Effect of Integrated Management of Childhood Illness Pneumonia Guideline Training on Health Workers Uptake of Oral Amoxicillin Among Children Aged 2-59 Months at Three Health Facilities in Nairobi County.

Abstract

Background In 2014, WHO re-classified childhood pneumonia syndromes. The new classification included; severe pneumonia, pneumonia, and no pneumonia(1). The class of pneumonia (non-severe) involved both age-specific tachypnea and or lower chest wall indrawing and no danger sign(s). Further, WHO recommended using oral high-dose amoxicillin for outpatient management of pneumonia. In 2018 Kenya MoH updated national IMNCI pneumonia guidelines and introduced oral high-dose amoxicillin for outpatient management of pneumonia (2). The broad objective was to determine the effect of IMCI pneumonia guidelines training and introduction of Sick Child Management Form on health workers uptake of high-dose amoxicillin among children aged 2-59 months. The effect of training and introduction of Sick Child Management Form on health workers adequacy of assessment and classification of pneumonia (non-severe pneumonia) were assessed as secondary outcomes. Methodology We conducted, in Eastleigh Health Centre, Westlands Health Centre and Huruma Lions Health Centre in Nairobi County, a before and after intervention study. We utilized an interrupted time series approach in analysis with an attempt to evaluate the effect of IMCI pneumonia guidelines training and the introduction of SCMF on health workers uptake of correct assessment, correct classification and correct treatment of non-severe pneumonia among children aged 2-59 months with cough and or difficulty in breathing reviewed between May 1, 2020 to February, 2022. We compared the trend of change overtime using health workers performance indicators for correct assessment, correct classification and correct treatment of non-severe pneumonia. Results During pre-intervention 1, the clinical adherence to IMCI pneumonia guidelines was poor with none of the children reviewed had a correct assessment, correct classification and correct treatment for non-severe pneumonia. After the training (1st intervention) there was no change of the same poor trend. After the introduction of the SCMF (2nd intervention) there was a noted immediate improvement with correct assessment by a factor of 19.4, P-value of 0.9, correct classification by a factor of 19.05, P-value of 0.9 and correct treatment by a factor of 17.3, P-value of 0.9. However, overtime there was a decline in the improvement effect. The correct assessment declined overtime by a factor of -0.009, P-value of 1, correct classification by a factor of -0.06, P-value of 1 and correct treatment by a factor of -0.1, P-value of 0.9. Conclusion Training health care workers alone may not improve and sustain uptake of IMCI pneumonia guidelines. The introduction of SCMF will improve uptake of IMCI pneumonia guidelines, however, better implementation strategies are needed to sustain the improvement overtime.