Background
Methods
Study site
Study design and data collection
Sampling procedure
Data collection procedure
Data analysis
Intermediate steps effectiveness
Cumulative systems effectiveness
The design effect and intra-cluster correlation coefficients
Ethics
Results
Description of health facility, healthcare providers and ANC attendees
Type | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 |
---|---|---|---|---|---|---|---|---|---|
Sub-district hospital | Sub-district hospital | Dispensary | District hospital | Mission hospital | Health centre | Dispensary | Health centre | Health centre | |
Level | 4 | 4 | 2 | 4 | 4 | 3 | 2 | 3 | 3 |
Catchment population | 79,200 | 88,000 | 7500 | 23,400 | 6825 | 13,200 | 8100 | 5808 | 19,800 |
Number of ANC visits in 2009 | 2734.00 | 1509.00 | 363.00 | 1156.00 | 500.00 | 449.00 | 807.00 | 1354.00 | 1038.00 |
Staffing | |||||||||
Medical officer | 1 | 1 | 1 | ||||||
Clinical officer | 9 | 2 | 1 | 6 | 1 | 1 | 2 | 1 | |
Pharmacist | 1 | 1 | 1 | ||||||
Public health/registered nurse | 8 | 8 | 3 | 12 | 6 | 6 | 2 | 3 | |
Enrolled nurse | 10 | 6 | 6 | 2 | 1 | 2 | 2 | 4 | |
Assistant nurse | 5 | ||||||||
Lab technician | 3 | 3 | 2 | 4 | 2 | 2 | |||
Number of staff usually working in ANC | 4 | 2 | 4 | 4 | 9 | 5 | 3 | 4 | 12 |
Time to closest referral centre (min) | 45 | 60 | 45 | 30 | 30 | 90 | 60 | 60 | 30 |
Laboratory | Yes | Yes | Yes | Yes | Yes | Yes | |||
Pharmacy | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | |
Number of observation | 222 | 115 | 50 | 99 | 37 | 42 | 64 | 92 | 64 |
Number of exit interviews | 128 | 115 | 50 | 57 | 37 | 35 | 56 | 86 | 49 |
Health facility | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | Overall |
---|---|---|---|---|---|---|---|---|---|---|
Number of staff interviewed | 16 | 8 | 3 | 16 | 7 | 5 | 2 | 9 | 12 | 78 |
Number female | 9 (56.3) | 3 (37.5) | 3 (100.0) | 11 (68.8) | 4 (57.1) | 4 (80.0) | 2 (100.0) | 3 (33.3) | 9 (75.0) | 48 (61.5) |
Mean age in years (SD) | 29 (8) | 34 (8) | 34 (8) | 31 (7) | 34 (11) | 34 (11) | 38 (5) | 37 (11) | 34 (10) | 33 (9) |
Number resident in the district | 3 (18.8) | 0 (0.0) | 1 (33.3) | 4 (25.0) | 1 (14.3) | 1 (20.0) | 0 (0.0) | 6 (66.7) | 3 (25.0) | 21 (25.6) |
Number from district | 4 (25.0) | 1 (12.5) | 1 (33.3) | 1 (43.8) | 3 (42.9) | 1 (20.0) | 1 (50.0) | 6 (66.7) | 4 (33.3) | 31 (37.8) |
Ethnicity | ||||||||||
Luo | 6 (46.2) | 5 (62.5) | 3 (100.0) | 14 (93.3) | 6 (85.7) | 2 (40.0) | 2 (100.0) | 8 (88.9) | 7 (58.3) | 53 (71.6) |
Luyha | 4 (30.8) | 0 | 0 | 0 | 0 | 0 | 0 | 1 (11.1) | 2 (16.7) | 7 (9.5) |
Kalenjin | 1 (7.7) | 2 (25.0) | 0 | 1 (6.7) | 0 | 1 (20.0) | 0 | 0 | 3 (25.0) | 8 (10.8) |
