Quality Of Care Provided To Adolescents Aged 10 Upto 19 Years In Kenyatta National Hospital, Nairobi, Kenya

Abstract

Background: A health care system that seeks to improve the quality of care across all population groups must ensure that it provides health care that is; Effective, Accessible, Acceptable, Equitable and Safe. In developing countries, adolescent health care remains a gray area and in Kenya, adolescents make up 24% of the total population. This study explored the nature of Adolescent Health Care, in both the inpatient and outpatient settings at Kenyatta National Hospital, the largest referral hospital in Kenya. This study was conducted at KNH Filter Clinic including Pediatric filter clinics for ages 10-12 years, walk in clinic for age >12 years as well as specialty clinics and adolescents admitted inpatient. Goal: To describe the quality of care provided by Health Care Providers attending to patients aged between 10 and 19 years seeking care at Kenyatta National Hospital. Study design: A mix- method research design was used combining quantitative and qualitative approaches. A descriptive cross-sectional survey was conducted together with focus group discussions involving adolescents and health care professionals. Primary Objective: To describe and compare the quality of care provided to adolescents [aged 10 to 19 years] both in the inpatient and outpatient clinics in Kenyatta National Hospital against the WHO Global Standards for Quality Health-Care Services for Adolescents [2015]. Secondary Objectives: To identify gaps faced by the Hospital and Health Care Providers in providing for the needs of adolescents and to determine the barriers and challenges faced by Adolescents receiving health care in Kenyatta National Hospital. Methodology: All study participants were provided consent before participating in the study. For an adolescent who was less than 18 years of age to participate in the study, a consent was sought from the parent/guardian of the adolescent. Data was collected using structured interviewer based questionnaires. These included 1) Adolescent client exit interview tool, 2) Health facility manager interview tool and 3) Health-care provider tool. We collected data on social-demographic characteristics and quality of health care aspects using a scored quality of care tool. Eight standards of Quality Care, centered around adolescent health care, were measured which included: Adolescents’ health literacy, Community support, Appropriate package of services, Health Care Provider Competencies, Facility characteristics, Equity and non-discrimination, Data and quality improvement and Adolescents’ participation. Results: Adolescents who were more likely to report acceptable quality of service were older (p<0.0001), coming for a repeat visit (p=0.03), those who saw the signboard (p<0.0001), those who were supported using the facility by guardians (p=0.026) as well as those who got the services they came for (p=0.033). Older age (OR 1.5, p<0.0001) and accompaniment by parents/guardians (OR 0.5, p=0.006) were independently x associated with acceptable quality of care. There was very limited training on adolescent care reported by the Health Care Providers (21.7%). Overall, 73.9% of the Health Care Providers were not aware of Adolescent Care SOPs and guidelines. According to the WHO Criteria, 69% of the services offered did not meet the quality threshold. Assessing the quality of services as per the 8 WHO standards of quality health care in adolescents, the services offered need some improvement with respect to Standard 5 and 6, needs major improvement for the rest of the standards except Standard 8 which does not meet the quality care standards. Conclusion: KNH performed overall poorly in meeting theWHO standards of quality health care in adolescents. It can be concluded that the quality of care provided to adolescents at Kenyatta National Hospital requires significant improvement despite the adolescents’ overall good perception. Recommendation: Active adolescent involvement is needed in the planning, monitoring and evaluation of their health services. There is need to train health-care providers in order that they can be competent in providing effective health services to adolescents. Adolescents health rights and knowledge practices is vital as part of health-care provision by health care providers. An adolescent client database to follow up patients after their visits, as well as allow for the health facility to collect, analyse and use data on service utilization and quality of care to support quality improvement is required. The Facility requires more visual information e.g signs-boards, and posters on services provided as well as operational times. The accompaniment by a guardian or parent needs to be discussed as part of the overall visitation guidance by the health care provider.