Extent of Home Based Care Program Support to Hospital Based Care for Children with Chronic and Terminal Illness in Meru County, Kenya

Introduction: Chronic and Terminal illnesses continue to increase and aggravate the burden of disease and the diminish space in our hospitals and communities, Worldwide, 57 million persons died in 2008, an estimated 40 million were in need of HBCP, 6.6 - 10.8 million Children died, 98% Chronic and Terminal illnesses (CI/TI) are found in low and middle-income Countries. Chronic and Terminal illnesses in Children are on the rise in Sub Saharan Africa. Kenya lags in implementation of Home Based Care to mitigate effects of CI/TI. WHO, 2017 and Ministry of Health-Kenya 2013 shows that Children are affected by these Illnesses. These illnesses have made families’ to suffer psychosocial and economic hardships. Evaluation of determinants of Home Based Care Program (EHBCP) services by assessing if effective and quality delivery of HBCP Supports Hospital Based Care is key.

Aims: To determine the extent to which Home Based Care Program services Support to Hospital Based Care for Children aged 1-14 years diagnosed with selected Chronic and Terminal illnesses in Meru County Kenya.

Study Design: A descriptive Cross Sectional Survey.

Place and Duration of Study: Meru County, Kenya between June 2018 and Dec 2019.

Methodology: Methodology: Descriptive Cross Sectional Survey of 245 Caregivers of Children diagnosed with Chronic and Terminal illness were selected by proportionate to size sampling and simple random sampling from Meru County Health Facilities.

Results: Delivery of quality and effective Home Based Care Program was positively associated with age, return rate of over 100% was achieved with about 245 respondents being interviewed (132%),experience of Health Care Workers (HCWs) 4.8 [95% CI = 1.06 – 21.68, P = 0.041]. HCWs profession, gender and years of work were positively related to Hospital Based Care services 3.03 [95%CI = 1.64 – 5.59, P<0.001]. Use of minimum HBCP package was found to be useful in support of hospital care, as 50.4% reported that its support was of a good or great extent. The trend was observed in all aspects of the minimum HBCP package studied, with 52.4%, 54.4% and 46.4% having the opinion that use of the package by caregivers, in management and mitigation of complications supported hospital care by a good or great extent respectively.

Conclusion: Need for an urgent adoption of holistic approach on health care system strengthening by putting up a well-integrated Home Based Care Program with quality Minimum HBCP essential package to support the mainstream health care system. In addition adopt better management practices, planning strategies, resource allocation and monitoring for effective HBCP programmes as per the current guidelines to bridge the gaps identified in planning, management practices to fill the disjointed policy implementation and resource inadequacies in implementation of HBCP services to support Hospital Based care for ultimate delivery of quality care among the Chronically and Terminally ill Children.