Preprint—Family and provider perceptions of quality of care in the management of sick young infants in primary health care settings in four counties of Kenya

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This article is a preprint and has not been peer-reviewed. It reports new medical research that has yet to be evaluated and so should not be used to guide clinical practice.


Background: Understanding the perceptions of quality of care given to sick young infants in primary health care settings is key for developing strategies for effective uptake and utilization of PSBI guidelines. The purpose of this study is to assess families' and providers' perceptions of care given to sick young infants at primary healthcare facilities in four diverse counties in Kenya. Methods: A cross-sectional qualitative design involving in-depth interviews (23) and focus group discussions (25) with very young (15-18 years), young (19-24 years) and older (25-45 years) caregivers of young infants 0-59 days; and key informant interviews with community- and facility-based frontline health providers (14) in primary health care facilities. Qualitative data were captured using audio tapes and field notes, transcribed, translated, and exported into QSR NVivo 12 for analysis. A thematic framework approach was adopted to classify and analyze data. Results: Perceived care given to SYIs was described around six domains of WHO's framework for the quality of maternal and newborn health care: evidence-based practices for routine and emergency care; functional referral systems; effective communication; respect and preservation of dignity; availability of competent, motivated human resources; and availability of physical resources. Views of caregivers and providers regarding SYIs care at PHCs were similar across the four sites. Main hindrance to SYI care includes stockout of essential drugs, limited infrastructure, lack of functional referral system, inadequate providers which led to delays in receiving treatment, inadequate provider skills and poor provider attitudes. Despite these challenges, motivation and teamwork of health providers were key tenets in care provision. Conclusion: The findings underscore the need to prioritize improving quality of SYIs services at PHCs by building capacity of providers through training, ensuring continuous supply of essential medicines and equipment, improving infrastructure including referral.