Kisi | 2 (15.4) | 1 (12.5) | 0 | 0 | 1 (14.3) | 1 (20.0) | 0 | 0 | 0 | 5 (6.8) |
Other | 0 | 0 | 0 | 0 | 0 | 1 (20.0) | 0 | 0 | 0 | 1 (1.4) |
Mean years in health facility (SD) | 0 (1) | 2 (3) | 3 (5) | 2 (2) | 3 (3) | 0 (0) | 4 (2) | 7 (7) | 3 (3) | 2 (4) |
Number working in other departments | 15 (93.8) | 7 (87.5) | 2 (66.7) | 12 (80.0) | 6 (85.7) | 4 (80.0) | 2 (100.0) | 9 (100.0) | 11 (91.7) | 72 (88.9) |
Highest qualifications | ||||||||||
Medical or clinical officers | 3 | 2 | 0 | 3 | 1 | 1 | 0 | 0 | 1 | 11 |
Pharmacist | 1 | 0 | 0 | 1 | 0 | 0 | 0 | 0 | 0 | 2 |
Registered nurse/midwife | 2 | 2 | 2 | 4 | 4 | 3 | 0 | 0 | 4 | 21 |
Enrolled nurse/midwife | 1 | 0 | 1 | 0 | 0 | 1 | 0 | 0 | 3 | 6 |
Nurse aid | 0 | 0 | 0 | 0 | 1 | 0 | 0 | 0 | 0 | 1 |
Laboratory technician | 1 | 1 | 0 | 2 | 1 | 0 | 0 | 2 | 1 | 8 |
Student | 6 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 2 | 8 |
Other | 1 | 1 | 1 | 1 | 0 | 0 | 0 | 5 | 0 | 9 |
Number with FANC training in last 5 years | 4 (25.0) | 1 (12.5) | 1 (33.3) | 1 (6.25) | 0 (0.0) | 0 (0.0) | 0 (0.0) | 1 (11.1) | 2 (16.7) | 10 (12.2) |
Number with PMTCT training in last 5 years | 6 (37.5) | 4 (50.0) | 2 (66.7) | 10 (62.5) | 3 (42.9) | 2 (40.0) | 1 (50.0) | 7 (77.8) | 6 (50.0) | 41 (50.0) |
Number with MiP in training last 5 years | 3 (8.8) | 3 (37.5) | 1 (33.3) | 2 (12.5) | 1 (14.3) | 0 (0.0) | 0 (0.0) | 2 (2.2) | 1 (9.3) | 15 (15.9) |
Level 4 | Level 3 | Level 2 | Overall | |
---|---|---|---|---|
Number | 473 | 198 | 114 | 785 |
Mean age (SD) | 23.8 (5.9) | 23.5 (5.6) | 24.7 (6.8) | 23.9 (6.0) |
Age group | ||||
<15 years | 4 (0.9) | 3 (1.5) | 2 (1.8) | 9 (1.2) |
15–20 years | 117 (24.7) | 48 (24.2) | 28 (24.6) | 193 (24.6) |
20–29 years | 269 (56.9) | 114 (57.6) | 57 (50.0) | 440 (56.1) |
30–39 years | 75 (15.9) | 30 (15.2) | 22 (19.3) | 127 (16.2) |
40–49 years | 8 (1.69) | 1 (0.5) | 4 (3.5) | 13 (1.7) |
≥50 years | 0 (0.0) | 2 (1.0) | 1 (0.9) | 3 (0.4) |
Marital status | ||||
Single | 77 (16.5) | 40 (20.2) | 17 (15.0) | 134 (17.3) |
Married | 384 (82.4) | 154 (77.8) | 92 (81.4) | 630 (81.2) |
Divorced | 2 (0.4) | 3 (1.5) | 4 (3.5) | 9 (1.2) |
Widowed | 3 (0.6) | 1 (0.5) | 0 (0.0) | 4 (0.5) |
Highest level of education | ||||
None | 144 (30.4) | 84 (42.4) | 70 (61.4) | 298 (38.0) |
Primary | 271 (57.3) | 99 (50.0) | 38 (33.3) | 408 (52.0) |
Secondary | 41 (8.7) | 11 (5.6) | 5 (4.4) | 57 (7.3) |
Higher education | 17 (3.6) | 4 (2.0) | 1 (0.9) | 22 (2.8) |
Gravidity | ||||
Primi | 145 (30.7) | 71 (35.9) | 27 (23.7) | 243 (31.0) |
2–3 | 272 (57.5) | 101 (51.0) | 56 (49.1) | 429 (54.7) |
4+ | 56 (11.8) | 26 (13.1) | 31 (27.2) | 113 (14.4) |
