ABSTRACT
Background: Globally, the COVID-19 pandemic has had broad consequences on health outcomes with significant morbidity and mortality. Rural health systems face more challenges in the availability of a workforce, adequate infrastructure and equipment. We completed a baseline assessment of the health system in Siaya at the beginning stages of the COVID-19 pandemic and designed an integrated intervention to maximize the prevention of COVID-19 cases and optimize case management at community and health facility levels. Methods: In partnership with the Ministry of Health (MOH), we trained health care workers in COVID-19 infection prevention, control, and case management at community and health facility levels. We strengthened the diagnostic and monitoring capacity of healthcare workers with thermometers and pulse oximeters, and we trained clinicians in basic critical care. In addition, we addressed leadership skills and psychological first aid. Youth were included during implementation to promote the uptake of digital tools by health care workers. Primary outcome measures were the total number of confirmed COVID-19 cases and the total number of COVID-19 related deaths in Siaya. Secondary outcome measures were related to hand hygiene practices and use of essential health services; specifically, the incidence of diarrheal diseases and respiratory infections not related to COVID-19, and the number of facility based deliveries. Findings: The incidence of confirmed COVID-19 cases was low compared to neighboring counties (with risk reduction ratios up to 7.8, CI 6.85-8.89). The total number of COVID-19 cases was 266 and the total number of COVID-19 related deaths was 7 at the time of the analysis in November 2020. The incidences of diarrheal diseases and respiratory infections (URTIs) not related to COVID-19 were lower in 2020 compared to 2019 and use of essential maternal health services was maintained during the COVID-19 response: specifically, the mean number of diarrheal cases was 3’033 in 2020 and 4’795 in 2019 (p=0.001); the mean number of URTIs not related to COVID-19 was 19’683 in 2020 and 27’567 in 2019 (p=0.015); and the mean number of facility based deliveries was 2’402 in 2020 and 2’322 in 2019 (p=0.2). Interpretation: An integrated and comprehensive intervention with capacity building at community and health facility levels results in the reduction of COVID-19 infections, and the reduction in the number of diarrheal and non COVID-19 related respiratory infections. Furthermore, the intervention resulted in the maintained use of maternal health services during the COVID-19 response.Trial Registration: Clinicaltrials.gov NCT04501458Funding Statement: Wellcome TrustDeclaration of Interests: None to declare.Ethics Approval Statement: Ethical review approvals received from the University of Nairobi Ethics Review Committee and Jaramogi Oginga Odinga Teaching and Referral Hospital Ethics Review Committee (approval number IERC/JOOTR/219/20)
Subject(s)
COVID-19 , Dysentery , Respiratory Tract InfectionsABSTRACT
Objective Our aim was to assess Siaya county COVID-19 preparedness at community and health facility levels and measure baseline household prevalences of fever and cough. Design There was retrospective and prospective data collection using standard tools. We determined the prevalence of fever and cough in households. We evaluated household knowledge about COVID-19 prevention and adherence to preventive measures. We evaluated the presence of a workforce, essential infrastructure and equipment needed for COVID-19 case management, and the availability of essential maternal and child health services in health facilities. Setting Siaya in rural Western Kenya Participants households and health facilities in Siaya Results We visited 19’474 households and assessed 152 facilities. The prevalences of fever and cough ranged from 1.4% to 4.3% and 0.2 to 0.8% respectively; 97% and 98% of households had not received a guest from nor travelled outside Siaya respectively; 97% knew about frequent handwashing, 66% knew about keeping distance, and 80% knew about wearing a mask; 63% washed their hands countless times; 53% remained home; and 74% used a mask when out in public. The health facility assessment showed: 93.6% were dispensaries and health centers; 90.4% had nurses; 40.5% had oxygen capacity; 13.5% had pulse oximeters; and 2 ventilators were available; 94.2% of facilities did not have COVID-19 testing kits; 94% and 91% of facilities continued to provide antenatal care and immunization services respectively. Health care worker training in COVID-19 had been planned. Conclusions Household prevalence of fever and cough was low suggesting Siaya had not entered the active community transmission phase in June 2020. Our assessment revealed a need for training in COVID-19 case management, and a need for basic equipment and supplies including pulse oximeters and oxygen. Future interventions should address these gaps. Strengths and limitations This study provides an example of how to successfully carry out an integrated rural health system baseline assessment of COVID-19 preparedness; an approach that would be useful for any country experiencing COVID-19 with a significant rural population. Some of our data were retrospective in nature and therefore vulnerable to multiple sources of bias including: recall bias and misclassification. Clinical Trial registration Clinicaltrials.gov NCT04501458 5/8/2020 Protocol The full protocol has been accepted for publication: Kaseje N, Kaseje D, Oruenjo K, Milambo J and Kaseje M: Engaging community health workers, technology, and youth in the COVID-19 response with concurrent critical care capacity building: A protocol for an integrated community and health system intervention to reduce mortality related to COVID-19 infection in Western Kenya. Wellcome Open Research. Ethical review approvals received from the University of Nairobi Ethics Review Committee and Jaramogi Oginga Odinga Teaching and Referral Hospital Ethics Review Committee ( approval number IERC/JOOTR/219/20 )