Characteristics of admissions and variations in the use of basic investigations, treatments and outcomes in Kenyan hospitals within a new Clinical Information Network

Ayieko, Philip; Ogero, Morris; Makone, Boniface; Julius, Thomas; Mbevi, George; Nyachiro, Wycliffe; Nyamai, Rachel; Were, Fred; Githanga, David; Irimu, Grace; English, Mike

doi:10.1136/archdischild-2015-309269

Cited by 71 publications

(128 citation statements)

References 16 publications

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“…Such differences in definitions make direct comparison with the prevalence of impaired circulation and of mortality between the two reports difficult. However, we believe CIN hospitals are fairly representative of practice in Kenyan hospitals in LICs providing first referral level care, although the fact that they receive regular feedback on their patterns of mortality and morbidity and are engaged in a network aiming to improve their documentation of illness over time [14] may result in better adherence to recently disseminated national guidelines for fluid management in keeping with previous efforts to use multifaceted interventions, including feedback, to improve adherence to guidelines in Kenya [24–26]. …”

Section: Discussionmentioning

confidence: 99%

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Prevalence, aetiology, treatment and outcomes of shock in children admitted to Kenyan hospitals

Mbevi

Ayieko

Irimu

et al. 2016

BMC Med

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BackgroundShock may complicate several acute childhood illnesses in hospitals within low-income countries and has a high case fatality. Hypovolemic shock secondary to diarrhoea/dehydration and septic shock are thought to be common, but there are few reliable data on prevalence or treatment that differ for the two major forms of shock. Examining prevalence and treatment practices has become important since reports suggest high risks from liberal use of fluid boluses in African children. The present study aims to estimate the prevalence, fluid management practices and outcomes of shock among hospitalised children.MethodsWe analysed paediatric in-patient data collected using discharge case record review between October 2013 and February 2016 from 14 hospitals in Kenya which are part of a network (referred to as the Clinical Information Network) using similar tools for standardised clinical records with care directed by the local clinical team leaders. Data are from a period after dissemination of national guidance seeking to limit use of bolus fluids.ResultsA total of 74,402 children were admitted between October 2013 and February 2016. Children aged < 30 days or > 5 years, with severe acute malnutrition, surgical/burns, or cases with pre-defined minimum data sets were excluded from analysis. This resulted in 42,937 patients meeting the inclusion criteria. Prevalence of clinically diagnosed shock was 1.5 % (n = 622) and overall bolus use was 0.9 % (n = 366); 41 % (256/622) of children with clinically diagnosed shock did not receive a fluid bolus (but had a fluid plan for management of dehydration). Identified cases appeared mostly to be hypovolaemic shock secondary to dehydration/diarrhoea (94 %, 582/622), with a high case fatality (34 %, 211/622). Overall mortality for all admitted children was 5 % (2115/42,937) and was 7.9 % (798/10,096) in children with dehydration/diarrhoea. The diagnosis of hypovolaemic shock was nearly always accompanied by additional clinical diagnosis (99 %), most often pneumonia or malaria. Where bolus fluids were used, they were prescribed in accordance with guidelines (isotonic fluid at correct volume) in 92 % of cases. Inappropriate use of bolus fluids to treat milder forms of impaired circulation appeared very rarely.ConclusionA diagnosis of shock is uncommon at admission and use of fluid bolus is rare in admissions to Kenyan hospitals. A fluid bolus, when prescribed, is mostly used in children with hypovolemic shock secondary to dehydration and case fatality in these cases is high. We found little evidence of liberal use of fluid bolus that might cause harm in a period following dissemination of national guidelines suggesting very strict criteria for fluid bolus use.

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Section: Discussionmentioning

confidence: 99%

“…A detailed description of the CIN hospitals, their selection process, management and geographical spread has been previously provided [14]. In summary, key partners at each site consist of the hospital paediatrician, the nurse in charge of the paediatric unit and the senior health records officer.…”

Section: Methodsmentioning

confidence: 99%

Prevalence, aetiology, treatment and outcomes of shock in children admitted to Kenyan hospitals

Mbevi

Ayieko

Irimu

et al. 2016

BMC Med

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“…Our analysis of data from 13 hospitals involved in collaborative efforts aimed at promoting guideline adherence across a range of common childhood illnesses in Kenyan hospitals shows that documentation for various processes of care improved . Using a recently developed composite score for processes of admission care, the PAQC score , we show that the process of DD admission care as a whole improved over time.…”

