

Delivery of oral PrEP, a potent HIV prevention intervention, has begun within public health systems in many countries in Africa. Training as many health providers as possible expeditiously is necessary to efficiently and rapidly scale up PrEP delivery among at risk populations and thereby realize the greatest impact of PrEP. We designed and implemented an innovative on-site modular training approach delivered in five two-hour modules. The modules could be covered in two consecutive days or be broken across several days enabling flexibility to accommodate health provider work schedules. We assessed knowledge gain comparing pre-and post-training test scores and determined monthly PrEP uptake for six months following the training intervention. We also evaluated the cost of this training approach and conducted key informant interviews to explore acceptability among health providers. Between January 2019 and December 2020, 2111 health providers from 104 health facilities were trained on PrEP. Of 1821 (83%) providers who completed both pre- and post-tests, 505 (28%) were nurses, 333 (18%) were HIV counsellors, 276 (15%) were clinical officers and 255 (14%) were lay providers. The mean score prior to and after training was 58% and 82% respectively (p <0.001). On average, health facilities initiated an average of 2.7 (SD 4.7) people on PrEP each month after the training, a number that did not decline over six months post-training (p = 0.62). Assuming Ministry of Health costs, the costs per provider trained was $16.27. Health providers expressed satisfaction with this training approach because it enabled many providers within a facility receive training. On-site modular training is an effective approach for improving PrEP education for health workers in public health facilities, It is also acceptable and low-cost. This method of training can be scaled up to rapidly amplify the number of health workers able to offer PrEP services.

Readiness of the Kenyan public health sector to provide pre-referral care for severe paediatric malaria.

ObjectiveTo assess readiness among primary public health facilities in Kenya to provide pre‐referral antimalarials for severe malaria.MethodsNine national surveys of randomly selected primary public health facilities undertaken bi‐annually between 2017 and 2021 were analysed. The outcomes included the availability of pre‐referral antimalarial drugs at the health facilities and health worker knowledge of recommended pre‐referral treatment for severe malaria.ResultsA total of 1540 health workers from 1355 health facilities were interviewed. Injectable artesunate was available at 46%, injectable quinine at 7%, and artemether at 3% of the health facilities. None of the facilities had rectal artesunate suppositories in stock. A total of 960 (62%) health workers were trained on the use of injectable artesunate. 73% of the health workers who had ever referred a child with severe malaria were aware that artesunate was the recommended treatment, 49% said that intramuscular injection was the preferred route of administration, and 60% stated the correct dose. The overall knowledge level of the treatment policy was low at 21% and only slightly higher among trained than untrained health workers (24% vs 14%; p < 0.001) and those with access to guidelines versus those without access (29% vs 17%; p < 0.001).ConclusionsThe readiness of primary health facilities and health workers to deliver appropriate pre‐referral care to children with complicated malaria in Kenya is inadequate. Further investments are required to ensure (a) availability of nationally recommended pre‐referral antimalarials; (b) appropriate training and supervision in their administration, and (c) monitoring of the entire referral process.

Nurses’ and midwives’ knowledge and practice of recommended evidence-based preterm care interventions in rural Kenya

