Clinical cascades as a novel way to assess physical readiness of facilities for the care of small and sick neonates in Kenya and Uganda

Morgan, Melissa C.; Spindler, Hilary; Nambuya, Harriet; Nalwa, Grace; Namazzi, Gertrude; Waiswa, Peter; Otieno, Phelgona; Cranmer, John N.; Walker, Dilys

doi:10.1371/journal.pone.0207156

Cited by 15 publications

(24 citation statements)

References 49 publications

(69 reference statements)

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“…The unit had incubators, oxygen cylinders and concentrators, a phototherapy machine, an improvised continuous positive airway pressure (CPAP) machine and other supplies essential for neonatal care. The hospital was one of the study sites for the Preterm Birth Initiative study (2016 to 2019) which provided some of the equipment and essential supplies at the start of the intervention [ 23 , 24 ]. However, there was no access to surfactant to treat Respiratory Distress Syndrome, and magnesium sulphate was not in use for neonatal brain protection among women with imminent birth.…”

Section: Methodsmentioning

confidence: 99%

Neurodevelopmental outcomes of preterm babies during infancy in Eastern Uganda: a prospective cohort study

Namazzi

Tumwine

Hildenwall

et al. 2020

Global Health Action

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Background Complications due to prematurity are a threat to child survival and full developmental potential particularly in low-income settings. Objective The aim of the study was to determine the neurodevelopmental outcomes among preterm infants and identify any modifiable factors associated with neurodevelopmental disability (NDD) Methods We recruited 454 babies (242 preterms with birth weight <2.5 kg, and 212 term babies) in a cohort study at birth from Iganga hospital between May and July 2018. We followed up the babies at an average age of 7 months (adjusted for prematurity) and assessed 211 preterm and 187 term infants for neurodevelopmental outcomes using the Malawi Developmental Assessment tool. Mothers were interviewed on care practices for the infants. Data were analyzed using STATA version 14. Results The study revealed a high incidence of NDD of 20.4% (43/211) among preterm infants compared to 7.5% (14/187) among the term babies, p < 0.001, of the same age. The most affected domain was fine motor (11.8%), followed by language (9.0%). At multivariate analysis, malnutrition and Kangaroo Mother Care (KMC) at home after discharge were the key factors that were significantly associated with NDD among preterm babies. The prevalence of malnutrition among preterm infants was 20% and this significantly increased the odds of developing NDD, OR = 2.92 (95% CI: 1.27–6.71). KMC practice at home reduced the odds of developing NDD, OR = 0.46, (95% CI: 0.21–1.00). Re-admission of preterm infants after discharge (a sign of severe illness) increased the odds of developing NDD but this was not statistically significant, OR = 2.33 (95% CI: 0.91–5.94). Conclusion Our study has shown that preterm infants are at a high risk of developing NDD, especially those with malnutrition. Health system readiness should be improved to provide follow-up care with emphasis on improving nutrition and continuity of KMC at home.

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Section: Methodsmentioning

confidence: 99%

Neurodevelopmental outcomes of preterm babies during infancy in Eastern Uganda: a prospective cohort study

Namazzi

Tumwine

Hildenwall

et al. 2020

Global Health Action

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“…Health facilities in LICs have limited capacity to offer quality health services, particularly in rural areas [12,13]. Where mental and support services exist they are usually managed by few providers, with inadequate supplies, and with insufficient information to caretakers on where to seek these services [11].…”

Section: Introductionmentioning

confidence: 99%

Caring for children with neurodevelopmental disability: Experiences from caretakers and health workers in rural eastern Uganda

et al. 2020

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Background Long term outcomes of children with neurodevelopmental disability are influenced by the condition itself, available health services and caretakers' coping ability to nurture the children which may be related to their beliefs and experiences. Most children with neurodevelopmental disabilities live in resource constrained settings. To inform design of contextually appropriate interventions, this study explored health workers' and caretakers' experiences in caring for infants with neurodevelopmental disability in rural eastern Uganda. Methods A qualitative case study was carried out in December 2017 and involved in-depth interviews with 14 caretakers of infants with severe neurodevelopmental disability, and five health workers in Iganga/Mayuge Demographic Surveillance Site in eastern Uganda. The interviews with caretakers were conducted in Lusoga, the local language, and in English for the health workers, using a predetermined open-ended interview guide. Data were analyzed using latent content analysis. Results Caretakers described the experience of caring for children with neurodevelopmental disability as impoverishing and 'imprisoning' due to high care costs, inability to return to income generating activities and nursing challenges. The latter resulted from failure in body control and several aspects of nutrition and maintaining vital functions, coupled with limited support from the community and the health system. Many caretakers expressed beliefs in supernatural causes of neurodevelopmental disability though they reported about complications

