Figures & Tables
Figures
- FIGURE 1
Map of Ponya Mtoto Project Counties, Kenya
- FIGURE 2
Ponya Mtoto Project Implementation Research Cycle
Abbreviations: CHMT, county health management team; CHV, community health volunteer; FGD, focus group discussion; KII, key informant interview; M&E, monitoring and evaluation; SCHMT, subcounty health management team.
- FIGURE 3
Timeline of Key Ponya Mtoto Project Milestones
Abbreviations: CHV, community health volunteer; COP, community of practice; IMNCI, integrated management of newborn and child illnesses; PSBI, possible serious bacterial infection; TAG, technical advisory group.
- FIGURE 4
Ponya Mtoto Project’s Revised Theory of Change
Abbreviations: CHV, community health volunteer; COP, community of practice; IEC, information, education, and communication; IMNCI, integrated management of newborn and child illnesses; MOH, Ministry of Health; PHC, primary health care; PSBI, possible several bacterial infection; SYI, sick young infant.
Tables
County and Subcounty Hospitals Health Centers Dispensaries Bungoma Webuye West subcounty 2 1 3 Tongaren subcounty 1 3 2 Turkana Turkana Central subcounty 1 2 3 Turkana West subcounty 2 2 2 Mombasa Mvita subcounty 1 3 2 Changamwe-Jomvu subcounty 1 3 2 Kilifi Kilifi North subcounty 1 2 3 Kaloleni subcounty 1 3 2 - TABLE 2.
Providers’ Concerns About 2018 IMNCI Revised Guidelines and Recommendations for Future Revision
Category Provider Concern Recommendations Day 2 follow-up Many caregivers bringing infants on day 2 to receive second dose of gentamycin tended to bypass consultation rooms and went directly to the injection rooms. Therefore, the SYIs missed the mandatory day 2 assessment. Partners felt that the day 2 assessment of the SYI was critical to ensure quality service provision. Health providers to educate caregivers to return SYIs on day 2 for review before the second dose of gentamycin is administered. Day 4 follow-up Fewer caregivers returned their SYIs for review on day 4 because they felt their infants’ condition had improved, despite the guidelines requiring caregivers to bring back SYIs for review. Health providers to educate caregivers on the need to return SYIs on day 4 for review to document whether the SYI’s condition is improving, has remained the same, or is deteriorating. Assessment The National IMNCI Chart Booklet lists 18 signs to be used in assessment of SYIs with PSBI, compared to 7 signs for assessment of SYIs in the PSBI section. Revise the national IMNCI and PSBI materials to harmonize the signs and symptoms for assessment of SYIs. Classification The National IMNCI Chart Booklet lists 11 signs for critical illness, compared to 6 signs under critical illness in the PSBI section. Revise the national IMNCI and PSBI materials to harmonize the signs and symptoms for classification of critical illness in infants presenting with PSBI. Fast breathing The National IMNCI Chart Booklet lumps together all infants aged 0–59 days with signs of fast breathing, compared to the PSBI section that makes a distinction between fast breathing in infants aged 0–6 days and infants aged 7–59 days. Revise the national IMNCI and PSBI materials to distinguish fast breathing between infants aged 0–6 days and aged 7–59 days. Infants aged 0–6 days with fast breathing need to be referred for inpatient treatment. If referral is declined, treat as outpatient with oral amoxycillin daily for 7 days. Infants aged 7–59 days with fast breathing need to be treated in outpatient settings. Review on day 4 is mandatory for both groups. Temperature The National IMNCI Chart Booklet indicates temperature for fever as “Fever 37.5°C or above or feels hot,” compared to the PSBI section that indicate temperature for fever as “38°C” or more. Revise the national IMNCI and PSBI materials to harmonize the value of temperature/fever. Abbreviations: IMNCI, integrated management of newborn and childhood illnesses; PSBI, possible serious bacterial infection; SYI, sick young infant.
Previous Content in Kenya IMNCI Guidelines Harmonized Content in Line With WHO Recommendations Classification
18 signs to guide classification for PSBI/serious disease on page 32 in Kenya IMNCI Chart Booklet
Signs and symptoms harmonized as follows:
Convulsions or convulsing now or
Not able to feed at all or not feeding well or
Fast breathing (60 breaths/minute or more in infants aged <7 days) or
Serious chest indrawing or
High body temperature (38°C or above) or
Low body temperature (less than 35.5°C) or
Movement only when stimulated or
No movements at all
Fast breathing
All infants aged 0–59 days lumped together (pages 32 and 37) in the Kenya IMNCI Chart Booklet
Revised Kenya IMNCI chart booklet distinguishes between fast breathing in infants aged 0–6 days and aged 7–59 days.
Infant aged 0–6 days with fast breathing needs to be referred for inpatient treatment. If referral is declined, treat as outpatient with oral amoxicillin daily for 7 days.
Infant aged 7–59 days treat in outpatient settings.
Review on day 4 is mandatory for both groups.
Critical Illness
11 signs for critical illness on page 37 of Kenya IMNCI Chart Booklet
Signs for SYIs with critical illness (has any 1 of the following):
Convulsions or convulsing now
Not able to feed at all
No movement on stimulation
Weight <1500 g
Abbreviations: IMNCI, integrated management of newborn and childhood illnesses; PSBI, possible serious bacterial infection; SYI, sick young infant; WHO, World Health Organization.
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