An intervention to improve paediatric and newborn care in Kenyan district hospitals: Understanding the context

English, Mike; Ntoburi, Stephen; Wagai, John; Mbindyo, Patrick; Opiyo, Newton; Ayieko, Philip; Opondo, Charles; Migiro, Santau; Wamae, Annah; Irimu, Grace

doi:10.1186/1748-5908-4-42

Cited by 58 publications

(86 citation statements)

References 14 publications

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“…The location of the hospitals and basic facility characteristics are described in detail elsewhere[13]. In brief the parent study was a parallel group, controlled intervention study with hospitals randomized into full (n = 4) or partial (referred to as control, n = 4) intervention groups [13].…”

Section: Methodsmentioning

confidence: 99%

Quality of hospital care for sick newborns and severely malnourished children in Kenya: A two-year descriptive study in 8 hospitals

Gathara

Opiyo

Wagai

et al. 2011

BMC Health Serv Res

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BackgroundGiven the high mortality associated with neonatal illnesses and severe malnutrition and the development of packages of interventions that provide similar challenges for service delivery mechanisms we set out to explore how well such services are provided in Kenya.MethodsAs a sub-component of a larger study we evaluated care during surveys conducted in 8 rural district hospitals using convenience samples of case records. After baseline hospitals received either a full multifaceted intervention (intervention hospitals) or a partial intervention (control hospitals) aimed largely at improving inpatient paediatric care for malaria, pneumonia and diarrhea/dehydration. Additional data were collected to: i) examine the availability of routine information at baseline and their value for morbidity, mortality and quality of care reporting, and ii) compare the care received against national guidelines disseminated to all hospitals.ResultsClinical documentation for neonatal and malnutrition admissions was often very poor at baseline with case records often entirely missing. Introducing a standard newborn admission record (NAR) form was associated with an increase in median assessment (IQR) score to 25/28 (22-27) from 2/28 (1-4) at baseline. Inadequate and incorrect prescribing of penicillin and gentamicin were common at baseline. For newborns considerable improvements in prescribing in the post baseline period were seen for penicillin but potentially serious errors persisted when prescribing gentamicin, particularly to low-birth weight newborns in the first week of life. Prescribing essential feeds appeared almost universally inadequate at baseline and showed limited improvement after guideline dissemination.ConclusionRoutine records are inadequate to assess newborn care and thus for monitoring newborn survival interventions. Quality of documented inpatient care for neonates and severely malnourished children is poor with limited improvement after the dissemination of clinical practice guidelines. Further research evaluating approaches to improving care for these vulnerable groups is urgently needed. We also suggest pre-service training curricula should be better aligned to help improve newborn survival particularly.

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Section: Methodsmentioning

confidence: 99%

Quality of hospital care for sick newborns and severely malnourished children in Kenya: A two-year descriptive study in 8 hospitals

Gathara

Opiyo

Wagai

et al. 2011

BMC Health Serv Res

Self Cite

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“…[8][9][10][11] However, few have focused on the quality of neonatal care. 12 13 The latest Countdown report, taking stock of maternal, newborn and child survival, has highlighted a major gap in evidence regarding the quality of facility care for newborns in LMICs, both immediately after delivery and of sick newborns in the postnatal period. 1 14 The objective of this paper was to address this evidence gap in rural Ghana and, in so doing, aim to impact positive change in newborn care and survival.…”

Section: Strengths and Limitations Of This Studymentioning

confidence: 99%

Quality of newborn care: a health facility assessment in rural Ghana using survey, vignette and surveillance data

