School of Public Health

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Browsing School of Public Health by Author "Abuya, Timothy"

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    PublicationOpen Access
    Institutionalizing the Management of Sick Young Infants: Kenya’s Experience in Revising National Guidelines on Integrated Management of Newborn and Childhood Illnesses
    (Global Health: Science and Practice, 2023-04) Liambila, Wilson; Were, Fred; Abuya, Timothy; Odwe, George; Natecho, Alice; Mungai, Samuel; Mwaura, Peter
    ntroduction: In 2015, the World Health Organization (WHO) developed guidelines for the management of sick young infants (SYIs) with possible serious bacterial infection (PSBI) where refer- ral is not feasible. The Ponya Mtoto project was designed as an implementation research project to demonstrate how to adopt the WHO PSBI guidelines in the Kenyan context. Ponya Mtoto Project Description: Between October 2017 and June 2021, Ponya Mtoto was implemented in 4 Kenyan counties with higher infant and newborn mortality rates than the national mean. A total of 48 health facilities stratified by level of services were selected as study sites. Implementation Approach: The following activities were done to institutionalize the management of SYIs with PSBI where referral is not feasible in Kenya’s health system: (1) participating in a cocreation workshop and development of a theory of change; (2) revising the national integrated management of newborn and childhood illnesses guidelines to incorporate the manage- ment of PSBI where referral is not feasible; (3) improving avail- ability of essential commodities; (4) strengthening provider confidence in the management of SYIs; (5) strengthening aware- ness about PSBI services for SYIs at the community level; and (6) harmonizing the national integrated management of newborn and childhood illnesses guidelines to address discrepancies in the content on the management of PSBI. In addition, the project fo- cused on strengthening quality of care for SYIs and using imple- mentation research to track progress in achieving project targets and outcomes. Conclusion: Using an implementation research approach to intro- duce new WHO guidelines on PSBI where referral is not feasible into Kenya’s health care service was critical to fostering engage- ment of a diverse range of stakeholders, monitoring provider skills and confidence-building, strengthening provision of key commodi- ties for managing SYIs with PSBI, and sustaining community-facility linkages.
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    PublicationMetadata only
    Institutionalizing the management of sick young infants: Kenya’s experience in revising national guidelines on integrated management of newborn and childhood illnesses
    (Global Health Science and Practice, 2023-04) Liambila, Wilson; Were, Fred; Abuya, Timothy; Odwe, George; Natecho, Alice; Mungai, Samuel; Mwaura, Peter; Githanga, David; Mbuthia, Joe; Kinuthia, Doris
    Introduction: In 2015, the World Health Organization (WHO) developed guidelines for the management of sick young infants (SYIs) with possible serious bacterial infection (PSBI) where referral is not feasible. The Ponya Mtoto project was designed as an implementation research project to demonstrate how to adopt the WHO PSBI guidelines in the Kenyan context. Ponya Mtoto Project Description: Between October 2017 and June 2021, Ponya Mtoto was implemented in 4 Kenyan counties with higher infant and newborn mortality rates than the national mean. A total of 48 health facilities stratified by level of services were selected as study sites. Implementation Approach: The following activities were done to institutionalize the management of SYIs with PSBI where referral is not feasible in Kenya’s health system: (1) participating in a cocreation workshop and development of a theory of change; (2) revising the national integrated management of newborn and childhood illnesses guidelines to incorporate the management of PSBI where referral is not feasible; (3) improving availability of essential commodities; (4) strengthening provider confidence in the management of SYIs; (5) strengthening awareness about PSBI services for SYIs at the community level; and (6) harmonizing the national integrated management of newborn and childhood illnesses guidelines to address discrepancies in the content on the management of PSBI. In addition, the project focused on strengthening quality of care for SYIs and using implementation research to track progress in achieving project targets and outcomes. Conclusion: Using an implementation research approach to introduce new WHO guidelines on PSBI where referral is not feasible into Kenya’s health care service was critical to fostering engagement of a diverse range of stakeholders, monitoring provider skills and confidence-building, strengthening provision of key commodities for managing SYIs with PSBI, and sustaining community-facility linkages.
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    PublicationMetadata only
    Measuring implementation outcomes in the context of scaling up possible serious bacterial infection guidelines: Implications for measurement and programs
    (Plos one, 2023-06-29) Abuya, Timothy; Odwe, George; Ndwiga, Charity; Okondo, Chantalle; Liambila, Wilson; Mungai, Samuel; Mwaura, Peter; Gitaka, Jesse; Warren, Charlotte E.
