No abstract

Background: Low-birthweight (LBW) infants (<2500 g) are at greatest risk of mortality in the neonatal period, particularly in low-and middle-income countries. Timely access to quality healthcare averts adverse outcomes. Aim: To explore caregiver experiences and healthcare provider perspectives of accessing healthcare for LBW infants in rural Kenya. Methods: This qualitative study was undertaken in Homa Bay County� of rural western Kenya in June 2019. In-depth interviews� witheleven caregivers and four healthcare providers were conducted by a trained research assistant. All interviews were transcribed verbatim, and transcripts in the local languages were translated into English. A thematic framework was used to analyse the data. Results: At the community and individual level � ; community misconceptions about LBW infants, inadequate infant care practices after discharge, lack of maternal support networks, � long distances from healthcare facilities and lack of financial support� were key challenges. � In addition, long hospital waiting times, healthcare worker strikes and the apparent inadequate knowledge and skills of healthcare providers �were disincentives among caregivers. �Among � healthcare providers health system deficiencies, � (staff shortages and inadequate resources for optimal assessment and treatment of LBW infants � ) � and maternal illiteracy� were key challenges. � Education by staff during antenatal visits and community support groups �were enablers Conclusion: Accessing healthcare for LBW infants in this community � is fraught with challenge � s. � that has implications� for their post-discharge outcomes There is an urgent need to develop and test strategies� to address the barriers both at the at the community and health system level to� optimise outcome � s. �

BackgroundGlobally, low birthweight (LBW) infants (&lt;2,500 g) have the highest risk of mortality during the first year of life. Those who survive often have adverse health outcomes. Post-discharge outcomes of LBW infants in impoverished communities in Africa are largely unknown. This paper describes the design and implementation of a mother-to-mother peer training and mentoring programme for the follow-up of LBW infants in rural Kenya.MethodsKey informant interviews were conducted with 10 mothers of neonates (infants &lt;28 days) from two rural communities in western Kenya. These data informed the identification of key characteristics required for mother-to-mother peer supporters (peer mothers) following up LBW infants post discharge. Forty potential peer mothers were invited to attend a 5-day training programme that focused on three main themes: supportive care using appropriate communication, identification of severe illness, and recommended care strategies for LBW infants. Sixteen peer mothers were mentored to conduct seven community follow-up visits to each mother-LBW infant pair with fifteen completing all the visits over a 6-month period. A mixed methods approach was used to evaluate the implementation of the programme. Quantitative data of peer mother socio-demographic characteristics, recruitment, and retention was collected. Two post-training focus group discussions were conducted with the peer mothers to explore their experiences of the programme. Descriptive statistics were generated from the quantitative data and the qualitative data was analysed using a thematic framework.ResultsThe median age of the peer mothers was 26 years (range 21–43). From March-August 2019, each peer mother conducted a median of 28 visits (range 7–77) with fourteen (88%) completing all their assigned follow-up visits. Post training, our interviews suggest that peer mothers felt empowered to promote appropriate infant feeding practices. They gave multiple examples of improved health seeking behaviours as a result of the peer mother training programme.ConclusionOur peer mother training programme equipped peer mothers with the knowledge and skills for the post-discharge follow-up of LBW infants in this rural community in Kenya. Community-based interventions for LBW infants, delivered by appropriately trained peer mothers, have the potential to address the current gaps in post-discharge care for these infants.

electroencephalogram and computer tomography suggestive of encephalitis, over one year. In these patients, VE was if CSF cell count was <1000 cells/mm3(lymphocyte predominance) and absence of non-viral pathogens in the CSF or blood. BM was CSF cell count > 1000 cells/mm3(polymorph predominance) and CSF protein >0.45 g/L and CSF/plasma glucose <40%, and/or positive Gram stain and/or bacterial culture. JE was VE with ! 40 units of anti JE-IgM in the CSF and/or serum. All CNS infections were defined as, suspected cases by treating clinician with or without fever with LP showing CSF cells > 4/mm 3. Results Out of 38, bacterial meningitis was found in 47%, JE 21% and other causes in 32%. Although WHO definition of AES was not significantly associated with all CNS infections (p-value= 0.069), it was significantly associated with VE (p-value£0.001, sensitivity 74%, specificity 93%, PPV 94%, NPV 70%) and BM (p-value£0.001, sensitivity 30%, specificity 7%, PPV 33%, NPV 6%). Likewise, CSF criteria(cytology and biochemistry) for diagnosing JE was significantly associated with confirmed diagnosis of JE(p-value= 0.001). Conclusion We validate WHO AES definition of BM and VE and CSF cytology and biochemistry analysis for the diagnosis of JE, as a significantly useful screening tool for children with these diseases specially in resource poor settings, endemic areas and confirmatory tests were not easily available.