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

Trends in under fives and infant mortality from 1990-2008-9 - Kenya

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

Policy environment

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

System Readiness for Neonatal Care

• KDHSs• KSPA surveys• Rapid assssment• Targeted supervision

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

Thank you

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

Neonatal contribution to underfive mortality in Kenya

Distribution of causes of deaths among under fives in kenya, 2000-2003

16%

15%

24%

3%

14%

20%

3%5%

Neonatal causes

HIV/ AIDS

Diarrhoeal diseases

measles

malaria

pneumonia

injuries

0thers

26,000 babies

die per yr in the first

month