BackgroundApproximately 25% of four million neonatal deaths globally are due to preterm birth, a majority occurring within the first week of life and, 60% in sub-Saharan Africa. Clinical interventions to improve preterm babies’ outcomes are often not used. The study assessed the availability of preterm care guidelines and resources in rural public health facilities in Kenya and nurses/midwives’ knowledge and practice of preterm care interventions as per the current preterm policies and guidelines in Kenya. MethodsA hospital-based cross-sectional design was conducted in 16 health facilities and among 102 nurses and midwives. Data were collected between January and March 2018 using the health assessment checklist and vignettes-based questionnaire. Frequencies and percentages were used to describe participants’ characteristics, availability of guidelines, equipment and medicines, and knowledge, and practice on preterm care interventions. All analyses were performed using Stata 13. ResultsSixteen public health facilities and 102 nurses were assessed. The mean age and period of clinical practice were 36 (SD: 9) and 12 (SD: 10) years, respectively. 71 (70%) participants were females, and 78 (77%) registered nurses. Three-quarters (n = 76, 74.5%) of them had in-service training in newborn care within the last two years, majority 67% (n = 69) worked at health centres/dispensaries. Vitamin K and chlorhexidine were available only in 60.8% and 47.1% of the facilities respectively. Guideline’s availability in facilities were 53%, 43%, and 32% for resuscitation, warmth provision, and breastfeeding within one hour respectively. None of the nurses would practice all the recommended preterm care intervention with 17 (16.7%) practicing none. The practice of the recommended preterm care intervention ranged from 7.6% for initiation of breathing to 29% for cord clamping, 32.4% use of chlorhexidine for cord care, 36.3% immediate feeding and 47.1% thermal protection. ConclusionThere exist gaps in the availability of medicines, equipment and guidelines for care of preterm babies, as well as implementation of evidence-based interventions to enhance the quality of care provided to preterm babies in the study area. We recommend increased provider-focussed strategies for improving the availability and implementation of low-cost high-impact evidence-based interventions for preterm care.

EHealth Benefits Realization at Public Health Facilities in Kenya: A User’s Perspective

eHealth Benefits Realization at Public Health Facilities in Kenya: A User’s Perspective

‘Sometimes I feel like the other life on heroin was better’: transitioning experiences towards methadone, and HIV prevention implications in Urban Kenya

In 2014 methadone as part of Medically Assisted Therapy (MAT) was introduced in Kenyan public health facilities as part of a comprehensive approach to HIV prevention and treatment. This paper explores the transition experiences for people moving from the use of heroin to MAT. The paper reports on a qualitative study conducted in an urban setting in Kenya in 2015. Findings show that transitioning from the use of heroin to methadone can both be a liberating and disempowering experience. While study participants were reportedly pleased with the life changes brought about by methadone, they struggled with negotiating the transition from an ‘old life’ of heroin use to methadone. Tensions were navigating the 'new life' on methadone and the 'old life' on heroin. These tensions generate new forms of social exclusion, as well as feelings of uncertainty and ambivalence. A particular effect of this challenging transition is how new forms of risk and vulnerability for HIV are created even whilst others are attended to. MAT programs need to attend to the dynamics described to address the risk of HIV posed by a ‘new life’ and the broader tensions involved in transitioning from the use of heroin to methadone.

The use of case advocates to manage child survivors of sexual violence in public health facilities in Kenya: A qualitative study exploring the perceptions of child survivors, care givers and health care providers

BackgroundThe uptake of and retention in health services by child survivors of violence (CSV) is a growing challenge, especially in sub-Saharan Africa. While lay health workers have been used in several settings to improve access to health services, there is limited literature on the use of such workers to support services for CSV. ObjectiveTo explore the acceptability of using trained lay health workers (case advocates) to provide basic information and escort CSV to various referral points within two public health facilities in Kenya. ParticipantsThe following participants were enrolled after giving their consent: CSV 14–18 years of age presenting for services along with their caregivers during the study; caregivers above age 18; and healthcare providers (HCPs) providing services for sexual violence at the two study sites. MethodsIn-depth interviews (14 with CSV and 27 with caregivers) and four focus group discussions (with 30 HCPs) were conducted. Data were transcribed in MSWord and analysed using a grounded theory analytical approach. ResultsCaregivers and CSV reported that the case advocates were useful in fast-tracking access to services, easing CSV movement through health facilities and helping CSV communicate their issues. HCPs reported improved timeliness and completeness of services due to the involvement of the case advocates. ConclusionThe use of case advocates to support CSV is acceptable to children, caregivers and HCPs. Task-sharing between case advocates and HCPs has the potential to improve the uptake of the various services offered to CSV, especially in resource-limited settings.

Patient costs of diabetes mellitus care in public health care facilities in Kenya.

