Strengthening the capacity of health facilities on integrated service delivery during outpatient treatment of malnutrition: Digitalized case fatality rate reduction among under-5 children in Kenyan Urban informal settlements

November 15, 2022

Patrick Amboka

Globally, malnutrition is a major contributor to more than 3 million deaths among children less than 5 years annually (Fanzo et. al, 2019). UNICEF estimates that 239,446 children in Kenya suffer from moderate acute malnutrition (MAM) and 2600 children suffer from severe acute malnutrition (SAM). Undernutrition also contributes to almost 35,000 deaths among children less than 5 years each year in Kenya (Fanzo et. al 2019). In Nairobi, stunting is at 26.3%, wasting at 6.3%, and underweight13.16%. (Vittoria De Vita 2019). A study done in Asia and African countries showed low recovery rates from Severe Acute Malnutrition having a lower range of 50% in outpatient management. (Ahmed et al, 2013). The disability-adjusted life years (DALYs) in Kenya by malnutrition in 2017 was 500,459. The cost per DALY averted for outpatient malnutrition treatment between 2000-2019 ranged between US$26 and US$53 (WHO, 2019).

Integrating service delivery during outpatient management of malnutrition with a webpage/Cisco phone system /USSD code /SMS push services between commodity suppliers-health facilities, Inter-healthcare facility collaboration, and connection between caregivers, will increase recovery rate and decrease case fatality rate due to malnutrition among the under 5 children. This system will digitalize the current monthly paper-based reporting tools. The robotic process automation will enhance outpatient treatment monitoring through data extraction using web crawlers, and generate ranked statistics. Application Programming Interphase, (API) will be integrated with a programming language to automate message reminders. Monitoring will be both verticalized (Health and Nutrition) and non-verticalized (All components of nurturing care framework). The Cisco phone system, USSD and push messages will be used as an alternative to the web page platform. Automated message reminders and follow-ups will be made possible through a Corporate Social Responsibility (CSR) provided by a tele-communication company.

For effective tele-monitoring with the Cisco phone system, the caregiver will dial a code before administering treatment, the information will then be integrated with an emailing system, together with time stamps, automated dashboards, and visualization and analytics. The web page and the Cisco phone system will enable tele-monitoring, tele-clinical assessment, and tele-interventions. The caregiver will also be able to check out on the availability of supplements in the nearest facility and book a favorable time they are willing to visit the health facility. Facility inter-collaboration on the treatment of malnutrition will also be through this system where facilities will be able to do effective referrals and re-supply commodities within the network. This will enable the commodity suppliers to re-supply commodities within collaborating facilities at the same time, therefore, saving on delivery costs. Caregivers to caregivers’ interphase will enable them to have support groups for sharing experiences.

This will be a multi-partnership project involving APHRC, telecommunication companies, national government (KEMSA), County governments, and stakeholders in the digital line. This project is also in line with the center’s signature issue and will bring synergy between at least four divisions.