Impact of a national nutritional support programme on loss to follow-up after tuberculosis diagnosis in Kenya

Mansour, Omar; Masini, Enos; Kim, B-S J; Kamene, Maureen; Githiomi, M M; Hanson, Christy

doi:10.5588/ijtld.17.0537

Cited by 20 publications

(19 citation statements)

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“…Implementation research is one of the most important and at the same time most neglected aspects of programme evaluation research. Rather, outcome/impact evaluations have become the norm for most researchers, especially those studying maternal nutrition intervention programmes in Kenya [25][26][27]. Such results provide information on what happened as a result of the programme without a clear picture of how it happened, and without sufficiently illuminating the reasons behind the success or failure of interventions.…”

Section: Ifas Intervention Is Implemented Through Miycn Programme Andmentioning

confidence: 99%

Implementation fidelity of Iron and Folic Acid supplementation (IFAs) and associated challenges among pregnant women in Uasin Gishu County Kenya

Riang’a

Nangulu²,

Broerse

2020

Preprint

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Introduction While Iron and Folic Acid Supplementation (IFAs) policy is offered free of charge in Kenya and has been implemented in Kenya and other low and middle-income-countries for decades, effectiveness of this intervention in improving maternal nutrition status has been inadequate. This study aims to acquire insight into the degree to which IFAs policy guidelines during pregnancy have been implemented as intended and the challenges to implementation fidelity. Methods Data was collected in rural Uasin Gishu County in the western part of Kenya through document analysis, questionnaires among programme recipients (n=188) and semi-structured interviews with programme implementers (n=6). Themes emerging from data are critically discussed using a conceptual framework based on programme theory and the programme implementation fidelity framework. Results Coverage of IFAs is widespread. However, policy content, frequency and participant responsiveness is not fully implemented. Only 10% accessed intervention within the first trimester as recommended by policy guidelines, only 18% and 15% of the respondents received 90 or more iron and folic acid pills respectively during their entire pregnancy period only 28% reported receiving nutritional counselling, and 66% completed taking the IFAs pills that were issued to them. Late initial bookings to antenatal care, drug stock shortage, staff shortage and long queues, confusing dosage instructions, side effects of the pills were established to be the main challenges to effective implementation fidelity. Anticipated health consequences and emphasis by the health officer to take the pills were established to be motivations for adherence to supplements. Conclusions Rather than targeting pregnant women who turn up for care at the health facilities, IFAs interventions should introduce community-based outreach programmes and make use of community-based health workers. This will not only relief the crowded health facilities for effective implementation integrity, but will also reach out to pregnant women within the first trimester when IFAs impact on health is greater and reach out to those women do not turn up at all for interventions at a health facility. Due to shortage and low compliance to IFAs pills, nutritional counselling is vital to promote consumption of locally available micro-nutrient rich food sources.

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Section: Ifas Intervention Is Implemented Through Miycn Programme Andmentioning

confidence: 99%

Implementation fidelity of Iron and Folic Acid supplementation (IFAs) and associated challenges among pregnant women in Uasin Gishu County Kenya

Riang’a

Nangulu²,

Broerse

2020

Preprint

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“…Studies reveal multiple challenges faced by people with RR-TB, including: economic struggles; food insecurity; discrimination and stigma; depression and anxiety; difficulty accessing therapy; hospital-based care; and side effects from treatment [12][13][14][15][16][17]. Some studies have documented that addressing these challenges by providing nutritional supplementation, conditional cash transfers, counseling, and peer support groups can result in improved TB outcomes [18][19][20][21]. Yet little is known about the specific support needs identified by people living with RR-TB themselves and their caregivers in a high-burden RR-TB context.…”