Number of children under 5 | ||||
0 | 209 (44.6) | 85 (43.2) | 35 (31.5) | 329 (42.3) |
1 | 141 (30.1) | 65 (33.0) | 37 (33.3) | 243 (31.3) |
2–4 | 117 (25.0) | 45 (22.8) | 39 (35.1) | 201 (25.9) |
5+ | 2 (0.4) | 2 (1.0) | 0 (0.0) | 4 (0.5) |
Socioeconomic status group | ||||
Poorest | 44 (13.1) | 28 (16.5) | 51 (48.1) | 123 (20.1) |
Very poor | 54 (16.0) | 50 (29.4) | 19 (17.9) | 123 (20.1) |
Poor | 63 (18.7) | 45 (26.5) | 14 (13.2) | 122 (19.9) |
Less poor | 79 (23.4) | 29 (17.1) | 15 (14.2) | 123 (20.1) |
Least poor | 97 (28.8) | 18 (10.6) | 7 (6.6) | 122 (19.9) |
Missing
a
|
136
|
28
|
8
|
172
|
Gestation trimester | ||||
First | 12 (2.5) | 5 (2.5) | 3 (2.6) | 20 (2.6) |
2nd | 155 (32.8) | 68 (34.3) | 36 (31.6) | 259 (33.0) |
3rd | 228 (48.2) | 98 (49.5) | 67 (58.8) | 393 (50.1) |
Missing
|
78 (16.5)
|
27 (13.6)
|
8 (7.0)
|
113 (14.4)
|
ANC visit number | ||||
1 | 190 (40.2) | 111 (55.8) | 43 (37.4) | 344 (43.7) |
2 | 117 (24.7) | 35 (17.6) | 32 (27.8) | 184 (23.4) |
3 | 82 (17.3) | 22 (11.1) | 19 (16.5) | 123 (15.6) |
4 | 32 (6.8) | 8 (4.0) | 12 (10.4) | 52 (6.6) |
5 | 6 (1.3) | 2 (1.0) | 0 (0.0) | 8 (1.0) |
6 | 3 (0.6) | 2 (1.0) | 0 (0.0) | 5 (0.6) |
Missing
|
43 (9.1)
|
19 (9.6)
|
9 (7.8)
|
71 (9.0)
|
Reason for visit | ||||
Routine ANC | 325 (95.9) | 162 (95.3) | 102 (96.2) | 587 (95.8) |
Routine ANC + ill | 2 (0.6) | 3 (1.8) | 1 (0.9) | 6 (1.0) |
Ill | 10 (3.0) | 4 (2.4) | 3 (2.8) | 17 (2.8) |
Missing
|
136
|
29
|
8
|
175
|
Systems effectiveness of delivery of IPTp-SP
Level 4 | Levels 3 and 2 | |||||
---|---|---|---|---|---|---|
n | Intermediate | Cumulative | n | Intermediate | Cumulative | |
% (95 % CI) | % (95 % CI) | % (95 % CI) | % (95 % CI) | |||
With DOT | ||||||
IPTp eligiblea
| 304 | 242 | ||||
SP in stock | 304 | 100.0 | 100.0 | 242 | 100.0 | 100.0 |
Receive SP during visit | 208 |
68.6 [60.2, 75.9]
| 68.6 [60.2, 75.9] | 198 | 80.3 [61.7, 91.1] | 80.3 [61.7, 91.1] |
Receive three doses SP during visit | 206 | 99.0 [96.1, 99.7] | 67.8 [60.6, 74.3] | 187 | 94.1 [77.5, 98.7] | 75.5 [55.4, 88.5] |
Took SP by DOT | 121 |
64.6 [22.2, 92.1]
| 39.8 [12.5, 75.4] | 129 |
70.1 [22.1, 95.1]
| 53.3 [21.0, 83.1] |
With or without DOTb
| ||||||
IPTp eligiblea
| 208 | 220 | ||||
SP in stock | 208 | 100.0 | 100.0 | 220 | 100.0 | 100.0 |
Being given SP during visit | 140 |
67.5 [60.3, 74.0]
| 67.5 [60.3, 74.0] | 181 | 79.7 [60.8, 90.9] | 79.7 [60.8, 90.9] |
Being given three doses SP during visit | 139 | 99.2 [96.2, 99.9] | 67.0 [60.6, 72.8] | 170 | 93.4 [74.5, 98.6] | 74.5 [53.6, 88.1] |
Has SP on exit | 52 | 88.0 [63.3, 96.9] | 40.3 [18.2, 67.2] | 50 | 93.4 [45.9, 99.6] | 54.0 [17.6, 86.5] |
