Determinants of Health Worker Adherence to National Diarrhoea Management Guidelines for Under-Five Children in Public Health Facilities in Embakasi Region, Nairobi County

Abstract

Diarrheal diseases remain a leading cause of morbidity and mortality among children under five years in Kenya. To combat this, national diarrhoea management guidelines were established; however, inconsistent adherence by healthcare workers often leads to preventable complications, prolonged illness, and avoidable child deaths. This study assessed the factors influencing health workers' adherence to these national guidelines in public health facilities in the Embakasi Region of Nairobi County, specifically examining the impact of sociodemographic, individual, facility-level, and managerial support factors. Adopting a positivist philosophy and a descriptive cross-sectional design, the study targeted 436 healthcare workers across 22 public facilities. A sample of 228 participants was selected using proportionate stratified random sampling. The study achieved a response rate of 93.9%. was 81.2%. Adherence was highest in dehydration assessment (89.3%) and oral rehydration salts (ORS) and zinc prescription (91.6%), while lower adherence was observed in caregiver counselling (78.5%) and documentation practices (73.8%). The study concludes that adherence to the National Diarrhoea Management Guidelines among healthcare workers in Embakasi Region public health facilities is generally high but remains influenced by healthcare worker capacity, availability of essential commodities, workload, and management support. The study recommends strengthening continuous professional development through IMCI training, ensuring uninterrupted availability of diarrhoea management commodities, enhancing supportive supervision, improving access to clinical guidelines, and addressing health worker workload to promote consistent delivery of quality diarrhoea care among under-five children.