August 2, 2023

Improving adherence to pediatric clinical care guidelines in Kenya

Deaths of children under five years of age in Kenya have been steadily decreasing since 1990. However, nearly 65,000 children are still dying each year from causes such as diarrhea, HIV/AIDS, pneumonia and malnutrition. While standard medical guidelines exist for clinical care for each of these conditions, adherence to those guidelines remains inconsistent in Kenya.

A team of researchers from the University of Washington and Kenya Medical Research Institute are currently testing new approaches to increase the use of pediatric clinical guidelines at Kenya’s Migori County Referral Hospital. UW investigators include faculty from the School of Nursing, Department of Global Health and Department of Human Centered Design & Engineering. One of the investigators is Megan Coe, a Ph.D. candidate in the UW’s School of Nursing and a pre-doctoral trainee in the Research in Nursing and Global Health training program.

The team is taking a participatory approach to selecting and developing a tailored implementation strategy at the hospital. “The overarching goal is to design a strategy to make it feasible for the staff on the ground to follow the guidelines with the end goal of improving outcomes for their patients,” explained Coe.

The project, which is funded by a Population Health Initiative pilot grant, invited Migori County Referral Hospital staff to a planning meeting to discuss barriers to guideline adherence identified in a previous study. The staff then chose one challenge to focus on and selected an implementation strategy to pilot. Coe emphasized, “We’re trying to use a participatory approach to secure buy-in from the front-line healthcare workers so that they’re engaged in the whole process.”

The challenge the study participants chose was the shortage of nutritionists available in the hospital, delaying care for children with severe acute malnutrition. “The nutritionist is an important team member, but they’re not there all the time,” said Coe. With this problem in mind, the team then designed a pilot strategy named the Team Approach to Malnutrition Services (TeAMS) Toolkit.

The TeAMS Toolkit aims to support facility staff by providing malnutrition treatment to pediatric patients during times the nutritionist is unavailable. The Toolkit combines malnutrition information from various sources and clarifies responsibilities within the healthcare team.

“There’s a general pediatric guideline that is good because it’s brief and easy to use, but it doesn’t include the amount of detail that sometimes you need. And then there are malnutrition guidelines that are [over] 100 pages,” described Coe. “So, the strategy is to pull and merge key information from the two different guidelines and then decide as a team how we’re going to provide care.”

Currently, the study team is developing and refining the TeAMS Toolkit through three cycles of design sessions and hope to pilot their strategy in August 2023. Once the TeAMS Toolkit is launched, the resources will be available to hospital staff and healthcare workers. After 10 weeks, the strategy will be evaluated for usability via interviews and follow-up surveys.

Improved adherence to treatment guideline can improve quality of patient care, however adherence is not always feasible due to staffing constraints. Ultimately, the research team believes that, through collaboration, innovation and reflection, strategies can be created to mitigate these barriers and ensure the best possible care for patients.