Our research team repurposed their skills to respond to Covid-19 pandemic through research. Through funding from The Scottish Funding Council (through The University of Edinburgh internal grant), we are assessing the impact of measures taken by Kenya government to curb the spread of Sars-Cov-2 on provision of health services in Machakos County, Kenya. We have focused on the early effects of the measures from March to June 2020. The study established trends of outpatient and inpatient attendance in 10 main public health hospitals in all the nine sub-counties of Machakos County. We also explored the use of technology to mitigate worse patient outcomes during the pandemic season, owing to treatment and other socio-economic disruptions that have resulted either directly or indirectly from the outbreak of Covid-19 pandemic in Kenya.
Our findings show a drastic reduction in patient attendance in all selected health hospitals. We were able to develop and deploy an application system that included a dashboard for data analytics and a mobile phone-based application for recording patient follow-up and referral. Patients attending four specialty clinics at Machakos Level 5 Hospital: cancer, diabetes, hypertension and paediatrics who missed scheduled clinic appointments were followed on phone and requested to share reasons for missing their appointments. Among reasons given for missing appointments were cancellation of all day clinics following government directives, fear of contracting the virus because of being highly vulnerable, increased public transport costs and having come to hospital but was advised to refill drugs for a loner period without being reviewed by a physician.
Patients who accepted to be referred for review at facilities closer to their residences were scheduled and given appointment dates to visit the facilities. The project facilitated a joint review of patients by specialists at Machakos Level 5 Hospital and the general physicians/clinicians at referral facilities. Briefly, on the day of visit, the clinician at the referral facility ensured that all vitals had been taken and examined the patient. He/she then called the specialist at Machakos Level 5 to update them on the patient condition. The specialist discussed the current patient condition and their treatment history with the clinician and both arrived at an agreed plan for patient management.
This intervention, dubbed “linking” was timely with some patients reporting worsening outcomes that could have led to further deterioration. Feedback interviews with specialists and clinicians further revealed that there was also a sharing of knowledge in that clinicians at referral facilities were updated on the new drugs and methods of diagnosing and managing cardiovascular diseases and diabetes. We hope to extend this work with additional funding to effectively monitor and manage chronic conditions at the community level.