High-Impact Low-Cost Interventions Implemented to Enhance the Quality of Care Given to Preterm Babies in Kilifi County, Kenya

Abstract

The main objective of this study was to explore and describe the implementation of national policies/guidelines regarding low-cost high-impact interventions to enhance health outcomes for preterm babies among health professionals in Kilifi County. A mixed method approach, with a convergent parallel design was used. Seventeen public health facilities were chosen purposively for the study. Census sampling for the nurses and midwives was utilized with a sampling frame of 146 nurses and midwives. Data was collected using semi structured questionnaires to the nurses and midwives (n=102); A health facility assessment tool with facility leaders (n=16); focus group discussions were held among with nurses and midwives (n=7); in-depth interviews with key informants n=seven and unstructured observation. Analysis of quantitative data was done using the Statistical Package for Social Sciences (SPSS) version 23. Descriptive statistics (i.e. mean and standard deviation for continuous variables, frequencies and percentages for discrete variables) and inferential statistics were used to answer the research questions. Qualitative data was coded and analysed thematically. The results provided rich information from several data sources highlighting a need to improve the implementation of four evidence-based practices that would enhance health outcomes for preterm babies. Guidelines/policies, important equipment and medications were not always available, which caused frustration among healthcare workers in their efforts to provide care for preterm babies. Despite common recognition of their key function, guidelines are not always adhered to, as shown in this study. Inadequate use of guidelines reflects the omission of beneficial treatments, possible avoidable harms, and suboptimal patient care. This study also established that there were associations between participants’ gender and percentage scores for knowledge and practice and implementation. The study also highlights barriers and enablers to implementation of clinical guidelines and possible strategies to effective implementation.