    Background Reducing the burden of neonatal sepsis requires timely identification and initiation of suitable antibiotic treatment in primary health care (PHC) settings. Countries are encouraged to adopt simplified antibiotic regimens at the PHC level for treating sick young infants (SYI) with signs of possible serious bacterial infection (PSBI). As countries implement PSBI guidelines, more lessons on effective implementation strategies and outcome measurements are needed. We document pragmatic approaches used to design, measure and report implementation strategies and outcomes while adopting PSBI guidelines in Kenya. Methods We designed implementation research using longitudinal mixed methods embedded in a continuous regular systematic learning and adoption of evidence in the PHC context. We synthesized formative data to co-create with stakeholders, implementation strategies to incorporate PSBI guidelines into routine service delivery for SYIs. This was followed by quarterly monitoring for learning and feedback on the effect of implementation strategies, documented lessons learned and tracked implementation outcomes. We collected endline data to measure the overall effect on service level outcomes. Results Our findings show that characterizing implementation strategies and linking them with implementation outcomes, helps illustrate the pathway between the implementation process and outcomes. Although we have demonstrated that it is feasible to implement PSBI in PHC, effective investment in continuous capacity strengthening of providers through blended approaches, efficient use of available human resources, and improving the efficiency of service areas for managing SYIs optimizes timely identification and management of SYI. Sustained provision of commodities for management of SYI facilitates increased uptake of services. Strengthening facility-community linkages supports adherence to scheduled visits. Enhancing the caregiver’s preparedness during postnatal contacts in the community or facility will facilitate the effective completion of treatment. Conclusion Careful design, and definition of terms related to the measurement of implementation outcomes and strategies enable ease of interpretation of findings. Using the taxonomy of implementation outcomes help frame the measurement process and provides empirical evidence in a structured way to demonstrate causal relationships between implementation strategies and outcomes. Using this approach, we have illustrated that the implementation of simplified antibiotic regimens for treating SYIs with PSBI in PHC settings is feasible in Kenya.
  • Thumbnail Image
    PublicationOpen Access
    Measuring implementation outcomes in the context of scaling up possible serious bacterial infection guidelines: Implications for measurement and programs
    (Plos One, 2023-06-29) Abuya, Timothy; Odwe, George; Ndwiga, Charity; Okondo, Chantalle; Liambila, Wilson; Mungai, Samuel; Mwaura, Peter; K’Oduol, Kezia; Natecho, Alice; Gitaka, Jesse
  • No Thumbnail Available
    PublicationMetadata only
    Measuring implementation outcomes in the context of scaling up possible serious bacterial infection guidelines: Implications for measurement and programs
    (Plos one, 2023-06-29) Abuya, Timothy; Odwe, George; Ndwiga, Charity; Okondo, Chantalle; Liambila, Wilson; Mungai, Samuel; Mwaura, Peter; K’Oduol, Kezia; Natecho, Alice; Gitaka, Jesse; Warren, Charlotte E.
    Background Reducing the burden of neonatal sepsis requires timely identification and initiation of suitable antibiotic treatment in primary health care (PHC) settings. Countries are encouraged to adopt simplified antibiotic regimens at the PHC level for treating sick young infants (SYI) with signs of possible serious bacterial infection (PSBI). As countries implement PSBI guidelines, more lessons on effective implementation strategies and outcome measurements are needed. We document pragmatic approaches used to design, measure and report implementation strategies and outcomes while adopting PSBI guidelines in Kenya. Methods We designed implementation research using longitudinal mixed methods embedded in a continuous regular systematic learning and adoption of evidence in the PHC context. We synthesized formative data to co-create with stakeholders, implementation strategies to incorporate PSBI guidelines into routine service delivery for SYIs. This was followed by quarterly monitoring for learning and feedback on the effect of implementation strategies, documented lessons learned and tracked implementation outcomes. We collected endline data to measure the overall effect on service level outcomes. Results Our findings show that characterizing implementation strategies and linking them with implementation outcomes, helps illustrate the pathway between the implementation process and outcomes. Although we have demonstrated that it is feasible to implement PSBI in PHC, effective investment in continuous capacity strengthening of providers through blended approaches, efficient use of available human resources, and improving the efficiency of service areas for managing SYIs optimizes timely identification and management of SYI. Sustained provision of commodities for management of SYI facilitates increased uptake of services. Strengthening facility-community linkages supports adherence to scheduled visits. Enhancing the caregiver’s preparedness during postnatal contacts in the community or facility will facilitate the effective completion of treatment. Conclusion Careful design, and definition of terms related to the measurement of implementation outcomes and strategies enable ease of interpretation of findings. Using the taxonomy of implementation outcomes help frame the measurement process and provides empirical evidence in a structured way to demonstrate causal relationships between implementation strategies and outcomes. Using this approach, we have illustrated that the implementation of simplified antibiotic regimens for treating SYIs with PSBI in PHC settings is feasible in Kenya.