SummaryObjectiveTo estimate the direct and indirect costs of diabetes mellitus care at five public health facilities in Kenya.MethodsWe conducted a cross‐sectional study in two counties where diabetes patients aged 18 years and above were interviewed. Data on care‐seeking costs were obtained from 163 patients seeking diabetes care at five public facilities using the cost‐of‐illness approach. Medicines and user charges were classified as direct health care costs while expenses on transport, food, and accommodation were classified as direct non–health care costs. Productivity losses due to diabetes were classified as indirect costs. We computed annual direct and indirect costs borne by these patients.ResultsMore than half (57.7%) of sampled patients had hypertension comorbidity. Overall, the mean annual direct patient cost was KES 53 907 (95% CI, 43 625.4‐64 188.6) (US$ 528.5 [95% CI, 427.7‐629.3]). Medicines accounted for 52.4%, transport 22.6%, user charges 17.5%, and food 7.5% of total direct costs. Overall mean annual indirect cost was KES 23 174 (95% CI, 20 910‐25 438.8) (US$ 227.2 [95% CI, 205‐249.4]). Patients reporting hypertension comorbidity incurred higher costs compared with diabetes‐only patients. The incidence of catastrophic costs was 63.1% (95% CI, 55.7‐70.7) and increased to 75.4% (95% CI, 68.3‐82.1) when transport costs were included.ConclusionThere are substantial direct and indirect costs borne by diabetic patients in seeking care from public facilities in Kenya. High incidence of catastrophic costs suggests diabetes services are unaffordable to majority of diabetic patients and illustrate the urgent need to improve financial risk protection to ensure access to care.

The Incremental Cost of Delivering PrEP as a Bridge to ART for HIV Serodiscordant Couples in Public HIV Care Clinics in Kenya

Background In 2016, the Kenyan Ministry of Health (MOH) released guidelines that recommend preexposure prophylaxis (PrEP) for persons with substantial ongoing HIV risk, including those in HIV serodiscordant partnerships. Estimates of the costs of delivering PrEP within Kenyan public health facilities are needed for planning for PrEP scale up. Methods We estimated the incremental annual costs of providing PrEP to HIV uninfected partners as a time-limited “bridge” until the infected partner is virally suppressed on ART within HIV serodiscordant couples as part of routine clinic care in Thika, Kenya. Costs were collected from the Partners Demonstration Project, a prospective evaluation of integrated delivery of preexposure prophylaxis (PrEP) and antiretroviral therapy (ART) to high-risk HIV serodiscordant couples. We conducted time and motion studies to distinguish between activities related to research, routine clinical care, and PrEP delivery. Costs (2015 US dollars) were collected from the MOH perspective and divided into staff, transportation, equipment, supplies, buildings and overhead, and start-up. Results PrEP related activities conducted during the screening, enrollment, and follow-up visits took an average of 13 minutes, 51 minutes, and 12 minutes, respectively. Assuming a staff structure of 3 counselors, 1 nurse, and 2 clinicians, we estimate that 3,178 couples can be screened, 1,444 couples offered PrEP and ART, and 6,138 couples followed up annually in an average HIV care clinic. Using costs incurred by the MOH for personnel, drug, and laboratory tests, we estimate that the incremental cost of offering PrEP to HIV uninfected partners within existing ART programs is $86.79 per couple per year. Personnel and PrEP medication made up the largest portion of the costs. We estimate that the total cost to Ministry of Health of delivering integrated PrEP and ART program in public health facilities is $250.19 per HIV serodiscordant couple per year. Conclusions Time-limited provision of PrEP to the HIV uninfected partner within HIV serodiscordant couples can be an affordable delivery model implemented in HIV care programs in Kenya and similar settings. These costs can be used for budgetary planning and cost effectiveness analyses.

