Optimizing integration of community-based management of possible serious bacterial infection (PSBI) in young infants into primary healthcare systems in Ethiopia and Kenya: successes and challenges.

Publication date: Mar 05, 2024

Ethiopia and Kenya have adopted the community-based integrated community case management (iCCM) of common childhood illnesses and newborn care strategy to improve access to treatment of infections in newborns and young infants since 2012 and 2018, respectively. However, the iCCM strategy implementation has not been fully integrated into the health system in both countries. This paper describes the extent of integration of iCCM program at the district/county health system level, related barriers to optimal integration and implementation of strategies. From November 2020 to August 2021, Ethiopia and Kenya implemented the community-based treatment of possible serious bacterial infection (PSBI) when referral to a higher facility is not possible using embedded implementation research (eIR) to mitigate the impact of COVID-19 on the delivery of this life-saving intervention. Both projects conducted mixed methods research from April-May 2021 to identify barriers and facilitators and inform strategies and summative evaluations from June-July 2022 to monitor the effectiveness of implementation outcomes including integration of strategies. Strategies identified as needed for successful implementation and sustainability of the management of PSBI integrated at the primary care level included continued coaching and support systems for frontline health workers, technical oversight from the district/county health system, and ensuring adequate supply of commodities. As a result, support and technical oversight capacity and collaborative learning were strengthened between primary care facilities and community health workers, resulting in improved bidirectional linkages. Improvement of PSBI treatment was seen with over 85% and 81% of estimated sick young infants identified and treated in Ethiopia and Kenya, respectively. However, perceived low quality of service, lack of community trust, and shortage of supplies remained barriers impeding optimal PSBI services access and delivery. Pragmatic eIR identified shared and unique contextual challenges between and across the two countries which informed the design and implementation of strategies to optimize the integration of PSBI management into the health system during the COVID-19 pandemic. The eIR participatory design also strengthened ownership to operationalize the implementation of identified strategies needed to improve the health system’s capacity for PSBI treatment.

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Concepts Keywords
Bacterial COVID-19
Healthcare Ethiopia
June Implementation research
Kenya Integration
Pandemic Kenya
Neonatal mortality


Type Source Name
disease MESH bacterial infection
disease MESH infections
disease IDO facility
disease MESH COVID-19
disease IDO intervention
disease VO effectiveness
disease IDO quality
disease VO LACK
pathway REACTOME Reproduction
drug DRUGBANK Coenzyme M
disease MESH live births
disease MESH neonatal deaths
disease IDO infection
disease VO organization
drug DRUGBANK Trestolone
disease IDO country
disease VO population
disease IDO process
disease MESH sepsis
disease VO injection
drug DRUGBANK Amoxicillin
drug DRUGBANK Alpha-Linolenic Acid
disease IDO production
drug DRUGBANK Spinosad
disease VO effective
disease VO monthly
disease VO time
drug DRUGBANK Gentamicin
drug DRUGBANK Etodolac
disease VO protocol
disease VO dose
disease MESH pneumonia
disease IDO site
drug DRUGBANK Etoperidone
drug DRUGBANK Tretamine
drug DRUGBANK Ilex paraguariensis leaf
disease VO Gap
disease VO report
disease MESH emergency
disease MESH malaria
pathway KEGG Malaria
drug DRUGBANK Water
drug DRUGBANK Serine
disease MESH trachoma
drug DRUGBANK Pentaerythritol tetranitrate
drug DRUGBANK Hexadecanal
disease VO Ply
disease MESH causality
disease VO USA
disease MESH maternal deaths
disease MESH stillbirths
disease MESH Neonatal Sepsis

Original Article

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