Examining the Contribution of Knowledge and Clinical Competency to Comprehensive Newborn Care Protocol Adherence: Evidence from Kerugoya County Referral Hospital

Abstract

Background: Despite the implementation of the Comprehensive Newborn Care Protocol (CNCP) in Kenya to standardize neonatal care, adherence by healthcare providers remains inconsistent, particularly at County Referral Hospitals. This contributes to preventable neonatal morbidity and mortality, with Kenya recording a neonatal mortality rate of 21 deaths per 1,000 live births. Variability in CNCP adherence is attributed to gaps in provider knowledge, clinical competency, and systemic barriers such as inadequate training, limited mentorship, and resource constraints. Objective: To assess the influence of healthcare providers’ knowledge and clinical competency on adherence to the CNCP at Kerugoya County Referral Hospital, Kirinyaga County, Kenya. Methods: A descriptive cross-sectional study design employing mixed methods was utilized. Quantitative data were collected using structured questionnaires to assess CNCP adherence and knowledge and Competence. Qualitative data were gathered through key informant interviews to explore contextual challenges affecting protocol implementation. The integration of both data types enabled triangulation and comprehensive analysis. Results: Preliminary findings revealed significant variability in CNCP adherence, particularly in feeding preterm infants, weight monitoring, and breastfeeding techniques and maternal support. Healthcare providers with higher knowledge and competency levels demonstrated better compliance with CNCP. Barriers to adherence included absence of structured mentorship programs leading to lack of up to date information and adequate support in skill improvement leading to reduced ability to follow CNCP correctly. Conversely, ongoing in-service training and supportive supervision help improve knowledge and skills, making it easier for providers to adhere to the protocol. Conclusion: Knowledge and clinical competency of healthcare providers significantly influence adherence to CNCP. Systemic challenges compound this issue, highlighting the need for capacity-strengthening interventions. Recommendations: Regular in-service training, establishment of structured mentorship programs, and regular trainings for skill development. County health leadership should prioritize provider performance management and continuous professional development to enhance neonatal outcomes.