Training health care providers to provide PrEP for HIV serodiscordant couples attending public health facilities in Kenya

ABSTRACT To catalyse national scale up of PrEP for HIV serodiscordant couples in public health facilities in Kenya, the Partners Scale-Up Project, using a two-day case-based interactive curriculum, trained health care providers working in 24 high volume facilities in central and western Kenya on PrEP service delivery. Using a standardised test with questions about PrEP and antiretroviral-based HIV prevention we assessed gain in knowledge and confidence gain by comparing pre-and post-training test scores. We explored experiences of the training through key informant interviews after clinics started delivering PrEP. Of 716 health care providers trained, 235 (32.9%) were nurses, 144 (20.2%) were clinical officers and 155 (21.7%) were HIV counsellors. There was a significant improvement between the means of pre-test and post-test scores (61.7% (SD 17.4) vs 86.4% (SD 12.7) p < 0.001). The proportion of those who reported being ‘very comfortable’ providing care to HIV serodiscordant couples increased from 22.8% to 67.3% (p < 0.001). Key themes that training increasing both knowledge of PrEP and confidence to deliver PrEP to HIV serodiscordant couples emerged from interviews. This short, standardised training resulted in a substantial increase in knowledge of PrEP and in the confidence of the health providers to provide PrEP to HIV serodiscordant couples. Trial registration ClinicalTrials.gov NCT03052010

Health Sector Inadequacies in Attending to Child Survivors of Sexual Abuse in Kenya: An Operations Research

In 2015, LVCT Health (a Kenyan non‐governmental organisation) conducted an exploratory study to assess the quality and comprehensiveness of services provided to child survivors of sexual violence at two public health facilities in Kenya. Both quantitative and qualitative data collection methods were used, including a retrospective review of 164 child survivor medical records, a health facility staff inventory, in‐depth interviews with 31 healthcare providers and 19 exit interviews with 14 child survivors and their caregivers. Ethical approval was obtained from two independent ethics committees. Quantitative data were analysed using SPSS version 22, while qualitative data were analysed using NVivo 10 based on a thematic coding framework. The health facility staff inventory indicated that only two out of 581 providers had undergone previous training on the management of child survivors of sexual violence. Both health facilities lacked the appropriate equipment for the collection of forensic evidence from children and private rooms in which to conduct the clinical examination. Providers cited challenges in offering psychosocial support to children. Only 27 per cent of child survivors were documented to have received trauma counselling. There is a need for health facilities to enhance their human resource and infrastructural capacity to facilitate the delivery of comprehensive care to child survivors.‘An exploratory study to assess the quality and comprehensiveness of services provided to child survivors of sexual violence… in Kenya’Key Practitioner Messages There is a need to develop child‐specific guidelines for healthcare providers in order to ensure that child survivors of sexual violence receive good‐quality services at the facility level. Healthcare providers in public health facilities need competency‐based training to enable them to acquire knowledge and skills to identify and respond to child survivors of sexual violence, collect evidence, communicate with the children and offer counselling support to child survivors effectively. Services for child survivors should be centralised in health facilities to minimise the number of different contact points.

Satisfaction with Delivery Services Offered under the Free Maternal Healthcare Policy in Kenyan Public Health Facilities.

Background Patients' satisfaction is an individual's positive assessment regarding a distinct dimension of healthcare and the perception about the quality of services offered in that health facility. Patients who are not satisfied with healthcare services in a certain health facility will bypass the facility and are unlikely to seek treatment in that facility. Objective To determine satisfaction level of mothers with the free maternal services in selected Kenyan public health facilities after the implementation of the free maternal healthcare policy. Methods Data was collected through a quantitative exit survey questionnaire. The respondents were mothers who had delivered in the health facilities and were waiting to leave the health facilities after discharge. The sample included 2,216 mothers in 77 public health facilities across 14 counties in Kenya under tier 3 and tier 4 categories. The number of respondents to be interviewed was proportionately arrived at based on each health facility's bed capacity. Results The study established a satisfaction rate of 54.5% among the beneficiaries of the free maternal healthcare services in the country. Mothers benefiting from the free delivery services were satisfied with communication by the healthcare workers, staff availability in the delivery rooms, availability of staff in the wards, and drug and supplies availability (>56%) but unsatisfied with consultation time, cleanliness, and privacy in the wards (<56%). High education levels and lengthy stay in healthcare facilities were negatively associated with the satisfaction with the free delivery services (P < 0.05). Conclusion There is a high satisfaction with the free maternal healthcare services in Kenya. However, the implementation of the free maternal healthcare policy was associated with low privacy, poor hygiene, and low consultation time in the health facilities. Therefore there is need to address these service gaps so as to attract more mothers to deliver in public health facilities.

