African Population and Health Research Center, Nairobi, Kenya.
Kidogo Innovations, Nairobi, Kenya.
Front Public Health. 2023 Aug 1;11:1194978. doi: 10.3389/fpubh.2023.1194978. eCollection 2023.
Informal childcare centres have mushroomed in the informal settlements of Nairobi, Kenya to meet the increasing demand. However, centre providers are untrained and the facilities are below standard putting children at risk of poor health and development. We aimed to co-design and test the feasibility, acceptability, cost and potential benefits of a communities of practice (CoP) model where trained community health volunteers (CHVs) provide group training sessions to build skills and improve practices in informal childcare centres.
A CoP model was co-designed with sub-county health teams, centre providers and parents with inputs from Kidogo, government nutritionists and ECD experts and implemented in 68 childcare centres by trained CHVs. Its feasibility and potential benefits were measured quantitatively and qualitatively. Centre provider ( = 68) and CHV ( = 20) knowledge and practice scores before and after the intervention were assessed and compared. Intervention benefits were examined using linear regressions adjusting for potential confounding factors. We conducted in-depth interviews with 10 parents, 10 CHVs, 10 centre providers and 20 local government officials, and two focus groups with CHVs and centre providers. Qualitative data were analysed, focusing on feasibility, acceptability, potential benefits, challenges and ideas for improvement. Cost for delivering and accessing the intervention were examined.
The intervention was acceptable and feasible to deliver within existing government community health systems; 16 CHVs successfully facilitated CoP sessions to 58 centre providers grouped into 13 groups each with 5-6 centre providers, each group receiving four sessions representing the four modules. There were significant improvements in provider knowledge and practice (effect size = 0.40; < 0.05) and quality of centre environment (effect size = 0.56; < 0.01) following the intervention. CHVs' scores showed no significant changes due to pre-existing high knowledge levels. Qualitative interviews also reported improvements in knowledge and practices and the desire among the different participants for the support to be continued. The total explicit costs were USD 22,598 and the total opportunity costs were USD 3,632 (IQR; USD 3,570, USD 4,049).
A simple model delivered by CHVs was feasible and has potential to improve the quality of informal childcare centres. Leveraging these teams and integration of the intervention into the health system is likely to enable scale-up and sustainability in Kenya and similar contexts.
为满足日益增长的需求，肯尼亚内罗毕的非正规住区如雨后春笋般涌现出许多非正规儿童保育中心。然而，中心提供者未经培训，设施标准低，使儿童面临健康和发育不良的风险。我们旨在共同设计并测试一种实践社区（CoP）模式的可行性、可接受性、成本和潜在效益，其中经过培训的社区卫生志愿者（CHV）提供小组培训课程，以提高非正规儿童保育中心的技能和改善实践。
该 CoP 模式是与县以下卫生团队、中心提供者和家长共同设计的，肯尼亚基多戈政府营养学家和幼儿发展专家也提供了投入，并由经过培训的 CHV 在 68 个儿童保育中心实施。通过定量和定性方法衡量其可行性和潜在效益。在干预前后评估并比较了中心提供者（=68）和 CHV（=20）的知识和实践得分。通过线性回归，在调整潜在混杂因素后，检验干预措施的益处。我们对 10 名家长、10 名 CHV、10 名中心提供者和 20 名地方政府官员进行了深入访谈，并对 CHV 和中心提供者进行了两次焦点小组讨论。对定性数据进行了分析，重点关注可行性、可接受性、潜在效益、挑战和改进思路。还审查了提供和获取干预措施的成本。
该干预措施在现有的政府社区卫生系统内是可接受且可行的；16 名 CHV 成功地为 58 名分为 13 组的中心提供者组织了 CoP 会议，每组 5-6 名中心提供者，每组接受四节代表四个模块的课程。在干预后，提供者的知识和实践有了显著提高（效应量=0.40；<0.05），中心环境质量也有所提高（效应量=0.56；<0.01）。由于 CHV 已经具有较高的知识水平，因此他们的分数没有显示出显著变化。定性访谈还报告了知识和实践的改进，以及不同参与者希望继续得到支持的愿望。总显式成本为 22598 美元，总机会成本为 3632 美元（IQR；3570 美元，4049 美元）。
由 CHV 提供的简单模式是可行的，并且有可能提高非正规儿童保育中心的质量。利用这些团队并将干预措施纳入卫生系统，可能使肯尼亚和类似情况下的扩大规模和可持续性成为可能。
