680 - Availability and Quality of Antenatal and Pediatric Clinical Services at Primary Healthcare Facilities in Western Kenya: An application of the Primary Care Assessment Tool

Publication Number: 3657.680

Sarah Hawi. Ngere, Kenya Medical Research Institute, Kisumu, Nyanza, Kenya; Edwin Kiplagat. Kiplelgo, Kenya Medical Research Institute, Kabarnet, Rift Valley, Kenya; Alex Ogutu. Chweya, Emory University School of Medicine, Kisumu, Nyanza, Kenya; Abraham Otieno, KENYA MEDICAL RESEARCH INSTITUTE, Kisumu, Nyanza, Kenya; Harun Owuor, Jaramogi Oginga Odinga University of Science and Technology, Kisumu, Nyanza, Kenya; Christopher Mugah, kenya medical research institution, Kisumu, Nyanza, Kenya; Richard SIR. Omore, Kenya Medical Research Institute, Kisumu, Nyanza, Kenya; Cynthia G.. Whitney, The Task Force for Global Health, Atlanta, GA, United States; Portia C. Mutevedzi, CHAMPS, Hilton, KwaZulu-Natal, South Africa; Victor Akelo, Liverpool School of Tropical Medicine, Kisumu, Nyanza, Kenya; Chris A. Rees, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA, United States

Background: Child mortality remains unacceptably high in western Kenya. Primary healthcare is an important part of the solution, with >60% of children who die accessing primary healthcare facilities in the immediate period prior to their death.

Objective: To assess availability and quality of antenatal and pediatric services at primary healthcare facilities in the catchment area of an ongoing childhood mortality surveillance program in western Kenya.

Design/Methods: We conducted a cross-sectional descriptive study using the Primary Care Assessment Tool (PCAT), a standardized series of surveys, in Siaya and Kisumu counties in western Kenya. Ten primary healthcare facilities were randomly selected in each county (i.e., 20 out of 62 healthcare facilities in these counties). The PCAT was administered to clinicians and caregivers of pediatric patients through in-person interviews and responses captured via REDCap. We conducted descriptive analysis of frequencies and proportions.

Results: Of 67 healthcare providers and 174 caregivers approached, 57 (85.1%) providers and 99 (56.9%) caregivers responded to the surveys. Most healthcare providers were female (77.2%) with a median age of 36 years; bedside nurses (33.3%) and clinical officers (31.6%) each accounted for 1/3rd of respondents. Most caregivers were mothers (90.9%) with a median age of 27 years. Nearly half of caregivers (47.4%) reported waiting < 30 minutes for healthcare services, but most perceived limited availability of after-hours care, especially on weekends and overnight (Figure 1). Delivery services (64.6%), breastfeeding support (63.6%), and postpartum depression support (61.6%) were less available compared to other services. Continuity of care was limited, with only 31.6% of providers stating they “definitely” knew their patients’ lives (Figure 2). While most providers were able to provide referral letters (91.2%), less than half (45.6%) reported that transportation support was available for such referrals. Although most providers (77.2%) reported considering patients’ opinions when providing clinical care, caregivers’ perceptions suggested gaps in continuity of care (Figure 3).

Conclusion(s): Primary healthcare services in western Kenya were generally accessible for pediatric and antenatal care but limited for postnatal care. Referral systems suffered from suboptimal coordination and transportation. Strengthening postnatal service delivery, improving referral coordination, and enhancing knowledge about patients are urgent priorities for improving care quality and availability.

Figure 1. Availability of primary healthcare services according to pregnant mothers and caregivers of young children (n=99)
Fig 1.pdf

Figure 2. Perspectives on continuity of clinical care among healthcare providers (n=57)
Fig2.pdf

Figure 3. Healthcare providers accounted for patient and community features in the provision of healthcare (n=57)
Fig3.pdf