Factors Influencing the Effectiveness of Integrated Management of Childhood Illnesses Among Mothers of Children attending the Mother Child Health/ Family Planning Clinic at Pumwani Maternity Hospital, Nairobi, Kenya

Abstract

The Sustainable Development Goals adopted by the United Nations in 2015 were developed to promote healthy lives and well-being for all children. The SDG Goal 3 is to end preventable deaths of newborns and under-5 children by 2030. Currently the infant mortality rate in Kenya is 39 deaths per 1,000 live births and under-5 mortality is 52 deaths per 1,000 live births. Since 1999 the Government of Kenya has introduced the Integrated Management of Childhood Illness (IMCI) in an attempt to reduce child mortality. The main objective of this study was to determine the factors influencing the effectiveness of the IMCI strategy among mothers attending the MCH/FP clinic at Pumwani Maternity Hospital. A cross-sectional survey was used in which quantitative data was collected using structured questionnaires and qualitative data was collected using key informant interviews and focus group discussions. The study comprised a sample size of 385 mothers, 2 groups of mothers attending the MCH/FP clinic and 3 health workers at the clinic. Quantitative data was entered using MS Access software and was analysed using IBM’s SPSS version 23. Pearson’s Chi-square test was used to test the strength between categorical varibles and a Binary logistic regression was used for the multivariate analysis. Odds Ratio (OR) and 95% Confidence Interval (CI) were used to estimate the strength of association between independent and the dependent variables (effectiveness of IMCI). The threshold for statistical significance was set at p<0.05. Qualitative data was analysed thematically. Ethical approval was sought from KEMRI and ERC and written informed consent from the participants. The results showed that the IMCI strategy was not fully effective. About 21.6% of the children had various ailments, 25.7% were underweight and about 11% had not been fully immunized for their ages. Living in Nairobi, practicing the Christian faith, starting complementary feeding at 6 – 9 months, mentorship and training of health workers, increasing health worker numbers in facilities, availability of job aids, support supervision and improving the community health strategy are factors influencing the effectiveness of IMCI. The National and County governments need to have focused health information promotion to the caregivers and community on the importance of regular interaction with a health facility or health workers, regular mentorship and trainings for the health workers, increase the number of health workers in the facilities, avail job aids, regular support supervision and regular trainings and increasing the community health worker numbers. Information from this study will help in the formulation of evidence based decisions by policy implementers to improve the effectiveness of the IMCI strategy in preventing childhood morbidity and mortality.