Section: Introductionmentioning

confidence: 99%

“A very humiliating illness”: a qualitative study of patient-centered Care for Rifampicin-Resistant Tuberculosis in South Africa

et al. 2020

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Background: Patient-centered care is pillar 1 of the "End TB" strategy, but little has been documented in the literature about what this means for people living with rifampicin-resistant (RR-TB). Optimizing care for such individuals requires a better understanding of the challenges they face and the support they need. Methods: A qualitative study was done among persons living with RR-TB and members of their support network. A purposive sample was selected from a larger study population and open-ended interviews were conducted using a semi-standard interview guide. Interviews were recorded and transcribed and the content analyzed using an iterative thematic analysis based in grounded theory. Results: 16 participants were interviewed from three different provinces. Four distinct periods in which support was needed were identified: 1) pre-diagnosis; 2) pre-treatment; 3) treatment; and 4) post-treatment. Challenges common in all four periods included: socioeconomic issues, centralized care, and the need for better counseling at multiple levels. Conclusions: Beyond being a "very humiliating illness", RR-TB robs people of their physical, social, economic, psychological, and emotional well-being far beyond the period when treatment is being administered. Efforts to tackle these issues are as important as new drugs and diagnostics in the fight against TB.

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Section: Introductionmentioning

confidence: 99%

Implementation fidelity of Iron and Folic Acid supplementation (IFAs) and associated challenges among pregnant women in Uasin Gishu County Kenya

Riang’a

Nangulu²,

Broerse

2020

Preprint

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Abstract Background Implementation fidelity which is defined as the degree to which programmes are implemented as intended is one of the factors that affect programme outcome, thus requiring careful examination. This study aims to acquire insight into the degree to which nutritional counselling and Iron and Folic Acid supplementation (IFAs) policy guidelines during pregnancy have been implemented as intended and the challenges to implementation fidelity. Methods Data were collected in rural Uasin Gishu County in the western part of Kenya through document analysis, questionnaires among programme recipients (n=188) and semi-structured interviews with programme implementers (n=6). Data collection and analysis were guided by an implementation fidelity framework. We specifically evaluated adherence to intervention design (content, frequency, duration and coverage), exposure or dosage quality of delivery and participant responsiveness. Results Coverage of nutritional counselling and IFAs policy is widespread. However, partial provision was reported in all the intervention components. Only 10% accessed intervention within the first trimester as recommended by policy guidelines, only 18% and 15% of the respondents received 90 or more iron and folic acid pills respectively during their entire pregnancy period, only 28% reported receiving nutritional counselling, and 66% completed taking the IFAs pills that were issued to them. Late initial bookings to antenatal care, drug stock shortage, staff shortage and long queues, confusing dosage instructions, side effects of the pills and issuing of many pills at one go, were established to be the main challenges to effective implementation fidelity. Anticipated health consequences and emphasis by the health officer to take the pills were established to be motivations for adherence to nutritional counselling and IFAs guidelines. Conclusions Implementation fidelity of nutritional counselling and IFAs policy in Kenya is generally weak. There is need for approaches to enhance early access to interventions, enhance stock availability, provide mitigation measures for the side effects, as well as intensify nutritional counselling to promote the consumption of micronutrient-rich food sources available in the local environment to substitute for the shortage of nutritional supplements and low compliance to IFAs.

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Impact of a national nutritional support programme on loss to follow-up after tuberculosis diagnosis in Kenya

Abstract: Nutritional support was associated with a reduction in the risk of LTFU. Providing nutrition counselling is important for patients receiving food support.

Cited by 20 publications

References 0 publications

Implementation fidelity of Iron and Folic Acid supplementation (IFAs) and associated challenges among pregnant women in Uasin Gishu County Kenya

Implementation fidelity of Iron and Folic Acid supplementation (IFAs) and associated challenges among pregnant women in Uasin Gishu County Kenya

“A very humiliating illness”: a qualitative study of patient-centered Care for Rifampicin-Resistant Tuberculosis in South Africa

Implementation fidelity of Iron and Folic Acid supplementation (IFAs) and associated challenges among pregnant women in Uasin Gishu County Kenya

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