Systems, supplies, and staff: a mixed-methods study of health care workers’ experiences and health facility preparedness during a large national cholera outbreak, Kenya 2015
Abstract Background From December 2014 to September 2016, a cholera outbreak in Kenya, the largest since 2010, caused 16,840 reported cases and 256 deaths. The outbreak affected 30 of Kenya’s 47 counties and occurred shortly after the decentralization of many healthcare services to the county level....
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| Language: | English |
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BMC
2018-06-01
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| Series: | BMC Public Health |
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| Online Access: | http://link.springer.com/article/10.1186/s12889-018-5584-5 |
| _version_ | 1831791021870022656 |
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| author | Kathryn G. Curran Emma Wells Samuel J. Crowe Rupa Narra Jared Oremo Waqo Boru Jane Githuku Mark Obonyo Kevin M. De Cock Joel M. Montgomery Lyndah Makayotto Daniel Langat Sara A. Lowther Ciara O’Reilly Zeinab Gura Jackson Kioko |
| author_facet | Kathryn G. Curran Emma Wells Samuel J. Crowe Rupa Narra Jared Oremo Waqo Boru Jane Githuku Mark Obonyo Kevin M. De Cock Joel M. Montgomery Lyndah Makayotto Daniel Langat Sara A. Lowther Ciara O’Reilly Zeinab Gura Jackson Kioko |
| author_sort | Kathryn G. Curran |
| collection | DOAJ |
| description | Abstract Background From December 2014 to September 2016, a cholera outbreak in Kenya, the largest since 2010, caused 16,840 reported cases and 256 deaths. The outbreak affected 30 of Kenya’s 47 counties and occurred shortly after the decentralization of many healthcare services to the county level. This mixed-methods study, conducted June–July 2015, assessed cholera preparedness in Homa Bay, Nairobi, and Mombasa counties and explored clinic- and community-based health care workers’ (HCW) experiences during outbreak response. Methods Counties were selected based on cumulative cholera burden and geographic characteristics. We conducted 44 health facility cholera preparedness checklists (according to national guidelines) and 8 focus group discussions (FGDs). Frequencies from preparedness checklists were generated. To determine key themes from FGDs, inductive and deductive codes were applied; MAX software for qualitative data analysis (MAXQDA) was used to identify patterns. Results Some facilities lacked key materials for treating cholera patients, diagnosing cases, and maintaining infection control. Overall, 82% (36/44) of health facilities had oral rehydration salts, 65% (28/43) had IV fluids, 27% (12/44) had rectal swabs, 11% (5/44) had Cary-Blair transport media, and 86% (38/44) had gloves. A considerable number of facilities lacked disease reporting forms (34%, 14/41) and cholera treatment guidelines (37%, 16/43). In FDGs, HCWs described confusion regarding roles and reporting during the outbreak, which highlighted issues in coordination and management structures within the health system. Similar to checklist findings, FGD participants described supply challenges affecting laboratory preparedness and infection prevention and control. Perceived successes included community engagement, health education, strong collaboration between clinic and community HCWs, and HCWs’ personal passion to help others. Conclusions The confusion over roles, reporting, and management found in this evaluation highlights a need to adapt, implement, and communicate health strategies at the county level, in order to inform and train HCWs during health system transformations. International, national, and county stakeholders could strengthen preparedness and response for cholera and other public health emergencies in Kenya, and thereby strengthen global health security, through further investment in the existing Integrated Disease Surveillance and Response structure and national cholera prevention and control plan, and the adoption of county-specific cholera control plans. |
| first_indexed | 2024-12-22T14:45:02Z |
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| institution | Directory Open Access Journal |
| issn | 1471-2458 |
| language | English |
| last_indexed | 2024-12-22T14:45:02Z |
| publishDate | 2018-06-01 |
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| spelling | doaj.art-8e54787e4c294378a24f0a5538ed68432022-12-21T18:22:28ZengBMCBMC Public Health1471-24582018-06-0118111210.1186/s12889-018-5584-5Systems, supplies, and staff: a mixed-methods study of health care workers’ experiences and health facility preparedness during a large national cholera outbreak, Kenya 2015Kathryn G. Curran0Emma Wells1Samuel J. Crowe2Rupa Narra3Jared Oremo4Waqo Boru5Jane Githuku6Mark Obonyo7Kevin M. De Cock8Joel M. Montgomery9Lyndah Makayotto10Daniel Langat11Sara A. Lowther12Ciara O’Reilly13Zeinab Gura14Jackson Kioko15US Centers for Disease Control and PreventionUS Centers for Disease Control and PreventionUS Centers for Disease Control and PreventionUS Centers for Disease Control and PreventionSafe Water and AIDS ProjectMinistry of Health, Kenya Field Epidemiology