Impact of COVID-19 on mortality in coastal Kenya: a longitudinal open cohort study.

The mortality impact of COVID-19 in Africa remains controversial because most countries lack vital registration. We analysed excess mortality in Kilifi Health and Demographic Surveillance System, Kenya, using 9 years of baseline data. SARS-CoV-2 seroprevalence studies suggest most adults here were infected before May 2022. During 5 waves of COVID-19 (April 2020-May 2022) an overall excess mortality of 4.8% (95% PI 1.2%, 9.4%) concealed a significant excess (11.6%, 95% PI 5.9%, 18.9%) among older adults ( ≥ 65 years) and a deficit among children aged 1-14 years (-7.7%, 95% PI -20.9%, 6.9%). The excess mortality rate for January 2020-December 2021, age-standardised to the Kenyan population, was 27.4/100,000 person-years (95% CI 23.2-31.6). In Coastal Kenya, excess mortality during the pandemic was substantially lower than in most high-income countries but the significant excess mortality in older adults emphasizes the value of achieving high vaccine coverage in this risk group.

The impact of the COVID-19 pandemic on vaccine coverage in Kilifi, Kenya: A retrospective cohort study.

The COVID-19 pandemic caused unprecedented disruption in health service delivery, globally. This study sought to provide evidence on the impact of the pandemic on vaccine coverage in Kilifi County, Kenya. We conducted a vaccine coverage survey between April and June 2021 within the Kilifi Health and Demographic Surveillance System (KHDSS). Simple random sampling was used to identify 1500 children aged 6 weeks-59 months. Participants were grouped into three retrospective cohorts based on when they became age-eligible for vaccination: before the pandemic, during the first year, or during the second year of the pandemic. Survival analysis with Cox regression was used to evaluate the association between the time-period at which participants became age-eligible for vaccination and the rate of vaccination within a month of age-eligibility for the third dose of pentavalent vaccine (Pentavalent-3) and within three months of age-eligibility for the first dose of Measles vaccine (MCV-1). A total of 1,341 participants were included in the survey. Compared to the pre-COVID-19 baseline period, the rate of vaccination within a month of age-eligibility for Pentavalent-3 was not significantly different in the first year of the pandemic (adjusted hazard ratio [aHR] 1.03, 95 % confidence interval [CI] 0.90-1.18) and was significantly higher during the second year of the pandemic (aHR 1.33, 95 % CI 1.07-1.65). The rate of vaccination with MCV-1 within three months of age-eligibility was not significantly different among those age-eligible for vaccination during the first year of the pandemic (aHR 1.04, 95 % CI 0.88-1.21) and was 35 % higher during the second year of the pandemic (95 % CI 1.11-1.64), compared to those age-eligible pre-COVID-19. After adjusting for known determinants of vaccination, the COVID-19 pandemic did not adversely affect the rate of vaccination within the KHDSS.

Impact of Health Sector Services Fund on the Quality of Maternity Services at Health Centres in Kisii South Sub-County

Background: The Ministry of Health used to disburse funds to the sub-counties through the sub-county treasury. However; there were operational difficulties and challenges for the health facilities in accessing these funds. It is against this background that the Ministry of Health came up with a more innovative approach in 2005 in which funds are credited directly into health facility accounts thereby bypassing the sub-county treasury. The direct funding innovation was first piloted in the Coast Province in 2005 and in 2010 it was rolled to the rest of the country. Since then no further evaluation has been carried out to assess the impact of this funding scheme in other sub counties.Objectives: To assess the impact of the direct funding on the quality of deliveries in maternity units of health centres in Kisii South Sub-county.Design: Descriptive study. Setting: The three health centres in Kisii South Sub-county namely; Nyamagundo; Riana and Riotanchi.Subjects: Secondary data from the maternity registers and interviewing staff working in maternity units.Results:There was statistically significant (p=0.05) increase in the number of deliveries in all the three health centres with Nyamagundo having 131%; Riana 114% and Riotanchi 103%; 33% of the facilities were conducting outreach services and purchasing medical supplies. However; the medical supplies and staffing challenges were still there in all and the structural barriers to quality maternity services were identified in all the facilities.Conclusions: The recommendations are that the funding should be enhanced and it should be workload or output based as the challenges vary among the facilities and other service delivery indicators should also be evaluated; besides rolling it to the other sub-counties in the same category