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“…Previous studies examining service readiness and availability in low- and middle-income countries have most commonly employed WHO’s SARA tool or DHS and USAID’s Service Provision Assessment (SPA) tool. Recently, researchers have also used the “clinical cascade” model to measure service-specific readiness, which organizes results hierarchically based on the order of variables necessary to sequentially identify, treat, and monitor or modify a particular health condition [62–64]. This methodology is clinically focused and less applicable to measures of general service readiness, which was the aim of this current study.…”

Section: Discussionmentioning

confidence: 99%

Assessing trends in the content of maternal and child care following a health system strengthening initiative in rural Madagascar: A longitudinal cohort study

et al. 2019

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Background In order to reach the health-related Sustainable Development Goals (SDGs) by 2030, gains attained in access to primary healthcare must be matched by gains in the quality of services delivered. Despite the broad consensus around the need to address quality, studies on the impact of health system strengthening (HSS) have focused predominantly on measures of healthcare access. Here, we examine changes in the content of maternal and child care as a proxy for healthcare quality, to better evaluate the effectiveness of an HSS intervention in a rural district of Madagascar. The intervention aimed at improving system readiness at all levels of care (community health, primary health centers, district hospital) through facility renovations, staffing, equipment, and training, while removing logistical and financial barriers to medical care (e.g., ambulance network and user-fee exemptions). Methods and findings We carried out a district-representative open longitudinal cohort study, with surveys administered to 1,522 households in the Ifanadiana district of Madagascar at the start of the HSS intervention in 2014, and again to 1,514 households in 2016. We examined changes in healthcare seeking behavior and outputs for sick-child care among children <5 years old, as well as for antenatal care and perinatal care among women aged 15–49. We used a difference-in-differences (DiD) analysis to compare trends between the intervention group (i.e., people living inside the HSS catchment area) and the non-intervention comparison group (i.e., the rest of the district). In addition, we used health facility–based surveys, monitoring service availability and readiness, to assess changes in the operational capacities of facilities supported by the intervention. The cohort study included 657 and 411 children (mean age = 2 years) reported to be ill in the 2014 and 2016 surveys, respectively (27.8% and 23.8% in the intervention group for each survey), as well as 552 and 524 women (mean age = 28 years) reported to have a live birth within the previous two years in the 2014 and 2016 surveys, respectively (31.5% and 29.6% in the intervention group for each survey). Over the two-year study period, the proportion of people who reported seeking care at health facilities experienced a relative change of +51.2% (from 41.4% in 2014 to 62.5% in 2016) and −7.1% (from 30.0% to 27.9%) in the intervention and non-intervention groups, respectively, for sick-child care (DiD p -value = 0.01); +11.4% (from 78.3% to 87.2%), and +10.3% (from 67.3% to 74.2%) for antenatal care ( p -value = 0.75); and +66.2% (from 23.1% to 38.3%) and +28.9% (from 13.9% to 17.9%) for perinatal care ( p -value = 0.13). Most indicators of care content, including rates of medication prescription and diagnostic test administration, appeared to increase more in the intervention compared to in the non-intervention group for the three areas of care we ...

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Clinical cascades as a novel way to assess physical readiness of facilities for the care of small and sick neonates in Kenya and Uganda

Cited by 15 publications

References 49 publications

Neurodevelopmental outcomes of preterm babies during infancy in Eastern Uganda: a prospective cohort study

Neurodevelopmental outcomes of preterm babies during infancy in Eastern Uganda: a prospective cohort study

Caring for children with neurodevelopmental disability: Experiences from caretakers and health workers in rural eastern Uganda

Assessing trends in the content of maternal and child care following a health system strengthening initiative in rural Madagascar: A longitudinal cohort study

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