Status and Preparedness of the Kenya health System to Support Critically ill neonates R Nyamai NCAHu...
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Status and Preparedness of the Kenya health System to Support Critically ill neonates
R Nyamai NCAHu
07 Feb 2014
Scope of Presentation
• Magnitude of problem in Target Population• The interventions aimed at better outcomes
for neonates• The health System-Kenyan Context• Policy environment• The health system performance for neonatal
care
Maternal and Child Mortality in kenya-KDHS 2008
•Maternal mortality is 488/100,000 live births
•Neonatal mortality is 31/1000 live births
•Infant mortality is 52/1000live births
•Under five mortality is 74/1000 live births
Kenya Health System organizationGazeted names KEPH
StandardsCurrent Proposed
National Referral Hospital Level 6 Tier 4
Provincial General Hospitals
Level 5 Tier 3
District Hospitals Level 4 Tier 3
Sub-district Hospitals Level 4 Tier 3
Health Centres Level 3 Tier 2
Dispensaries Level 2 Tier 2
Community Level 1 Tier 1
The Health System-Kenya context
• Human resources• Medical products and other technologies• Finance• Service delivery• Health information System• Leadership and governance
High Impact Interventions targeted at Neonates
Hand washing with soap by caregiverNewborn temperature managementEarly initiation and EBFAntibiotics for neonatal infectionsNewborn resuscitationAntenatal steroidsARV prophylaxis
Priority High Impact Interventions for neonates by Level of Care, and Intervention Area
Community-L1 (Tier 1)Newborn temperature managementHand washing with soap by caregiver Early initiation and EBF
Level 2;3;4 (tier 2 and 3)Hand washing with soap by caregiverTemperature managementAntibiotics for neonatal infectionsNewborn resuscitation ARV prophylaxis
Guidelines
• Mother child Booklet• Integrated Community case Mangement Manual• Integrated Management of Childhood Illness (IMCI)
Guide for healthcare workers August, 2012 Edition• Ministry of Health Basic Paediatric Protocols for ages up
to 5 years July 2013• GOK Clinical Management and Refferal Guidelines 2009• Managing Newborn Problems WHO A guide guied for
doctors Nurses and midwives• Pocket Book of Hospital Care for children WHO
Case management of the small young infant
Integrated Management of Childhood Illnes• iCCM• IMCI• ETAT+
The 6 major steps in IMCI Case Management approach
1. Assessment2. Classification3. Identify Treatment4. Treat the child5. Counsel the mother6. Follow Up care
Sick Young InfantAssessment at the community
• Watch for signs often found in sick young babies and refer
Classification at the outpatient
• Make decision on severity of illness• Colour coded triage system• Pink-Admission or pre-refferal treatment• Yellow-Specific medical Treatment and adcice• Green- not serous, mostly no drugs needed,
advice mother
Safe DeliveryKDHS 2008
• 43% of Births are conducted in a health Facility
• 56% of births take place at Home
KSPA survey 2010
• Weighing the newborn, Rooming in, vit A to were well practiced across the facilities
• Newborn respiratory support available in 92%of Hospitals
• New born respiratory Support available in 7 out of 10 facilities offering delivery services
• External heat source was available in 67%of Hospitals
Facility Readiness17 level 4 and five Hospitals rapid survey
• 64% of the NBU nursing staff had inadequate knowledge to resuscitate a newborn baby
• Although 88% of the facilities had a resuscitation tray ready for immediate use, only 41% of facilities had an up to date resuscitation tray check list
• Only 11 hospitals had sterile delivery packs for inpatient mothers
Findings from Hospital reforms supervision
2009 2010 2012
%Hospital with at least two rooms for admitting sick neonate and preterm
27 47 66
% of PGHs with 10 functional incubators 26 85 100
% of hospitals with at least one oxygen source in the newborn unit
46 86.3 100
% of hospital with basic paediatric protocols immediately available at clinical area
38 80 96
Challenges in Scaling up
•Health Systems ChallengesHuman resources- numbers, skills, attitude, Health FinancingReliable DataReferralsCommodity securityGovernance
gaps at community level service delivery•Access
Geographic, Financial, CulturalLow male involvement
•Multi-sectoral challengesInfrastructure, safe water, status of women
Table 2a: Cost Effective Preventive Interventions: Lancet 2003
0% 5% 10% 15%
Antimalarial for IPT in pregnancy
Antibiotics for premature rupture of membranes
Nevirapine and replacement feeding
Tetanus Toxoid
New born Temperature Management
Water Sanitation Hygiene
Antenatal steroids
Hib Vaccine
Clean delivery
Zinc
Complementary feeding
ITM
Breastfeeding