Moving towards Routine Evaluation of Quality of Inpatient Pediatric Care in Kenya

Abstract

BackgroundRegular assessment of quality of care allows monitoring of progress towards system goals and identifies gaps that need to be addressed to promote better outcomes. We report efforts to initiate routine assessments in a low-income country in partnership with government.MethodsA cross-sectional survey undertaken in 22 ‘internship training’ hospitals across Kenya that examined availability of essential resources and process of care based on review of 60 case-records per site focusing on the common childhood illnesses (pneumonia, malaria, diarrhea/dehydration, malnutrition and meningitis).ResultsAvailability of essential resources was 75% (45/61 items) or more in 8/22 hospitals. A total of 1298 (range 54–61) case records were reviewed. HIV testing remained suboptimal at 12% (95% CI 7–19). A routinely introduced structured pediatric admission record form improved documentation of core admission symptoms and signs (median score for signs 22/22 and 8/22 when form used and not used respectively). Correctness of penicillin and gentamicin dosing was above 85% but correctness of prescribed intravenous fluid or oral feed volumes for severe dehydration and malnutrition were 54% and 25% respectively. Introduction of Zinc for diarrhea has been relatively successful (66% cases) but use of artesunate for malaria remained rare. Exploratory analysis suggests considerable variability of the quality of care across hospitals.ConclusionQuality of pediatric care in Kenya has improved but can improve further. The approach to monitoring described in this survey seems feasible and provides an opportunity for routine assessments across a large number of hospitals as part of national efforts to sustain improvement. Understanding variability across hospitals may help target improvement efforts.

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

“…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]. …”

A health partnership to reduce neonatal mortality in four hospitals in Rwanda

“…Introduction of focused neonatal-specific records was considered a priority to support structured clinical assessments and to allow monitoring of improvements in care [5]. …”

Inappropriate prescription of cough remedies among children hospitalised with respiratory illness over the period 2002–2015 in Kenya

“…The study uses data collected using a consistent method as part of four research studies in Kenya that provide data from six time points between 2002 and 2015 . These studies were carried out in hospital facilities located in a district's (now county) main town, which provide first referral care.…”

“…There have, however, been few reports on the use of cough medication in children in the sub‐Saharan region, and most have examined their use in outpatient settings . Three prior studies in Kenyan hospitals using standardised methods and ongoing inpatient surveillance in paediatric wards in 13 Kenyan county hospitals present an opportunity to examine trends in prescription of cough mixtures over the period 2002–2015 in ill children admitted to hospital for whom risks of adverse effects may be higher. Although behaviour change at scale may take time to manifest, it is unusual to have longitudinal data from a low‐income setting.…”