Lessons learnt from community referral and follow up of sick young infants with possible severe bacterial infection in Turkana County, Kenya

Abstract

Introduction: Management of possible severe bacterial infections in young infants (0–59 days) requires timely identification of danger signs and prompt administration of efficacious antibiotic treatment. The Possible Severe Bacterial Infection guidelines underscore the importance of close follow up in an outpatient basis to ensure treatment adherence and early detection of illness-related complications. The purpose of this study was to strengthen the follow up and referral of sick young infants on day 4 and 8 by introducing community-led interventions that facilitated community health volunteers to identify sick young infants, conduct community reviews, link data with responsive facilities, and refer appropriately. Methods: Six health facilities were included in a longitudinal, descriptive, mixed methods approach weaved around an initial formative context assessment and three-monthly assessments between October 2019 to January 2020 with a endline assessment in August 2020. Quantitative data was extracted from facility registers to identify gaps in follow up and referral feasibility. Qualitative data was through focus group discussions with community health volunteers and key informant interviews with frontline providers. Results: Qualitative data provided insights into key barriers and facilitators of community follow up and referral. Barriers include community socio-cultural practices, competing tasks, dysfunctional community referral pathway, drivers of common infections, and unavailability of essential commodities. Key facilitators entail indication of competency in identification of danger signs in sick young infants, presence of older women, men, and community resource persons that can leveraged on in community engagement and sensitization, and mothers are the primary decision makers in care seeking. There was increased utilization of decision support tools and an increase in the number of sick young infants managed in dispensaries. The COVID-19 pandemic however negatively impacted community follow up and referral of sick young infants. Conclusion: Essential barriers and facilitators to follow up and community referral entwined with facility-based vulnerabilities were highlighted. A two-pronged intervention on improving communication, linkage and subsequent follow up of sick young infants was employed in the six participating facilities. The feasibility, adoption, and fidelity of strengthening community facility linkage through integrated communication strategies was documented, indicative of a successful community-facility linkage in dispensaries and health centers despite the effects of the COVID-19 pandemic.