Assessment of neonatal care in clinical training facilities in Kenya

Jalemba Aluvaala, Rachael Nyamai, Fred Were, Aggrey Wasunna, Rose Kosgei, Jamlick Karumbi, David Gathara, Mike English, SIRCLE/Ministry of Health Hospital Survey Group, Koigi Kamau, Francis Kimani, John Masasabi, Wycliffe Mogoa, Simon Mueke, Stephen B Mwinga, Elesban Kihuba, Arnold Njagi, Isaac Odongo, Jim Todd, Jalemba Aluvaala, Rachael Nyamai, Fred Were, Aggrey Wasunna, Rose Kosgei, Jamlick Karumbi, David Gathara, Mike English, SIRCLE/Ministry of Health Hospital Survey Group, Koigi Kamau, Francis Kimani, John Masasabi, Wycliffe Mogoa, Simon Mueke, Stephen B Mwinga, Elesban Kihuba, Arnold Njagi, Isaac Odongo, Jim Todd

Abstract

Objective: An audit of neonatal care services provided by clinical training centres was undertaken to identify areas requiring improvement as part of wider efforts to improve newborn survival in Kenya.

Design: Cross-sectional study using indicators based on prior work in Kenya. Statistical analyses were descriptive with adjustment for clustering of data.

Setting: Neonatal units of 22 public hospitals.

Patients: Neonates aged <7 days.

Main outcome measures: Quality of care was assessed in terms of availability of basic resources (principally equipment and drugs) and audit of case records for documentation of patient assessment and treatment at admission.

Results: All hospitals had oxygen, 19/22 had resuscitation and phototherapy equipment, but some key resources were missing—for example kangaroo care was available in 14/22. Out of 1249 records, 56.9% (95% CI 36.2% to 77.6%) had a standard neonatal admission form. A median score of 0 out of 3 for symptoms of severe illness (IQR 0-3) and a median score of 6 out of 8 for signs of severe illness (IQR 4-7) were documented. Maternal HIV status was documented in 674/1249 (54%, 95% CI 41.9% to 66.1%) cases. Drug doses exceeded recommendations by >20% in prescriptions for penicillin (11.6%, 95% CI 3.4% to 32.8%) and gentamicin (18.5%, 95% CI 13.4% to 25%), respectively.

Conclusions: Basic resources are generally available, but there are deficiencies in key areas. Poor documentation limits the use of routine data for quality improvement. Significant opportunities exist for improvement in service delivery and adherence to guidelines in hospitals providing professional training.

Keywords: Data Collection; Evidence Based Medicine; Health services research; Measurement; Neonatology.

Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Figures

Figure 1
Figure 1
Top three disease episodes.

References

    1. Oestergaard M, Inoue M, Yoshida S, et al. Neonatal mortality levels for 193 countries in 2009 with trends since 1990: a systematic analysis of progress, projections, and priorities. PLoS Med 2011;8:e1001080.
    1. Kenya National Bureau of Statistics (KNBS) and ICF Macro. Infant and child mortality. In: Kenya Demographic and Health Survey 2008–09. .
    1. Ministry of Health, Government of Kenya. The Kenya Health Sector Strategic and Investment Plan-KHSSP July 2012-June 2017 2013.
    1. WHO. Pregnancy, childbirth, postpartum and newborn care: a guide for essential practice. 2009.
    1. The Partnership for Maternal, Newborn & Child Health. A Global Review of the Key Interventions Related to Reproductive, Maternal, Newborn and Child Health (RMNCH) 2011.
    1. Gathara D, Opiyo N, Wagai J, et al. Quality of hospital care for sick newborns and severely malnourished children in Kenya: a two-year descriptive study in 8 hospitals. BMC Health Serv Res 2011;11:307.
    1. Opondo C, Ntoburi S, Wagai J, et al. Are hospitals prepared to support newborn survival?—an evaluation of eight first-referral level hospitals in Kenya. Tropical Med Int Health 2009;14:1165–72.
    1. Ntoburi S, Hutchings A, Sanderson C, et al. Development of paediatric quality of inpatient care indicators for low-income countries—a Delphi study. BMC Pediatr 2010;10:90.
    1. English M, Esamai F, Wasunna A, et al. Assessment of inpatient paediatric care in first referral level hospitals in 13 districts in Kenya. Lancet 2004;363:1948–53.
    1. Ministry of Medical Services, Government of Kenya. Basic Paediatric Protocols-Revised 2010.
    1. Opiyo N, English M. What clinical signs best identify severe illness in young infants aged 0–59 days in developing countries? A systematic review. Arch Dis Child 2011;96:1052–9.
    1. Ayieko P, Ntoburi S, Wagai J, et al. A multifaceted intervention to implement guidelines and improve admission paediatric care in Kenyan district hospitals: a cluster randomized trial. PLoS Med 2011:8:e1001018.
    1. English M, Ntoburi S, Wagai J, et al. An intervention to improve paediatric and newborn care in Kenyan district hospitals: understanding the context. Implement Sci 2009;4.
    1. Harris PA, Taylor R, Thielke R, et al. Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 2009;42:377–81.
    1. Milner KM, Duke T, Bucens I. Reducing newborn mortality in the Asia–Pacific region: quality hospital services and community-based care. J Paediatr Child Health 2013;49:511–18.
    1. Conde-Agudelo A, Belizán J, Diaz-Rossello J. Kangaroo mother care to reduce morbidity and mortality in low birthweight infants. Cochrane Database Syst Rev 2011;16(3):CD002771.
    1. Mbwele B, Reddy E, Reyburn H. A rapid assessment of the quality of neonatal healthcare in Kilimanjaro region, northeast Tanzania. BMC Pediatr 2012;12:182.
    1. Vesel L, Manu A, Lohela TJ, et al. Quality of newborn care: a health facility assessment in rural Ghana using survey, vignette and surveillance data. BMJ Open 2013;3:e002326.
    1. Tamburlini G, Siupsinskas G, Bacci A, et al. Quality of maternal and neonatal care in Albania, Turkmenistan and Kazakhstan: a systematic, standard-based, participatory assessment. PLoS ONE 2011;6:e28763.
    1. Hoque D, Rahman M, Billah S, et al. An assessment of the quality of care for children in eighteen randomly selected district and sub-district hospitals in Bangladesh. BMC Pediatr 2012;12:197.
    1. Mann R, Williams J. Standards in medical record keeping. Clin Med 2003;3:329–32.
    1. Rao SC, Srinivasjois R, Hagan R, et al. One dose per day compared to multiple doses per day of gentamicin for treatment of suspected or proven sepsis in neonates. Cochrane Database Syst Rev 2011;(11):CD005091.
    1. Krishnamoorthy S, Nair A, Furness J, et al. Gentamicin use in neonates: should we have a change of practice? Scott Med J 2013;58:241–5.

Source: PubMed

Sponsor e collaboratori

Condizioni mediche

Interventi farmacologici

3
Sottoscrivi