Preventive Health Services Provided at Infant and Child Visits at Six Maternal-Child Health Clinics in Western Kenya: A Cross-Sectional Assessment, 2017 Open Access

Abstract

Despite Kenya making great progress in reducing child mortality and improving child health outcomes in recent decades, the Millennium Development Goals related to child mortality were not reached by 2015 and the country is not on track to achieve the Sustainable Development Goals by 2030. Effective interventions and services are available at Maternal and Child Health (MCH) clinics and have the potential to eliminate preventable child deaths. The purpose of this thesis was to determine what services are provided at six MCH clinics, estimate the coverage of services, and identify factors associated with service coverage.

A cross-sectional study of 78 caregivers and their children from six MCH clinics in Kenya was performed. Child health records were reviewed to determine coverage of immunizations, growth monitoring, vitamin A supplementation, deworming, and developmental screening. Caregivers were administered a questionnaire on their attitudes and practices related to the services provided at their MCH clinic and their child’s care and development.

Nearly 70% (69.2) of children were fully vaccinated for their age. We found a significant disparity in full vaccination coverage by gender, as males were 3.5 times more likely to be fully vaccinated than females. Further, full vaccination coverage also differed significantly across MCH clinic sites and ranged from 43.8% to 92.9%. No children in the study had developmental screening provided at any visit and few caregivers reported their clinic provides any child developmental services.

Preventive health service coverage estimated in this study is consistent with national and sub-national findings. However, our study found significant equity gaps in coverage at these six clinics that need to be further investigated to ensure that all children are reached with life-saving interventions and services. Child development is not routinely incorporated into MCH clinic visits, indicating an opportunity to dramatically scale up this component of MCH clinic service delivery and to maximize caregivers’ ability to enhance their child’s development.

Table of Contents

Chapter 1: Introduction. 1

Problem Statement 4

Purpose Statement 4

Significance statement 5

Research questions. 5

Chapter 2: Literature Review.. 7

Figure 1. Map of Countdown Priority Countries. 10

Figure 2. Map of Kenya. 11

Childhood Mortality and Morbidity. 11

Figure 3. Trends in childhood mortality (per 1,000 live births) in Kenya, 1999-2014. 12

Child Development 14

Maternal, Neonatal and Child Health Care in Kenya. 16

Figure 4. Continuum of Care for Maternal, Neonatal, and Child Health – Through Time & Place 17

Table 1. Kenya Essential Package for Health (KEPH) Interventions and Services for Children 1-59 Months 18

Immunization. 19

Deworming. 20

Vitamin A Supplementation. 20

Coverage of Interventions and Services. 21

Summary. 22

Chapter 3: Methodology. 24

Population and sample. 24

Table 2. Caregiver Recruitment by MCH Site. 25

Figure 5. Map of AMPATH Clinic Sites (study sites designated by circle) 25

Procedures. 25

Instruments. 26

Figure 6. Kenya’s Mother and Child Health Booklet 26

Figure 7. Sample Pages from Mother and Child Health Booklet 27

Variables. 28

Table 3. List of Immunization and Vitamin A Supplementation Variables. 29

Data Analysis. 30

Chapter 4: Results. 32

Table 4. Participant Demographics. 32

Immunizations. 33

Figure 8. Individual Dose Coverage for Each Vaccine Series. 34

Table 5. Number and Percentage of Eligible Children Receiving Specific Vaccinations by Background Characteristics 35

Table 6. Number and Percent of Children Up-to-Date on Vaccines by Sex and MCH Site. 36

Figure 9. Vaccine Coverage by Series and All Vaccines in the Immunization Schedule. 37

Table 7. Variables Included in Logistic Regression Model with Up-to-Date on All Vaccines. 37

Vitamin A and Deworming. 38

Table 8. Number and Percentage of Children Receiving Individual and All Eligible Doses of Vitamin A Supplementation and Deworming Medicine. 38

Growth Monitoring. 38

Table 9. Number and Percentage of Children with Weight Recorded at Each Visit 39

Child Development 40

Chapter 5: Discussion. 41

Limitations. 45

Chapter 6: Recommendations. 47

References. 49

About this Master's Thesis

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School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
Keyword	Child development Child mortality Kenya Immunization Health service coverage Child health
Committee Chair / Thesis Advisor	Winskell, Kate, Emory University
Committee Members	Rochat, Roger, Emory University McHenry, Megan, Indiana University School of Medicine
Partnering Agencies	University, college or education institution (other than Emory)

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