Kenya to pilot new tools to detect severe illness in children

Kenya is among four countries that will pilot new tools to detect severe illness, especially pneumonia, in children.

The Tools for Integrated Management of Childhood Illness (TIMCI) project seeks to introduce the use of pulse oximeters and clinical decision support algorithm in 60 primary health care facilities across three counties.

The pilot is expected to start in January will be in Kakamega, Kitui and Uasin Gishu counties.

The three counties were consultatively selected based on the current morbidity and mortality trends, burden of pneumonia and diversity in geographical altitudes.

A pulse oximeter is a painless and reliable way for clinicians to measure a person's blood oxygen levels.

Clinical decision support algorithms (CDSAs) on the other hand are digitized tools that combine an individual's health information with the health worker's knowledge and clinical protocols to assist in making diagnosis and treatment decisions.

In each pilot county, 20 health facilities have been selected totaling to 60 of them of which 17 have been randomly selected for research activities.

The four year global project is led by PATH in partnership with the Health Ministry, Swiss Tropical Public Health Institute and the University of Nairobi with support from Unitaid.

Other countries taking part in the project include Tanzania, India, and Senegal.

The major goal of the project seeks to improve detection of severe disease in children below the age of five including infants aged between zero to 60 days.

“The TIMCI is an attempt to provide pulse oximeters and clinical decision support algorithm tools to health workers to be able to identify children who are severely ill in particular pneumonia which continues to be a major killer of children in Kenya,” Kenya project lead Andolo Miheso said on Tuesday.

“Health workers don’t identify those children correctly and make referral immediately so the two tools will guide health workers step by step to identify those who have conditions like pneumonia, assess them properly, identify the correct treatment and refer them to the next level,” he added.

Globally, clinical decision support algorithms tools have been widely used while in low and middle income countries the tool has been used in Malawi and it demonstrated that there was an increase of close to 25 per cent patients seeking care in health facilities.

This was attributed to the ability of the tool to detect illnesses and was able to identify children who would otherwise have gone home on the basis of not having a severe illness.

According to Dr Andre Mulwa, Kenya’s under five mortality remains a key issue of public health concern and currently stands at 52 per 1,000 live births. Pneumonia, malaria, Diarrhoea and neonatal factors is the leading cause of under-five mortalities.

Mulwa is the acting Diretor of Preventive and Promotive Health Services at the Health Ministry.

Neonatal mortality alone accounts for 45 per cent of overall under 5 mortalities and 59 per cent of infant mortality.

The main causes of neonatal death are birth asphyxia, prematurity / low birth weight, and sepsis.

Pneumonia remains the one of the top two killers of children under five in Kenya accounting for one out of every three deaths.

Fifteen per cent of child deaths were due to pneumonia in 2018, and it was the second biggest killer of children under-five in 2017. Pneumonia killed almost 9,000 children under-five in 2018 – more than one child every hour.

“In most of these conditions, oxygen saturation levels in the children is compromised and hence the need to monitor the same to inform decision in diagnosis and management,” Mulwa said.

“The goal of the research component is to generate evidence on the operational fit and cost effectiveness of introducing pulse oximetry and electronic Clinical Decision Support Algorithms (eCDSA) into primary health care in low- and middle-income countries to facilitate national and international decision-making on scale-up.”

Pulse Oximetry is recommended by the World Health Organization in assessment of sick children and has been adopted in Kenya’s Integrated Management of Newborn and Child hood illnesses guidelines (IMNCI) 2018.

The University of Nairobi has finalised development of data collection tools, identified 17 research sites, trained research assistants and deployed them.

Similarly, servers have been procured and configured to receive data from research sites.