and Laboratory Training ProgramMinistry of Health, Kenya Field Epidemiology and Laboratory Training ProgramMinistry of Health, Kenya Field Epidemiology and Laboratory Training ProgramUS Centers for Disease Control and PreventionUS Centers for Disease Control and PreventionMinistry of Health, Disease Surveillance and Response UnitMinistry of Health, Disease Surveillance and Response UnitUS Centers for Disease Control and PreventionUS Centers for Disease Control and PreventionMinistry of Health, Kenya Field Epidemiology and Laboratory Training ProgramMinistry of Health, Department of Preventive and Promotive HealthAbstract Background From December 2014 to September 2016, a cholera outbreak in Kenya, the largest since 2010, caused 16,840 reported cases and 256 deaths. The outbreak affected 30 of Kenya’s 47 counties and occurred shortly after the decentralization of many healthcare services to the county level. This mixed-methods study, conducted June–July 2015, assessed cholera preparedness in Homa Bay, Nairobi, and Mombasa counties and explored clinic- and community-based health care workers’ (HCW) experiences during outbreak response. Methods Counties were selected based on cumulative cholera burden and geographic characteristics. We conducted 44 health facility cholera preparedness checklists (according to national guidelines) and 8 focus group discussions (FGDs). Frequencies from preparedness checklists were generated. To determine key themes from FGDs, inductive and deductive codes were applied; MAX software for qualitative data analysis (MAXQDA) was used to identify patterns. Results Some facilities lacked key materials for treating cholera patients, diagnosing cases, and maintaining infection control. Overall, 82% (36/44) of health facilities had oral rehydration salts, 65% (28/43) had IV fluids, 27% (12/44) had rectal swabs, 11% (5/44) had Cary-Blair transport media, and 86% (38/44) had gloves. A considerable number of facilities lacked disease reporting forms (34%, 14/41) and cholera treatment guidelines (37%, 16/43). In FDGs, HCWs described confusion regarding roles and reporting during the outbreak, which highlighted issues in coordination and management structures within the health system. Similar to checklist findings, FGD participants described supply challenges affecting laboratory preparedness and infection prevention and control. Perceived successes included community engagement, health education, strong collaboration between clinic and community HCWs, and HCWs’ personal passion to help others. Conclusions The confusion over roles, reporting, and management found in this evaluation highlights a need to adapt, implement, and communicate health strategies at the county level, in order to inform and train HCWs during health system transformations. International, national, and county stakeholders could strengthen preparedness and response for cholera and other public health emergencies in Kenya, and thereby strengthen global health security, through further investment in the existing Integrated Disease Surveillance and Response structure and national cholera prevention and control plan, and the adoption of county-specific cholera control plans.http://link.springer.com/article/10.1186/s12889-018-5584-5KenyaCholeraMixed-methodsDecentralizationDevolutionPreparedness |
| spellingShingle | Kathryn G. Curran Emma Wells Samuel J. Crowe Rupa Narra Jared Oremo Waqo Boru Jane Githuku Mark Obonyo Kevin M. De Cock Joel M. Montgomery Lyndah Makayotto Daniel Langat Sara A. Lowther Ciara O’Reilly Zeinab Gura Jackson Kioko Systems, supplies, and staff: a mixed-methods study of health care workers’ experiences and health facility preparedness during a large national cholera outbreak, Kenya 2015 BMC Public Health Kenya Cholera Mixed-methods Decentralization Devolution Preparedness |
| title | Systems, supplies, and staff: a mixed-methods study of health care workers’ experiences and health facility preparedness during a large national cholera outbreak, Kenya 2015 |
| title_full | Systems, supplies, and staff: a mixed-methods study of health care workers’ experiences and health facility preparedness during a large national cholera outbreak, Kenya 2015 |
| title_fullStr | Systems, supplies, and staff: a mixed-methods study of health care workers’ experiences and health facility preparedness during a large national cholera outbreak, Kenya 2015 |
| title_full_unstemmed | Systems, supplies, and staff: a mixed-methods study of health care workers’ experiences and health facility preparedness during a large national cholera outbreak, Kenya 2015 |
| title_short | Systems, supplies, and staff: a mixed-methods study of health care workers’ experiences and health facility preparedness during a large national cholera outbreak, Kenya 2015 |
| title_sort | systems supplies and staff a mixed methods study of health care workers experiences and health facility preparedness during a large national cholera outbreak kenya 2015 |
| topic | Kenya Cholera Mixed-methods Decentralization Devolution Preparedness |
| url | http://link.springer.com/article/10.1186/s12889-018-5584-5 |
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