Impact of devolution on the trends of paediatric malaria admissions and mortality in Homa-Bay County, Kenya

Abstract

AbstractBackground: Malaria is a leading cause of paediatric admissions, morbidity and mortality. Malaria burden is endemic in Homa Bay County in the Lake Region in Kenya. Low social-economic status in Homa Bay County enhances malaria transmission, morbidity and mortality. Paediatric malaria admission and mortality have recently increased in the lake region unlike the rest of Kenya. Literature review did not show studies interrogating health policy correlates of this malaria problem in the region. The policy of the recently devolvement of the government system in Kenya was to bring services closer to the people. Devolved government in which the county governments are now responsible for healthcare delivery may have unique challenges that may influence disease morbidity and mortality. Objective: The aim of this study was to investigate the impact of devolution on paediatric malaria admission and mortality trends in public health facilities in Homa Bay County. Methods: This was a retrospective quasi-experimental study in which paediatrics records of 36 months before and 36 months after the devolvement of government were retrieved and analyzed for malaria incidence and deaths. All records of paediatric malaria cases reported in all 164 public health facilities in Homa-Bay County were examined. Data from the sub-County was obtained from the electronic records at the County Hospital. Hard copy data from health facilities in eight sub-Counties was also inspected at the sub-County level. Analysis of the data was accomplished by use of the Interrupted Time Series (ITS). Permission to conduct the study was obtained from the appropriate authorities. Data coding system was used in order to ensure confidentiality. Results: From January 2013, deaths increased gradually until around the 33rd month when it rose abruptly to nearly 800 then declined to levels below 200 in the 34 th month, which was around the time of devolution. This was followed by a period of stability. Admissions had a similar trend. Conclusions: There was a slight raise in paediatric malaria admissions and in the number of deaths due to malaria morbidity in Homa Bay County after the devolvement of government system in Kenya a factor which could be attributed to teething challenges of devolution. More studies are necessary to assess progress towards universal access to good healthcare services post devolution.