Assessment of neonatal care in clinical training facilities in Kenya

Abstract

ObjectiveAn 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.DesignCross-sectional study using indicators based on prior work in Kenya. Statistical analyses were descriptive with adjustment for clustering of data.SettingNeonatal units of 22 public hospitals.PatientsNeonates aged <7 days.Main outcome measuresQuality 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.ResultsAll 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.ConclusionsBasic 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.

Pulse oximetry values of neonates admitted for care and receiving routine oxygen therapy at a resource‐limited hospital in Kenya

“…Furthermore, wider availability of pulse oximeters in facilities is essential. In 2012, only 4 of 22 Kenyan training hospitals had functional pulse oximeters 49. Oxygen provision may be improved through enhanced nurse training, including multiple ‘doses’ over time; increased numbers of neonatal nurses; and training mothers, who often participate in the care of their babies in low‐resource facilities, to titrate oxygen with supervision.…”

“…Oxygen provision may be improved through enhanced nurse training, including multiple ‘doses’ over time; increased numbers of neonatal nurses; and training mothers, who often participate in the care of their babies in low‐resource facilities, to titrate oxygen with supervision. A study assessing the effects of a parent training programme for infants being discharged home on oxygen found that those who received training had significantly improved post‐test scores 49. Employment of trained care facilitators and development of simple SpO 2 monitors with algorithm‐based instructions to support mothers could also be beneficial.…”

Assessment of the quality of neonatal care in the Solomon Islands

“…As the Solomon Islands embarks on efforts to improve and scale up newborn care, an understanding of the baseline quality of care is required. Previous studies assessing the quality of care for children in the Solomon Islands and neonates in other countries have illustrated the links between assessments, health policy and quality improvement activities. Information regarding gaps in standards of care, referral guidelines, infrastructure (basic equipment and medications for neonatal care) and health systems for neonatal services are essential to understand, shape and prioritise interventions.…”

A hidden burden of neonatal illness? A cross-sectional study of all admissions aged less than one month across twelve Kenyan County hospitals

“…One option to ensure newborns access specialised care, while also limiting infection, is to expand the capacity of NBUs to appropriately accommodate older and outborn newborns. However, NBUs in public sector hospitals in Kenya currently struggle with overcrowding and high patient to nurse ratios 12 . Hence, such a policy would require strategic investment in space, including isolation rooms, and specific staff for different patient groups in many settings.…”