Section: Discussionmentioning

confidence: 85%

Magnitude and pattern of improvement in processes of care for hospitalised children with diarrhoea and dehydration in Kenyan hospitals participating in a clinical network

Akech

Ayieko

Irimu

et al. 2018

Tropical Med Int Health

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Objective WHO recommends optimisation of available interventions to reduce deaths of under‐five children with diarrhoea and dehydration ( DD ). Clinical networks may help improve practice across many hospitals but experience with such networks is scarce. We describe magnitude and patterns of changes in processes of care for children with DD over the first 3 years of a clinical network. Methods Observational study involving children aged 2–59 months with DD admitted to 13 hospitals participating in the clinical network. Processes of individual patient care including agreement of assessment, diagnosis and treatment according to WHO guidelines were combined using the composite Paediatric Admission Quality of Care ( PAQC ) score (range 0–6). Results Data from 7657 children were analysed and improvements in PAQC scores were observed. Predicted mean PAQC score for all the hospitals at enrolment was 59.8% (95% CI : 54.7, 64.9) but showed a wide variation (variance 10.7%, 95% CI : 5.8, 19.6). Overall mean PAQC score increased by 13.8% (95% CI : 8.7–18.9, SD between hospitals: ±8.2) in the first 12 months, with an average 0.9% (95% CI : 0.3–1.5, SD ± 1.0) increase per month and plateaued thereafter, and changes were similar in two groups of hospitals joining the network at different times. Conclusion Adherence to guidelines for children admitted with DD can be improved through participation in a clinical network but improvement is limited, not uniform for all aspects of care and contexts and occurs early. Future research should address these issues.

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“…The percentage of adults living in extreme poverty in the counties with hospitals’ in the CIN ranges from 21% to 65% 10 . Using these crude population estimates of poverty provides no clear picture: Nairobi has moderately high levels of poverty and the highest prevalence of rickets, while overall levels of poverty are as high in the Western region with almost no rickets.…”

Section: Discussionmentioning

confidence: 99%

Using data from a multi-hospital clinical network to explore prevalence of pediatric rickets in Kenya

Karuri¹,

Murithi²,

Irimu³

et al. 2017

Wellcome Open Res

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Background: Nutritional rickets is a public health concern in developing countries despite tropical climates and a re-emerging issue in developed countries. In this study, we reviewed pediatric admission data from the Clinical Information Network (CIN) to help determine hospital and region based prevalence of rickets in three regions of Kenya (Central Kenya, Western Kenya and Nairobi County). We also examine the association of rickets with other diagnosis, such as malnutrition and pneumonia, and study the effect of rickets on regional hospital stays. Methods: We analyzed discharge records for children aged 1 month to 5 years from county (formerly district) hospitals in the CIN, with admissions from February 1 st 2014 to February 28 th 2015. The strength of the association between rickets and key demographic factors, as well as with malnutrition and pneumonia, was assessed using odds ratios. The Fisher exact test was used to test the significance of the estimated odd ratios. Kaplan-Meier curves were used to analyze length of hospital stays. Results: There was a marked difference in prevalence across the three regions, with Nairobi having the highest number of cases of rickets at a proportion of 4.01%, followed by Central Region at 0.92%. Out of 9756 admissions in the Western Region, there was only one diagnosis of rickets. Malnutrition was associated with rickets; this association varied regionally. Pneumonia was found to be associated with rickets in Central Kenya. Children diagnosed with rickets had longer hospital stays, even when cases of malnutrition and pneumonia were excluded in the analysis. Conclusion: There was marked regional variation in hospital based prevalence of rickets, but in some regions it is a common clinical diagnosis suggesting the need for targeted public health interventions. Factors such as maternal and child nutrition, urbanization and cultural practices might explain these differences.

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Characteristics of admissions and variations in the use of basic investigations, treatments and outcomes in Kenyan hospitals within a new Clinical Information Network

Cited by 71 publications

References 16 publications

Prevalence, aetiology, treatment and outcomes of shock in children admitted to Kenyan hospitals

Prevalence, aetiology, treatment and outcomes of shock in children admitted to Kenyan hospitals

Magnitude and pattern of improvement in processes of care for hospitalised children with diarrhoea and dehydration in Kenyan hospitals participating in a clinical network

Using data from a multi-hospital clinical network to explore prevalence of pediatric rickets in Kenya

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