Understanding Factors Associated With Adherence to the Follow Up Visits in the Pediatric Development Clinic in the Eastern Province of Rwanda From 2014 - 2019

Abstract

Neonatal mortality has been declining since 1990s as a result of efforts and resources deployed to tackle neonatal mortality globally. Therefore, more infants are surviving beyond the neonatal period. In Rwanda alone, for the past 5 years, it has been estimated that 10% of live births were born too soon. However, successful care for the development of these at-risk neonates remains a challenge. Part 1 of this thesis summarizes the literature review on neonatal care in Rwanda. Part 2 is an explanatory sequential mixed-methods design study conducted to understand the adherence to the follow-up care in a pediatric development clinic in the Eastern province of Rwanda. We used the PDC EMR data to describe the demographic characteristics of children who adhered and those who did not, using frequencies, proportions, and multivariable regression analysis. We also interviewed caregivers and PDC providers to identify the drivers of adherence. Interviews were analyzed using thematic analysis. Of the 1292 children whose characteristics were analyzed in this study, 472 (36.53%) of them did not adhere to the PDC follow-up schedule. Children from Kirehe district PDC (OR: 3.620; 95% CI: 2.802 – 4.677), children whose caregivers were divorced (OR: 3.496; 95% CI: 1.417 – 8.624), were living with a partner (OR: 1.830; 95% CI: 1.354 – 2.474) and whose marital status was missing in our records (OR: 1.995; 95% CI: 1.315 – 3.026) were significantly more likely to not adhere to the PDC follow-up. Being in Ubudehe category 2 (OR: 1.493; 95% CI: 1.101 – 2.026), missing information on Ubudehe category (OR: 2.070; 95% CI: 1.498 – 2.858) were more likely to not adhere to the PDC follow-up schedule. In our qualitative analysis, barriers related to accessing PDC services; structural factors - caregiver experiences at the PCDs themselves; caregiver - community perceptions around children living with chronic or developmental difficulty; and caregiver motivations for seeking care were the recurring themes.