Home-based record (HBR) ownership and use of HBR recording fields in selected Kenyan communities: Results from the Kenya Missed Opportunities for Vaccination Assessment

Abstract

BackgroundHome-based records (HBRs), which take many forms, serve as an important tool for frontline health workers by providing a standardized patient history vital to making informed decisions about the need for immunization services. There are increasing concerns around HBRs with recording areas that are functionally irrelevant because records are incomplete or not up-to-date. The aim of this report was to describe HBR ownership and report on the utilization of selected recording areas in HBRs across selected study communities in Kenya.MethodsThe Kenya Missed Opportunities for Vaccination Assessment utilized a mixed-methods approach that included exit interviews, using a standardized questionnaire, among a convenience sample of caregivers of children aged <24 months attending a health facility during November 2016 as well as interviews of health staff and facility administrators. In addition to the exit interview data, we analysed data obtained from a review of available HBRs from the children.ResultsA total of 677 children were identified with a valid date of birth and who were aged <24 months. A HBR was in hand and reviewed for three-quarters of the children. Nearly one-third (n = 41) of those without a HBR in hand at the visit noted that they did not know the importance of bringing the document with them. Roughly two-thirds (n = 443) of caregivers noted they were asked by clinic staff to see the HBR during the clinic visit. Across the 516 reviewed HBRs, recording areas were most commonly identified for the child’s demographic information (80% of HBRs) and vaccination history (82%) with information marked in >90% of records. Recording areas were less frequently available for child early eye / vision problems (61%), growth monitoring (74%) and vitamin A (76%); with information marked in 33%, 88% and 60% of records, respectively.ConclusionsCritical to the reduction of missed opportunities for vaccination, the HBR’s importance must be emphasized and the document must be requested by health workers at every health encounter. Health workers must not only ensure that all children receive a HBR and counsel caregivers of its importance, but they must also ensure that all sections of the record are legibly completed to ensure continuity of care. Programmes are encouraged to periodically review and critically assess the HBR to determine whether the document’s design and content areas are optimal to end user needs.

Qualitative insights into reasons for missed opportunities for vaccination in Kenyan health facilities

“…All groups discussed the stock-outs of both vaccines and vaccination-related supplies as a cause of MOV at their health facilities. Stock-outs of the MCH booklets made it difficult for health workers to easily assess the child's accurate age and the vaccines a child has received in the past, and can lead to confusion about which vaccine doses children are eligible to receive PLOS ONE [40][41][42]. Stock-outs of vaccines also have the potential to deter caregivers from visiting specific health facilities, and health services in general, if they had previously visited the clinic but were unable to be vaccinated because of limited vaccine supplies.…”

How Should Home-Based Maternal and Child Health Records Be Implemented? A Global Framework Analysis

“…14 In multiple-focus child health or maternal and child health books, the patient demographics and vaccination sections were the most consistently completed sections, and other sections including the growth monitoring charts were often neglected. 32 As our respondents alluded, having unused content sections could undermine the value of the rest of the HBR as perceived by both health care workers and women or caregivers. The extra resources used in creating these unused sections may have been unjustifiable and unnecessary costs.…”

“…Retention of the record plummeted when the record was not explained clearly. [22][23][24]32 Strengths of this study include a broad and comprehensive approach to exploring HBR implementation; this meant that we were able to develop a more complete picture of the implementation process, not simply 1 or 2 factors. Our key respondents had a breadth of experience: across continents, across different health and development sectors, and involving both policy-and groundlevel implementation.…”

Literature Review: Pemanfaatan Buku Kesehatan Ibu dan Anak (KIA) serta Potensi Pengembangan Selanjutnya

“…Jepang telah mencapai angka cakupan buku KIA tingkat tinggi, dengan rata-rata cakupan sebesar 100% (Akashi, et al, 2018;Takeuchi, Sakagami, & Perez, 2016), namun di beberapa negara lain diketahui bahwa masih terdapat kesenjangan terkait cakupan layanan (Ronsmans, et al, 2009;World Health Organization & UNICEF, 2013). Permintaan masyarakat terhadap catatan berbasis rumah juga dapat dikatakan masih rendah (Brown, et al, 2018). Demikian halnya dengan peran petugas kesehatan dan integrasi buku KIA di berbagai program juga belum memadai (World Health Organization, 2015).…”

“…Dampak penggunaan buku KIA terhadap kesehatan anak sebagai dampak penggunaan layanan buku KIA, antara lain: peningkatan pengetahuan ibu tentang kesehatan anak termasuk mengenal tanda bahaya pada anak dan jadwal vaksinasi anak (Kawakatsu, et al, 2015); anak mendapatkan dan memiliki catatan imunisasi lengkap (Osaki, Hattori, Kosen, 2013); catatan tersebut dapat mengurangi peluang kehilangan vaksinasi pada anak (diketahuinya vaksinasi yang sudah diberikan dan mana yang belum); memberikan referensi tanggal kembali untuk vaksinasi selanjutnya; sebagai catatan perawatan dan pemantauan pertumbuhan anak; mengakses layanan perawatan di komunitas maupun klinik; memperoleh akte kelahiran dari pencatatan kelahiran, serta untuk kepentingan masuk sekolah anak (Brown, et al, 2018); meningkatkan kesadaran ibu untuk aktif berinteraksi dengan anak, sehingga membantu menurunkan risiko gangguan perkembangan kognitif pada anak (Dagvadorj, et al, 2017); menerima pemberian suplemen vitamin A; memperkenalkan makanan pendamping ASI, penyediaan pemberian makan yang benar; makan makanan bervariasi; melatih anak makan sendiri, merawat anak batuk, serta memonitor/ mengawasi tingkat overweight dan stunting pada anak (Osaki, et al, 2018); serta mencari pelayanan kesehatan yang baik saat terjadi demam dan diare pada anak (Kawakatsu, et al, 2015). (Yanagisawa, et al, 2015;Mori, et al, 2015).…”