Knows to take three tablets SP | 48 | 92.1 [78.1, 97.5] | 37.2 [17.7, 61.9] | 49 | 96.4 [59.6, 99.8] | 52.5 [16.3, 86.2] |
SP by DOT | 80 |
58.3 [19.3, 89.1]
| 39.1 [15.9, 68.6] | 118 |
71.0 [22.9, 95.3]
| 52.9 [20.2, 83.2] |
Knows to take three tablets SP or took SP as DOT | 128 | 92.1 [87.4, 95.1] | 61.7 [55.7, 67.4] | 167 | 97.1 [70.6, 99.8] | 72.3 [46.9, 88.6] |
Systems effectiveness for delivery of ITNs
Steps for ITN delivery | Level 4 | Levels 3 and 2 | ||||
---|---|---|---|---|---|---|
n | Intermediate | Cumulative | n | Intermediate | Cumulative | |
% (95 % CI) | % (95 % CI) | % (95 % CI) | % (95 % CI) | |||
Attend ANC | 142 | 100.0 | 135 | 100.0 | ||
ITN in stock | 127 | 90.0 [76.9, 96.1] | 90.0 [76.9, 96.1] | 115 | 82.6 [47.6, 96.1] | 82.6 [47.6, 96.1] |
Given ITN during consultation by healthcare provider | 91 |
70.1 [54.3, 82.2]
| 63.1 [55.9, 69.7] | 94 | 83.0 [61.2, 93.8] | 68.6 [38.0, 88.6] |
Women took ITN | 91 | 100 | 63.1 [55.9, 69.7] | 93 | 98.4 [81.8, 99.9] | 67.4 [35.6, 88.6] |
Clustering and design effects for each intermediate delivery step
Delivery steps | Level 4 | Level 3 and 2 | Overall | |||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
% Pregnant women | % Range | DE | ICC | % Pregnant women | % Range | DE | ICC | % Pregnant women | % Range | DE | ICC | |
ITN eligible: attend ANC first visit | 100.0 | 100 | 100 | |||||||||
ITN in stock | 90.9 | (84.9–100.0) | 3.1 | 0.023 | 100 | 94.8 | (84.9–100.0) | 5.1 | 0.044 | |||
Offered an ITN | 63.4 | (55.6–74.2) | 0.7 | −0.003 | 68.6 | (35.3–100.0) | 9.1 | 0.087 | 66.0 | (35.3–100.0) | 4.4 | 0.037 |
IPTp eligiblea
| 100.0 | 100 | 100 | |||||||||
SP in stock | 100.0 | 100 | 100 | |||||||||
Seen at ANC consultation | 100.0 | 100.0 | 99.7 | (98.6–100.0) | 0.7 | −0.003 | 99.9 | (98.5–100.0) | 0.9 | -0.001 | ||
Being given SP during visit | 68.6 | (61.5–73.2) | 2.2 | 0.013 | 80.3 | (60.7–95.7) | 6.8 | 0.062 | 74.0 | (60.7–95.7) | 4.6 | 0.039 |
Being given three tabs SP during visit | 99.0 | (98.2–100.0) | 0.9 | −0.001 | 94.1 | (76.5–100.0) | 5.1 | 0.044 | 96.5 | (46.4–95.7) | 4.9 | 0.042 |
SP by DOT | 64.6 | (0.0–86.9) | 38.0 | 0.398 | 70.1 | (24.1–100.0) | 34.2 | 0.357 | 67.3 | (24.1–100.0) | 29.0 | 0.301 |
Has SP on exit | 36.7 | (11.3–96.6) | 26.0 | 0.269 | 27.1 | (0–80.0) | 28.7 | 0.298 | 31.5 | (0–96.6) | 22.3 | 0.229 |
Knows to take three tablets SP | 92.1 | (85.7–100.0) | 1.0 | 0.000 | 96.4 | (87.5–100.0 | 2.7 | 0.018 | 94.2 | (85.7–100.0) | 1.7 | 0.008 |
Knows to take three tablets SP or took SP as DOT | 92.1 | (86.2–93.8) | 0.6 | −0.004 | 97.1 | (70.0–100.0) | 6.4 | 0.058 | 94.8 | (70.0–100.0) | 2.9 | 0.020 |