High-impact low-cost interventions implemented to enhance the quality of care given to preterm babies in Kilifi County, Kenya

Abstract

The main objective of this study was to explore and describe the implementation of national policies/guidelines regarding low-cost high-impact interventions to enhance health outcomes for preterm babies among health professionals in Kilifi County. A mixed method approach, with a convergent parallel design was used. Seventeen public health facilities were chosen purposively for the study. Census sampling for the nurses and midwives was utilized with a sampling frame of 146 nurses and midwives. Data was collected using semi structured questionnaires to the nurses and midwives (n=102); A health facility assessment tool with facility leaders (n=16); focus group discussions were held among with nurses and midwives (n=7); in-depth interviews with key informants n=seven and unstructured observation. Analysis of quantitative data was done using the Statistical Package for Social Sciences (SPSS) version 23. Descriptive statistics (i.e. mean and standard deviation for continuous variables, frequencies and percentages for discrete variables) and inferential statistics were used to answer the research questions. Qualitative data was coded and analysed thematically. The results provided rich information from several data sources highlighting a need to improve the implementation of four evidence-based practices that would enhance health outcomes for preterm babies. Guidelines/policies, important equipment and medications were not always available, which caused frustration among healthcare workers in their efforts to provide care for preterm babies. Despite common recognition of their key function, guidelines are not always adhered to, as shown in this study. Inadequate use of guidelines reflects the omission of beneficial treatments, possible avoidable harms, and suboptimal patient care. This study also established that there were associations between participants’ gender and percentage scores for knowledge and practice and implementation. The study also highlights barriers and enablers to implementation of clinical guidelines and possible strategies to effective implementation.

Lengo la utafiti huu lilikuwa ni kuchunguza na kuelezea utekelezaji wa sera za taifa/miongozo kuhusu gharama nafuu hatua juu ya athari ya kuimarisha matokeo ya afya, kwa ajili ya watoto njiti kati ya wataalamu wa afya katika kata la Kilifi. Mchanganyiko njia mbinu, na muunganiko sambamba kubuni ilitumika. Vituo vya afya vya umma Kumi na saba vilichaguliwa makusudi kwa ajili ya utafiti. Sensa sampuli kwa wauguzi na wakunga ulitumiwa kwa sampuli hii ya wauguzi na wakunga mia moja arobaini na sita. Takwimu zilikusanywa kwa kutumia nusu ya muundo dodoso za wauguzi na wakunga (nambari= mia moja na mbili); vituo vya afya tathmini chombo na viongozi kituo (Nambari= kumi na sita), majadiliano ya vikundi kati ya wauguzi na wakunga (nambari=saba); mahojiano ya kina na watoa habari wakuu (nambari=saba) na uchunguzi haujatengenezwa. Data ya ubora ilikuwa kuchambuliwa kwa kutumia SPSS toleo la ishirini na tatu. Takwimu maelezo (yaani maana na kiwango kupotoka kwa vigezo endelevu, masafa na asilimia kwa vigezo vya kipekee) na takwimu sisizo na mapendeleo zilitumika kujibu maswali ya utafiti. Data ya ubora ilikuwa kutolewa na kuchambuliwa kwa makusudi. Matokeo kutoa habari tajiri na vyanzo kadhaa data kuonyesha haja ya kuboresha utekelezaji wa shughuli nne ushahidi wa msingi ambayo kuongeza matokeo ya afya kwa ajili ya watoto njiti. Miongozo / sera, vifaa muhimu na dawa zilikuwa hazipatikani kila wakati, ambazo zilisababisha kuchanganyikiwa miongoni mwa wafanyakazi wa afya katika juhudi zao za kutoa huduma kwa ajili ya watoto njiti. Pamoja na kutambua kawaida ya kazi yao muhimu, miongozo si daima kuzingatiwa na, kama inavyoonekana katika utafiti huu. Matumizi duni ya miongozo huonyesha upungufu wa matibabu ya manufaa, madhara yanayoweza kuepukwa, na huduma ya afya ya watoto njiti ya chini.Utafiti huu pia ulibaini kwamba kulikuwa na uhusiano kati ya jinsia ya washiriki na asilimia alama kwa maarifa na mazoezi na utekelezaji. Utafiti huo pia unaonyesha vikwazo na wawezeshaji na utekelezaji wa miongozo ya kliniki na mikakati inawezekana utekelezaji.