RESUMEN
INTRODUCTION: Appropriate demand for, and supply of, high quality essential neonatal care is key to improving newborn survival but evaluating such provision has received limited attention in low- and middle-income countries. Moreover, specific local data are needed to support healthcare planning for this vulnerable population. METHODS: We conducted health facility assessments between July 2015-April 2016, with retrospective review of admission events between 1st July 2014 and 30th June 2015, and used estimates of population-based incidence of neonatal conditions in Nairobi to explore access and evaluate readiness of public, private not-for-profit (mission), and private-for-profit (private) sector facilities providing 24/7 inpatient neonatal care in Nairobi City County. RESULTS: In total, 33 (4 public, 6 mission, and 23 private) facilities providing 24/7 inpatient neonatal care in Nairobi City County were identified, 31 were studied in detail. Four public sector facilities, including the only three facilities in which services were free, accounted for 71% (8,630/12,202) of all neonatal admissions. Large facilities (>900 annual admissions) with adequate infrastructure tended to have high bed occupancy (over 100% in two facilities), high mortality (15%), and high patient to nurse ratios (7-15 patients per nurse). Twenty-one smaller, predominantly private, facilities were judged insufficiently resourced to provide adequate care. In many of these, nurses provided newborn and maternity care simultaneously using resources shared across settings, newborn care experience was likely to be limited (<50 cases per year), there was often no resident clinician, and sick babies were often referred onwards. Results suggest 44% (9,764/21,966) of Nairobi's small and sick newborns may not access any of the identified facilities and a further 9% (2,026/21,966) access facilities judged to be inadequately equipped. CONCLUSION: Over 50% of Nairobi's sick newborns may not access a facility with adequate resources to provide essential care. A very high proportion of care accessed is provided by four public and one low cost mission facility; these face major challenges of high patient acuity (high mortality), high patient to nurse ratios, and often overcrowding. Reducing high neonatal mortality in this urban, predominantly poor, population will require effective long-term, multi-sectoral planning and investment.
Asunto(s)
Mortalidad Infantil , Cuidado Intensivo Neonatal/organización & administración , Estudios Transversales , Geografía , Instituciones de Salud , Accesibilidad a los Servicios de Salud , Hospitalización , Hospitales , Humanos , Lactante , Recién Nacido , Pacientes Internos , Kenia , Admisión del Paciente , Sector Privado , Calidad de la Atención de Salud , Reproducibilidad de los Resultados , Estudios Retrospectivos , Resultado del Tratamiento , Población UrbanaRESUMEN
OBJECTIVE: To determine the role of participant factors on the acceptance of a Prevention-of-Mother-to-Child (PMTCT) HIV test programme in a situation with an opt-out testing strategy. METHODS: We analysed antenatal clinic (ANC) HIV sentinel surveillance data. All 43 sites in the 2005 round of Kenya's ANC surveillance offered opt-out PMTCT services and recorded if women were offered PMTCT HIV testing and whether they accepted or refused. Logistic regression was used to determine the role of participant-level factors on PMTCT acceptance. RESULTS: During the period of sentinel surveillance, 13,026 women attended ANC and testing was offered to 12,030 women. Of those offered testing, 9690 (80.5%) accepted, with a large variation in the percent of acceptors by site. Age, residence and educational status were significant determinants of PMTCT acceptance. However, after adjusting for site none of the participant-level factors were significant determinants of PMTCT acceptance. CONCLUSIONS: Participant level factors were not significant determinants of PMTCT HIV test acceptance after adjusting for sites. PMTCT programmes should collect and evaluate the role of site-level (provider and testing service) factors on PMTCT acceptance. Improvement of site-level factors could improve PMTCT uptake.
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Serodiagnóstico del SIDA/estadística & datos numéricos , Infecciones por VIH/transmisión , VIH-1 , Accesibilidad a los Servicios de Salud/normas , Transmisión Vertical de Enfermedad Infecciosa/prevención & control , Aceptación de la Atención de Salud/estadística & datos numéricos , Atención Prenatal/normas , Adolescente , Adulto , Femenino , Humanos , Kenia , Modelos Logísticos , Persona de Mediana Edad , Vigilancia de la Población , Embarazo , Adulto JovenRESUMEN
OBJECTIVE: To assess an intervention for increasing access to and use of HIV testing among family planning clients through provider-initiated testing and counselling for HIV. DESIGN: Two versions of the intervention were prospectively compared using a prepost intervention only design. Health facilities were purposively selected and family planning consultations randomly selected. SETTING: Twenty-three public-sector hospitals, health centres and dispensaries in two districts of Central Province, Kenya. PARTICIPANTS: One group of 28 family planning providers were trained in the integrated family planning-HIV counselling intervention and in providing HIV testing and counselling to family planning clients requesting a test during the consultation and another group of 47 family planning providers were trained in the intervention and in referring clients interested in an HIV test. Samples of family planning clients willing to be observed and interviewed were randomly selected (538 preintervention, 520 postintervention) and their informed consent obtained to observe their consultation. INTERVENTION: All family planning providers were trained in an algorithm that integrates HIV/sexually transmitted infection prevention counselling, including offering HIV testing and counselling, with family planning counselling. Clients choosing to be tested were either referred or tested during the consultation by a trained family planning provider. MAIN OUTCOME MEASURES: The proportion of family planning clients with whom HIV testing was discussed; the proportion offered HIV testing; and the proportion choosing to have a test. RESULTS: The proportion of consultations in which HIV prevention counselling was provided and HIV testing offered increased significantly. The proportion of clients requesting an HIV test increased from 1 to 26%; approximately one third of these had never been tested previously. CONCLUSION: Provider-initiated testing and counselling is feasible and acceptable in family planning services, does not adversely affect the quality of the family planning consultation and increases access to and use of HIV testing in a population who would benefit from knowing their status.