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. 2018 Jun 11;18(1):723.
doi: 10.1186/s12889-018-5584-5.

Systems, supplies, and staff: a mixed-methods study of health care workers' experiences and health facility preparedness during a large national cholera outbreak, Kenya 2015

Kathryn G Curran  1 , Emma Wells  2 , Samuel J Crowe  2 , Rupa Narra  2 , Jared Oremo  3 , Waqo Boru  4 , Jane Githuku  4 , Mark Obonyo  4 , Kevin M De Cock  2   5 , Joel M Montgomery  2   5 , Lyndah Makayotto  6 , Daniel Langat  6 , Sara A Lowther  2   5 , Ciara O'Reilly  2 , Zeinab Gura  4 , Jackson Kioko  7
Affiliations

Systems, supplies, and staff: a mixed-methods study of health care workers' experiences and health facility preparedness during a large national cholera outbreak, Kenya 2015

Kathryn G Curran et al. BMC Public Health. .

Abstract

Background: From December 2014 to September 2016, a cholera outbreak in Kenya, the largest since 2010, caused 16,840 reported cases and 256 deaths. The outbreak affected 30 of Kenya's 47 counties and occurred shortly after the decentralization of many healthcare services to the county level. This mixed-methods study, conducted June-July 2015, assessed cholera preparedness in Homa Bay, Nairobi, and Mombasa counties and explored clinic- and community-based health care workers' (HCW) experiences during outbreak response.

Methods: Counties were selected based on cumulative cholera burden and geographic characteristics. We conducted 44 health facility cholera preparedness checklists (according to national guidelines) and 8 focus group discussions (FGDs). Frequencies from preparedness checklists were generated. To determine key themes from FGDs, inductive and deductive codes were applied; MAX software for qualitative data analysis (MAXQDA) was used to identify patterns.

Results: Some facilities lacked key materials for treating cholera patients, diagnosing cases, and maintaining infection control. Overall, 82% (36/44) of health facilities had oral rehydration salts, 65% (28/43) had IV fluids, 27% (12/44) had rectal swabs, 11% (5/44) had Cary-Blair transport media, and 86% (38/44) had gloves. A considerable number of facilities lacked disease reporting forms (34%, 14/41) and cholera treatment guidelines (37%, 16/43). In FDGs, HCWs described confusion regarding roles and reporting during the outbreak, which highlighted issues in coordination and management structures within the health system. Similar to checklist findings, FGD participants described supply challenges affecting laboratory preparedness and infection prevention and control. Perceived successes included community engagement, health education, strong collaboration between clinic and community HCWs, and HCWs' personal passion to help others.

Conclusions: The confusion over roles, reporting, and management found in this evaluation highlights a need to adapt, implement, and communicate health strategies at the county level, in order to inform and train HCWs during health system transformations. International, national, and county stakeholders could strengthen preparedness and response for cholera and other public health emergencies in Kenya, and thereby strengthen global health security, through further investment in the existing Integrated Disease Surveillance and Response structure and national cholera prevention and control plan, and the adoption of county-specific cholera control plans.

Keywords: Cholera; Decentralization; Devolution; Global health security; Kenya; Mixed-methods; Outbreak response; Preparedness; Surveillance.

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Conflict of interest statement

Ethics approval and consent to participate

This evaluation was reviewed in accordance with human subjects protection policy and was determined to be nonresearch, routine public health activities, by the Human Research Protection Office of the National Center for Emerging and Zoonotic Infectious Diseases (NCEZID) of the Centers for Disease Control and Prevention, Atlanta, GA, USA (determination # 061215CO) and the Kenya Ministry of Health, Disease Surveillance and Response Unit and Department of Preventive and Promotive Health. All participants provided oral informed consent, which was documented by a facilitator before commencing focus group discussions (CDC NCEZID determination # 061215CO).

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Counties and sub-counties selected for rapid assessment of cholera response, Kenya July 2015. Map of Kenya shows three counties selected for rapid assessment of cholera response in yellow. Homa Bay, Nairobi, and Mombasa County maps show selected sub-counties in orange
Fig. 2
Fig. 2
Quantitative and qualitative methods employed during a rapid assessment of cholera outbreak response, Kenya July 2015. Number of health facility cholera preparedness checklists, number of focus group discussions (FGD) completed with community health extension workers (CHEW) and nurses, and number of FGD participants (n) in parenthesis are listed by sub-counties in Nairobi, Homa Bay, and Mombasa Counties
See this image and copyright information in PMC

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MeSH terms