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Status and Preparedness of the Kenya health System to Support Critically ill neonates

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

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Status and Preparedness of the Kenya health System to Support Critically ill neonates

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  1. Status and Preparedness of the Kenya health System to Support Critically ill neonates R Nyamai NCAHu 07 Feb 2014

  2. 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

  3. 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

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

  5. Kenya Health System organization

  6. The Health System-Kenya context • Human resources • Medical products and other technologies • Finance • Service delivery • Health information System • Leadership and governance

  7. High Impact Interventions targeted at Neonates • Hand washing with soap by caregiver • Newborn temperature management • Early initiation and EBF • Antibiotics for neonatal infections • Newborn resuscitation • Antenatal steroids • ARV prophylaxis

  8. Priority High Impact Interventions for neonates by Level of Care, and Intervention Area Community-L1 (Tier 1) Level 2;3;4 (tier 2 and 3) Hand washing with soap by caregiver Temperature management Antibiotics for neonatal infections Newborn resuscitation ARV prophylaxis • Newborn temperature management • Hand washing with soap by caregiver • Early initiation and EBF

  9. Policy environment

  10. 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

  11. Case management of the small young infant Integrated Management of Childhood Illnes • iCCM • IMCI • ETAT+

  12. The 6 major steps in IMCI Case Management approach • Assessment • Classification • Identify Treatment • Treat the child • Counsel the mother • Follow Up care

  13. Sick Young InfantAssessment at the community • Watch for signs often found in sick young babies and refer

  14. 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

  15. System Readiness for Neonatal Care • KDHSs • KSPA surveys • Rapid assssment • Targeted supervision

  16. Safe DeliveryKDHS 2008 • 43% of Births are conducted in a health Facility • 56% of births take place at Home

  17. 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

  18. 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

  19. Findings from Hospital reforms supervision

  20. Challenges in Scaling up • Health Systems Challenges • Human resources- numbers, skills, attitude, • Health Financing • Reliable Data • Referrals • Commodity security • Governance • gaps at community level service delivery • Access • Geographic, Financial, Cultural • Low male involvement • Multi-sectoral challenges • Infrastructure, safe water, status of women

  21. Thank you

  22. Neonatal contribution to underfive mortality in Kenya 26,000 babies die per yr in the first month

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