Browsing by Author "Githanga, David"

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    Devolved health system capacity in the provision of care for sick newborns and young infants in four counties serving vulnerable populations in Kenya
    (Plos Global Public Health, 2020-10-20) Gitaka, Jesse; Mwaura, Peter; Gatungu, Daniel; Githanga, David; Ndwiga, Charity; Abuya ,Timothy; K’Oduol,Kezia; Liambila , Wilson; Were , Fred; Mbugua , Samuel
    Possible severe bacterial infections (PSBI) is one of the three leading causes of newborn and young infant mortality globally that can be prevented by timely diagnosis and treatment using suitable antibiotics. High impact interventions such as use of out-patient injectable gentamicin and dispersible Amoxicillin with community-based follow up have been shown to reduce mortality in clinical trials. The objective of this study was to assess the health systems’ preparedness and organizational gaps that may impact execution in providing care for newborns and sick young infants. This formative research study was embedded within a three-year implementation research project in 4 Counties in Kenya. The indicators were based on facility audits for existing capacity to care for newborns and young infants as well as County organizational capacity assessment. The organizational capacity assessment domains were derived from the World Health Organization’s Health Systems Building blocks for health service delivery. The scores were computed by adding average scores in each domain and calculated against the total possible scores to generate a percentage outcome. Statistical analyses were descriptive with adjustment for clustering of data. Overall, the Counties have inadequate organizational capacity for management of sick young infants with Organizational Capacity Index scores of between 61–64%. Among the domains, the highest score was in Health Management Information System and service delivery. The lowest scores were in monitoring and evaluation (M&E). Counties scored relatively low scores in human resources for health and health products and commodities with one scoring poorly for both areas while the rest scored average performance. The four counties revealed varying levels of organizational capacity deficit to effectively manage sick young infants. The key underlying issues for the below par performance include poor coordination, low funding, inadequate supportive supervision, and M&E to enable data utilisation for quality improvement. It was evident that newborn and young infant health services suffer from inadequate infrastructure, equipment, staffing, and coordination. As Kenya, continuously rolls out the guidelines on management of sick young infants, there is need to focus attention to these challenges to enhance sustainable adoption and reduction of young infant morbidity and mortality.
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    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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    PublicationOpen Access
    Institutionalizing the Management of Sick Young Infants:Kenya’s Experience in Revising National Guidelines onIntegrated Management of Newborn and Childhood Illnesses
    (Global Health Sciences And Practices, 2023-04-13) Liambila, Wilson; Mwaura, Peter; Githanga, David; Mbuthia, Joe; Mungai, Samuel; Kinuthia, Doris; Govoga, Allan; Charlotte E. , Warren; K’Oduol, Kezia; Gitaka, Jesse; Natecho, Alice; Odwe, George; Abuya, Timothy; Were, Fred
    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 refer-ral is not feasible. The Ponya Mtoto project was designed as animplementation research project to demonstrate how to adopt theWHO PSBI guidelines in the Kenyan context.Ponya Mtoto Project Description:Between October 2017 andJune 2021, Ponya Mtoto was implemented in 4 Kenyan countieswith higher infant and newborn mortality rates than the nationalmean. A total of 48 health facilities stratified by level of serviceswere selected as study sites.Implementation Approach:The following activities were done toinstitutionalize the management of SYIs with PSBI where referralis not feasible in Kenya’s health system: (1) participating in acocreation workshop and development of a theory of change;(2) revising the national integrated management of newbornand childhood illnesses guidelines to incorporate the manage-ment of PSBI where referral is not feasible; (3) improving avail-ability of essential commodities; (4) strengthening providerconfidence 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 newbornand childhood illnesses guidelines to address discrepancies in thecontent 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 targetsand outcomes.Conclusion:Using an implementation research approach to intro-duce new WHO guidelines on PSBI where referral is not feasibleinto Kenya’s health care service was critical to fostering engage-ment of a diverse range of stakeholders, monitoring provider skillsand confidence-building, strengthening provision of key commodi-ties for managing SYIs with PSBI, and sustaining community-facilitylinkages
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    PublicationOpen Access
    Institutionalizing the Management of Sick Young Infants:Kenya’s Experience in Revising National Guidelines onIntegrated Management of Newborn and Childhood Illnesses
    (Global Health, 2023-04-28) Gitaka, Jesse; K’Oduol, Kezia; Odwe, George; Natecho, Alice; Mwaura, Peter; Githanga, David; Mbuthia, Joe; Wanjiru, Doris; Warren, Charlotte; Govoga, Allan; Mwaura, Peter
    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.