BackgroundObservational data in the United States suggests that those without health insurance have a higher mortality and worse health outcomes. A linkage between insurance coverage and outcomes in hospitalized patients has yet to be demonstrated in resource-poor settings.MethodsTo determine whether uninsured patients admitted to the public medical wards at a Kenyan referral hospital have any difference in in-hospital mortality rates compared to patients with insurance, we performed a retrospective observational study of all inpatients discharged from the public medical wards at Moi Teaching and Referral Hospital in Eldoret, Kenya, over a 3-month study period from October through December 2012. The primary outcome of interest was in-hospital death, and the primary explanatory variable of interest was health insurance status.ResultsDuring the study period, 201 (21.3%) of 956 patients discharged had insurance. The National Hospital Insurance Fund was the only insurance scheme noted. Overall, 211 patients (22.1%) died. The proportion who died was greater among the uninsured compared to the insured (24.7% vs. 11.4%, Chi-square=15.6, p<0.001). This equates to an absolute risk reduction of 13.3% (95% CI 7.9–18.7%) and a relative risk reduction of 53.8% (95% CI 30.8–69.2%) of in-hospital mortality with insurance. After adjusting for comorbid illness, employment status, age, HIV status, and gender, the association between insurance status and mortality remained statistically significant (adjusted odds ratio (AOR)=0.40, 95% CI 0.24–0.66) and similar in magnitude to the association between HIV status and mortality (AOR=2.45, 95% CI 1.56–3.86).ConclusionsAmong adult patients hospitalized in a public referral hospital in Kenya, insurance coverage was associated with decreased in-hospital mortality. This association was comparable to the relationship between HIV and mortality. Extension of insurance coverage may yield substantial benefits for population health.

Kangaroo mother care (KMC) implies placing the newborn pre-term baby in intimate skin-to-skin contact with the mother's chest and abdomen coupled with frequent and preferably exclusive breast-feeding. This is similar to marsupial care-giving, where the premature baby is kept warm in the maternal pouch and close to the breasts for unlimited feeding. KMC has emerged as a non-conventional low cost method for newborn care that provides warmth, touch, and security to the newborn and is believed to confer significant survival benefit. The purpose of this study was to understand the mothers lived experience and perception towards 24-hour Kangaroo Mother Care (KMC) during hospitalization of their preterm babies. Phenomenological study methods were applied through in-depth unstructured interviews, on purposefully selected participants. Their lived experience was analyzed using Collaizzi's steps to phenomenological data analysis. Data analysis revealed three major themes: (a) "it is a bond between me and my child" (b) nurse-parent interaction, and (c) "it is tiring and exhaustive". The study found that all the mothers in spite of exhaustion, reported high level of satisfaction with KMC because it allowed them to be closer to their babies, hence giving them the opportunity to observe their growth and became fully involved in the care. The excellent nurse-mothers' interaction reinforced the KMC concept in care of preterm babies and was rated significant in the transition period of motherhood. The interaction enabled mothers to shift from passive observers to active participants in the care of the preterm babies. KMC was additionally noted to have provided a comforting and warm environment for the babies, thus enabling them to grow faster via weight gains and this in turn increased maternal satisfaction. Recommendation for further research preferably using quantitative methods to establish relationship between production of breast milk and the use of KMC is envisaged. The principle of 24-hour KMC should also be incorporated and emphasized in all levels of preterm baby care hospitals and educational training as this practice has been found to have numerous benefits both to the mothers and to their preterm babies.

Among adult patients on the medical wards, patients admitted on weekends had similar mortality rates to those admitted on weekdays. This similarity may reflect a stable level of care or a generalized shortage of resources and staffing that subsumes any impact of weekly variations. Future research examining optimal staffing and resource levels is needed in such settings.

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