The effect of Kenya’s free maternal health care policy on the utilization of skilled delivery services and maternal and neonatal mortality rates in public health facilities

Background: Kenya abolished delivery fees in all public health facilities through a presidential directive effective on June 1, 2013 with an aim of promoting skilled delivery service utilization and reducing pregnancy-related mortality in the country. This paper aims to provide a brief overview of the free maternal health care policy’s effect on skilled delivery service utilization and maternal and neonatal mortality rates in Kenyan public health facilities. Methods: Interrupted time series analysis of skilled delivery services utilization, maternal and neonatal mortality rates two years before and after the policy intervention was carried out in 77 Kenyan public health facilities. Results: A statistically significant increase in the number of facility-based deliveries was identified with no significant changes in the rates of maternal mortality and neonatal mortality. Conclusions: The findings suggest that cost is a deterrent to skilled delivery service utilization in Kenya and thus free delivery services are an important strategy in the effort to promote the utilization of skilled delivery services; however, there is a need to simultaneously address other factors that contribute to pregnancy-related deaths when addressing maternal and neonatal mortality rates.

Coverage of routine reporting on malaria parasitological testing in Kenya, 2015–2016

ABSTRACTBackground: Following the launch of District Health Information System 2 across facilities in Kenya, more health facilities are now capable of carrying out malaria parasitological testing and reporting data as part of routine health information systems, improving the potential value of routine data for accurate and timely tracking of rapidly changing disease epidemiology at fine spatial resolutions. Objectives: This study evaluates the current coverage and completeness of reported malaria parasitological testing data in DHIS2 specifically looking at patterns in geographic coverage of public health facilities in Kenya. Methods: Monthly facility level data on malaria parasitological testing were extracted from Kenya DHIS2 between November 2015 and October 2016. DHIS2 public facilities were matched to a geo-coded master facility list to obtain coordinates. Coverage was defined as the geographic distribution of facilities reporting any data by region. Completeness of reporting was defined as the percentage of facilities reporting any data for the whole 12-month period or for 3, 6 and 9 months. Results: Public health facilities were 5,933 (59%) of 10,090 extracted. Fifty-nine per Cent of the public facilities did not report any data while 36, 29 and 22% facilities had data reported at least 3, 6 and 9 months, respectively. Only 8% of public facilities had data reported for every month. There were proportionately more hospitals (86%) than health centres (76%) and dispensaries/clinics (30%) reporting. There were significant geographic variations in reporting rates. Counties along the malaria endemic coast had the lowest reporting rate with only 1% of facilities reporting consistently for 12 months.Conclusion: Current coverage and completeness of reporting of malaria parasitological diagnosis across Kenya’s public health system remains poor. The usefulness of routine data to improve our understanding of sub-national heterogeneity across Kenya would require significant improvements to the consistency and coverage of data captured by DHIS2.

Mobile Based mhGAP-IG Depression Screening in Kenya.

We aimed to determine the prevalence and determinants of depression using mobile based mental health Global Action Programme Intervention guide (mhGAP-IG) in remote health care settings where most priority mental health problems are managed by non-mental health specialists and evaluate the feasibility of the application. Adult patients were recruited from four rural public health facilities in Kenya using systematic random sampling and screened for depression. There were no missing items since the application prevented saving of data unless all the items were answered. The prevalence of depression was 25% with suicidal behavior being the most significant comorbid problem. Older age, personal and a family history of a mental disorder were significantly correlated with depression. Exploring the use of health-related mobile applications in identification of priority mental health problems is useful notably in low-resource settings; and also forms a basis for prevention of mental disorders and intervention at acute stages.