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The Effectiveness of an Integrated Rural Health Care Intervention During the COVID-19 Pandemic Response in Siaya, Kenya: A Prospective Quasi-Experimental Study

14 Pages Posted: 9 Mar 2021

See all articles by Neema Kaseje

Neema Kaseje

Surgical Systems Research Group

Kennedy Oruenjo

Ministry of Health

Dan Kaseje

Tropical Institute of Community Health and Development

Meghna Ranganathan

London School of Hygiene & Tropical Medicine

Marcel Tanner

University of Basel - Swiss Tropical and Public Health Institute

Andy Haines

London School of Hygiene & Tropical Medicine - Centre on Climate Change and Planetary Health

More...

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 NCT04501458

Funding Statement: Wellcome Trust

Declaration 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)

Suggested Citation

Kaseje, Neema and Oruenjo, Kennedy and Kaseje, Dan and Ranganathan, Meghna and Tanner, Marcel and Haines, Andy, The Effectiveness of an Integrated Rural Health Care Intervention During the COVID-19 Pandemic Response in Siaya, Kenya: A Prospective Quasi-Experimental Study. Available at SSRN: https://ssrn.com/abstract=3798564 or http://dx.doi.org/10.2139/ssrn.3798564

Neema Kaseje (Contact Author)

Surgical Systems Research Group ( email )

Kisumu
Kenya

Kennedy Oruenjo

Ministry of Health

Muscat
Oman

Dan Kaseje

Tropical Institute of Community Health and Development ( email )

Kisumu
Kenya

Meghna Ranganathan

London School of Hygiene & Tropical Medicine

London
United Kingdom

Marcel Tanner

University of Basel - Swiss Tropical and Public Health Institute ( email )

Basel
Switzerland

Andy Haines

London School of Hygiene & Tropical Medicine - Centre on Climate Change and Planetary Health ( email )

London
United Kingdom

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