Details:

Alternative Title:
BMC Public Health
Personal Author:
Curran, Kathryn G. ; Wells, Emma ; Crowe, Samuel J. ; Narra, Rupa ; Oremo, Jared ; ... More +
Curran, Kathryn G. ; Wells, Emma ; Crowe, Samuel J. ; Narra, Rupa ; Oremo, Jared ; Boru, Waqo ; Githuku, Jane ; Obonyo, Mark ; De Cock, Kevin M. ; Montgomery, Joel M. ; Makayotto, Lyndah ; Langat, Daniel ; Lowther, Sara A. ; O’Reilly, Ciara ; Gura, Zeinab ; Kioko, Jackson Less -
Description:
Background

From December 2014 to September 2016, a cholera outbreak in Kenya, the largest since 2010, caused 16,840 reported cases and 256 deaths. The outbreak affected 30 of Kenya’s 47 counties and occurred shortly after the decentralization of many healthcare services to the county level. This mixed-methods study, conducted June–July 2015, assessed cholera preparedness in Homa Bay, Nairobi, and Mombasa counties and explored clinic- and community-based health care workers’ (HCW) experiences during outbreak response.

Methods

Counties were selected based on cumulative cholera burden and geographic characteristics. We conducted 44 health facility cholera preparedness checklists (according to national guidelines) and 8 focus group discussions (FGDs). Frequencies from preparedness checklists were generated. To determine key themes from FGDs, inductive and deductive codes were applied; MAX software for qualitative data analysis (MAXQDA) was used to identify patterns.

Results

Some facilities lacked key materials for treating cholera patients, diagnosing cases, and maintaining infection control. Overall, 82% (36/44) of health facilities had oral rehydration salts, 65% (28/43) had IV fluids, 27% (12/44) had rectal swabs, 11% (5/44) had Cary-Blair transport media, and 86% (38/44) had gloves. A considerable number of facilities lacked disease reporting forms (34%, 14/41) and cholera treatment guidelines (37%, 16/43). In FDGs, HCWs described confusion regarding roles and reporting during the outbreak, which highlighted issues in coordination and management structures within the health system. Similar to checklist findings, FGD participants described supply challenges affecting laboratory preparedness and infection prevention and control. Perceived successes included community engagement, health education, strong collaboration between clinic and community HCWs, and HCWs’ personal passion to help others.

Conclusions

The confusion over roles, reporting, and management found in this evaluation highlights a need to adapt, implement, and communicate health strategies at the county level, in order to inform and train HCWs during health system transformations. International, national, and county stakeholders could strengthen preparedness and response for cholera and other public health emergencies in Kenya, and thereby strengthen global health security, through further investment in the existing Integrated Disease Surveillance and Response structure and national cholera prevention and control plan, and the adoption of county-specific cholera control plans.


Subjects:
[+]
Checklist Cholera Community Health Workers Delivery Of Health Care Disease Outbreaks Equipment And Supplies Focus Groups Health Education Health Facility Administration Humans Infection Control Laboratories Politics Qualitative Research
Source:
BMC Public Health. 18
Pubmed ID:
29890963
Pubmed Central ID:
PMC5996545
Document Type:
Journal Article
Place as Subject:
Kenya
Collection(s):
CDC Public Access
Main Document Checksum:
[+]
urn:sha256:2406282fe00304f58a286b660e06d11fdd5a13b36e10473ef1584feb29c2187b
Download URL:
https://stacks.cdc.gov/view/cdc/94880/cdc_94880_DS1.pdf
File Type:

Supporting Files

• 	12889_2018_5584_Fig1_HTML.gif	gif
  	12889_2018_5584_Fig1_HTML.jpg	jpeg
  	12889_2018_5584_Fig2_HTML.gif	gif
  	12889_2018_5584_Fig2_HTML.jpg	jpeg
  	12889_2018_Article_5584.nxml	xml

More +