Abstract:
Background
Maternal, fetal and neonatal mortality are higher in low-income compared to
high-income countries primarily due to weak health systems that impede access and
utilization of health services. Despite significant improvements in maternal, neonatal and
under five children indicators, in some low-income countries, including Kenya these
indicators remain relatively high prompting the search for innovative interventions to
catalyze the progress towards attaining the Sustainable Development Goal (SDG) 3 target
by 2030. We describe the results of a study that assessed the impact of an innovative
health systems approach on maternal, neonatal and under-five children outcomes.
MethodsMethods
This was a four year pre-post prospective study to describe trends in the outcomes
through the implementation of the Enhanced Health Care (EHC) using the Find Link Treat
and Retain (FLTR) strategy. This was implemented in the catchment population of a ‘level
2’ facility, Obekai dispensary in Busia County, Kenya between January 2016 and January
2019. The study population was pregnant women, newborns and under-five children
identified and referred to the facility over the study period. Women were identified in the
community by community health workers early in pregnancy and followed up in Obekai
dispensary until delivery. The newborns were followed up for the whole period the mother
baby dyads were in the study. The EHC was implemented on these pairs during the
duration of study upto 2-3 years. An interrupted time series model for a single group was
used to assess the effect of the intervention on the outcome.
ResultsResults
Attendance in the outpatient, under five and antenatal clinic increased by 76%, 37% and
54% respectively from 2015 to 2018. There was a 90% fully immunization coverage with
97% and 94% BCG and Polio coverage respectively among children studied. There was a
91% facility delivery rate among the pregnant women enrolled in the study. After
introduction of FLTR the immunization uptake increased significantly per quarter at a
rate of 29.2 (95% confidence interval, CI=20.1-38.3). There was an increase in facility
delivery, antenatal (ANC) attendance and decrease in neonatal death after introduction
on FLTR.
ConclusionsConclusions
Maternal and under-five health indicators in Obekai improved over the study period
following the implementation of the EHC package.
