To assess the coverage of four low-cost high impact interventions for enhancing the outcomes of preterm babies and describe the factors associated with implementation of these interventions in rural Kenya
Methods:
This paper was part of a PhD study that used a mixed method approach. The study presents the quantitative section which was carried out in 16 health facilities in Kilifi County in the coastal region of Kenya. All the health facilities are public and categorized as level three (Health Centres) and level four (Sub-county) according to the Kenyan Government Ministry of Health. It also included nurses and midwives who work in these health facilities at the time of data collection. Census sampling was utilized to recruit a total of 102 nurses and midwives working in the 16 health facilities. Health facilities were chosen purposively. A semi - structured questionnaire was developed, pretested and used to collect the information from the participants, and a health facility assessment tool was utilized to assess the coverage of the interventions. Univariate analysis was conducted using chi-square test of association and multiple logistic regression was used to determine factors associated with implementation in multivariate analysis. Summary statistics i.e. mean and standard deviation for continuous variables, frequencies and percentages for discrete variables was done and inferential statistics to test the hypothesis. All the analyses were done using Statistical Package for the Social Sciences (SPSS v23).
Results:
The majority of the respondents were female n=70 (69%), mean age was 36±9 years with a range between 24 and 58 years, n=67 (65.7%) were registered nurses/midwives. Three quarters of the respondents were educated to diploma level n=79 (77.5%), n=76 (74.5%) had prior in-service training on new-born care, majority had worked for 12(SD=10; Range=1-36) years.
Resuscitation guidelines were available in n=7 (41.2%) health facilities, provision of warmth in n=11 (64.7%), early and exclusive breast feeding and use of chlorhexidine in n=5 (29.4%). For resuscitation of a preterm baby, most of the facilities had implemented administration of oxygen n=76 (74.5%), use of ambu bag and mask n=79 (77.5%) and chest compression n=71 (69.6), although intubation n=67 (65.7%) was not implemented at these facilities. For warmth provision, n=80 (78.4%) had implemented immediate drying of preterm baby, wrapping of the baby to include the head n=73 (71.6%), use of incubator/radiant warmer n=63 (61.8%), kangaroo mother care n=57 (55.9%) and delayed bath n=54 (52.9%). With regard to feeding, the majority n=65(63.7%) of the respondents reported feeding within one hour of birth and exclusive breastfeeding n=60 (58.8%). Conversely, majority of the respondents reported that use of chlorhexidine for cord care was not implemented n=43 (42.2%). Most n=61 (59.8%), of the respondents said they would give nothing to a preterm baby unable to breast feed, n=13 (32.7 %) would give expressed breast milk, n=4(3.9%), would give formula milk =n3(2.9%) would refer the baby. The odds of a male implementing the guidelines were 0.23 times less likely compared to females (OR=0.28; 95%CI=0.093-0.822; p-value=0.021). The odds of the staff with average knowledge regarding care of preterm were 5.13 times more likely compared with those with poor knowledge (OR=5.13; 95%CI=1.522-17.295; p-value=0.008). Similarly, the odds of the staffs with good knowledge regarding care of preterm were 5.05 times more likely compared with those with poor knowledge (OR=5.05 ;95%CI=1.319-19.349; p-value=0.018).
Conclusion:
The above findings show that although some interventions were implemented, a discrepancy exists in the implementation of evidence based interventions among nurses and midwives in the study area. Dissimilarities in the implementation of evidence based care represents failures to implement evidence-based best practices, which would adversely affect the preterm babies’ health outcomes. some evidence based interventions are not implemented because of lack of knowledge but also lack of resources. Several factors are associated with implementation of guidelines on cost effective interventions to enhance preterm babies’ outcomes. Factors or determinants of implementation of guidelines may differ amongst health care settings, health care professionals and demographic characteristics of care givers. These factors will be further explored.