Healthcare Workers Adherence to The Integrated Management of Neonatal and Childhood Illness Guidelines In Management of Children Below 5 Years in Isiolo County, Kenya

Abstract

The Integrated Management of Neonatal and Childhood Illnesses guidelines (IMNCI) has improved efficiency and quality of services for children. IMNCI recognizes that often, sick children present with more than one illness which contribute to childhood deaths if not appropriately assessed, classified and treated. For this reason, sick children should be managed by an integrated approach so as to deal with the main causes of childhood deaths. However, low adherence has been an important reason for failure to achieve the goal of substantially decreasing childhood deaths. Moreover, the IMNCI adherence level in Kenya (34%) is below the WHO recommended level (68%), furthermore, there is no data on adherence in Isiolo County. This study assessed health care workers adherence to the IMNCI guidelines in management of children below 5 years in Isiolo County. A cross sectional analytical study design was adopted. Twelve (12) health facilities were conveniently selected and the number of participants determined proportionate to the population of health care workers in each public health facility. A total of 190 Health care workers were systematically selected by picking the first participant randomly and the rest at 4th interval. A structured questionnaire and Key Informant Interview were utilized in data collection. Data was uploaded in Excel spreadsheet 2013 and analysed using Statistical Package for Social Sciences version 27. Chi square test was used to establish relationship between study variables and a P value <0.05 was considered statistically significant. Binary logistic regression and Adjusted Odds Ratio (AOR) with 95% Confidence Interval was used to quantify associations. Results: The overall adherence to the IMNCI guideline was 47.7%, the under 5 caseloads >20 (AOR=3.8; 95% C1 (1.450-10.056) and frequent supervision (AOR=8.4; 95% CI (3.257-21.679) were significantly associated with adherence. In conclusion; the adherence level to the IMNCI guideline in Isiolo County was low and health system factors, that is, under 5 caseloads >20 and frequent supervision were found to influence adherence. Qualitative insights from the informant highlighted the importance of IMNCI and areas of improvement. Recommendation; support supervision should be strengthened to improve adherence.