et al. 2013

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ObjectiveTo assess the structural capacity for, and quality of, immediate and essential newborn care (ENC) in health facilities in rural Ghana, and to link this with demand for facility deliveries and admissions.DesignHealth facility assessment survey and population-based surveillance data.SettingSeven districts in Brong Ahafo Region, Ghana.ParticipantsHeads of maternal/neonatal wards in all 64 facilities performing deliveries.Main outcome measuresIndicators include: the availability of essential infrastructure, newborn equipment and drugs, and personnel; vignette scores and adequacy of reasons given for delayed discharge of newborn babies; and prevalence of key immediate ENC practices that facilities should promote. These are matched to the percentage of babies delivered in and admitted to each type of facility.Results70% of babies were delivered in health facilities; 56% of these and 87% of neonatal admissions were in four referral level hospitals. These had adequate infrastructure, but all lacked staff trained in ENC and some essential equipment (including incubators and bag and masks) and/or drugs. Vignette scores for care of very low-birth-weight babies were generally moderate-to-high, but only three hospitals achieved high overall scores for quality of ENC. We estimate that only 33% of babies were born in facilities capable of providing high quality, basic resuscitation as assessed by a vignette plus the presence of a bag and mask. Promotion of immediate ENC practices in facilities was also inadequate, with coverage of early initiation of breastfeeding and delayed bathing both below 50% for babies born in facilities; this represents a lost opportunity.ConclusionsUnless major gaps in ENC equipment, drugs, staff, practices and skills are addressed, strategies to increase facility utilisation will not achieve their potential to save newborn lives.Trial registrationhttp://clinicaltrials.gov NCT00623337.

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“…However, shortfalls in the quality of maternal and child health in LMICs9–12 have resulted from a serious lack of attention to the evaluation and quality improvement of facility newborn care 13–15. Health facilities play a crucial role in reducing neonatal mortality, and thus it is critical that they have the capacity and QoC to meet demand and move towards greater improvements in health and survival for newborn infants.…”

Section: Introductionmentioning

confidence: 99%

Cross-sectional observational assessment of quality of newborn care immediately after birth in health facilities across six sub-Saharan African countries

et al. 2017

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ObjectiveTo present information on the quality of newborn care services and health facility readiness to provide newborn care in 6 African countries, and to advocate for the improvement of providers' essential newborn care knowledge and skills.DesignCross-sectional observational health facility assessment.SettingEthiopia, Kenya, Madagascar, Mozambique, Rwanda and Tanzania.ParticipantsHealth workers in 643 facilities. 1016 health workers were interviewed, and 2377 babies were observed in the facilities surveyed.Main outcome measuresIndicators of quality of newborn care included (1) provision of immediate essential newborn care: thermal care, hygienic cord care, and early and exclusive initiation of breast feeding; (2) actual and simulated resuscitation of asphyxiated newborn infants; and (3) knowledge of health workers on essential newborn care, including resuscitation.ResultsSterile or clean cord cutting instruments, suction devices, and tables or firm surfaces for resuscitation were commonly available. 80% of newborns were immediately dried after birth and received clean cord care in most of the studied facilities. In all countries assessed, major deficiencies exist for essential newborn care supplies and equipment, as well as for health worker knowledge and performance of key routine newborn care practices, particularly for immediate skin-to-skin contact and breastfeeding initiation. Of newborns who did not cry at birth, 89% either recovered on their own or through active steps taken by the provider through resuscitation with initial stimulation and/or ventilation. 11% of newborns died. Assessment of simulated resuscitation using a NeoNatalie anatomic model showed that less than a third of providers were able to demonstrate ventilation skills correctly.ConclusionsThe findings shared in this paper call attention to the critical need to improve health facility readiness to provide quality newborn care services and to ensure that service providers have the necessary equipment, supplies, knowledge and skills that are critical to save newborn lives.

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An intervention to improve paediatric and newborn care in Kenyan district hospitals: Understanding the context

Cited by 58 publications

References 14 publications

Quality of hospital care for sick newborns and severely malnourished children in Kenya: A two-year descriptive study in 8 hospitals

Quality of hospital care for sick newborns and severely malnourished children in Kenya: A two-year descriptive study in 8 hospitals

Quality of newborn care: a health facility assessment in rural Ghana using survey, vignette and surveillance data

Cross-sectional observational assessment of quality of newborn care immediately after birth in health facilities across six sub-Saharan African countries

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