Population Council, Nairobi, Kenya.
Directorate of Research and Innovation, Mount Kenya University, Thika, Kenya.
PLoS One. 2023 Jun 29;18(6):e0287345. doi: 10.1371/journal.pone.0287345. eCollection 2023.
Reducing the burden of neonatal sepsis requires timely identification and initiation of suitable antibiotic treatment in primary health care (PHC) settings. Countries are encouraged to adopt simplified antibiotic regimens at the PHC level for treating sick young infants (SYI) with signs of possible serious bacterial infection (PSBI). As countries implement PSBI guidelines, more lessons on effective implementation strategies and outcome measurements are needed. We document pragmatic approaches used to design, measure and report implementation strategies and outcomes while adopting PSBI guidelines in Kenya.
We designed implementation research using longitudinal mixed methods embedded in a continuous regular systematic learning and adoption of evidence in the PHC context. We synthesized formative data to co-create with stakeholders, implementation strategies to incorporate PSBI guidelines into routine service delivery for SYIs. This was followed by quarterly monitoring for learning and feedback on the effect of implementation strategies, documented lessons learned and tracked implementation outcomes. We collected endline data to measure the overall effect on service level outcomes.
Our findings show that characterizing implementation strategies and linking them with implementation outcomes, helps illustrate the pathway between the implementation process and outcomes. Although we have demonstrated that it is feasible to implement PSBI in PHC, effective investment in continuous capacity strengthening of providers through blended approaches, efficient use of available human resources, and improving the efficiency of service areas for managing SYIs optimizes timely identification and management of SYI. Sustained provision of commodities for management of SYI facilitates increased uptake of services. Strengthening facility-community linkages supports adherence to scheduled visits. Enhancing the caregiver's preparedness during postnatal contacts in the community or facility will facilitate the effective completion of treatment.
Careful design, and definition of terms related to the measurement of implementation outcomes and strategies enable ease of interpretation of findings. Using the taxonomy of implementation outcomes help frame the measurement process and provides empirical evidence in a structured way to demonstrate causal relationships between implementation strategies and outcomes. Using this approach, we have illustrated that the implementation of simplified antibiotic regimens for treating SYIs with PSBI in PHC settings is feasible in Kenya.
在初级卫生保健（PHC）环境中，减少新生儿败血症的负担需要及时识别和启动合适的抗生素治疗。各国被鼓励在 PHC 层面采用简化的抗生素方案，用于治疗有潜在严重细菌感染（PSBI）迹象的患病婴幼儿（SYI）。随着各国实施 PSBI 指南，需要更多关于有效实施策略和结果测量的经验教训。我们记录了肯尼亚在采用 PSBI 指南时，用于设计、衡量和报告实施策略和结果的实用方法。
我们采用纵向混合方法设计实施研究，将其嵌入 PHC 背景下持续的系统学习和采用证据中。我们综合形成性数据，与利益相关者共同制定实施策略，将 PSBI 指南纳入 SYI 常规服务提供。随后，每季度进行监测，了解实施策略的效果，并提供反馈，记录经验教训，并跟踪实施结果。我们收集终线数据，以衡量服务水平结果的总体效果。
我们的研究结果表明，描述实施策略并将其与实施结果联系起来，可以说明实施过程与结果之间的关系。虽然我们已经证明在 PHC 中实施 PSBI 是可行的，但通过混合方法对提供者进行持续的能力建设投资、有效利用现有人力资源以及改善管理 SYI 的服务区效率，可以优化 SYI 的及时识别和管理。持续提供 SYI 管理所需的商品可以促进服务的普及。加强医疗机构与社区的联系有助于坚持预约访视。在社区或医疗机构的产后接触期间增强照顾者的准备，将有助于有效完成治疗。
精心设计和定义与实施结果和策略衡量相关的术语，便于解释研究结果。使用实施结果分类法有助于构建衡量过程，并以结构化的方式提供实证证据，以展示实施策略和结果之间的因果关系。通过这种方法，我们已经表明，在肯尼亚的 PHC 环境中，对 PSBI 患病婴幼儿采用简化抗生素方案进行治疗是可行的。
