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Assessment of neonatal care in clinical training facilities in Kenya
  1. Jalemba Aluvaala1,2,3,
  2. Rachael Nyamai1,
  3. Fred Were2,
  4. Aggrey Wasunna2,
  5. Rose Kosgei4,
  6. Jamlick Karumbi1,3,
  7. David Gathara3,
  8. Mike English3,5
  9. On behalf of the SIRCLE/Ministry of Health Hospital Survey Group
  1. 1Ministry of Health, Government of Kenya, Nairobi, Kenya
  2. 2Department of Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya
  3. 3KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
  4. 4Department of Obstetrics and Gynecology, University of Nairobi, Nairobi, Kenya
  5. 5Nuffield Department of Medicine & Department of Paediatrics, University of Oxford, Oxford, UK
  1. Correspondence to Dr Jalemba Aluvaala, KEMRI-Wellcome Trust Research Programme, P.O. Box 43640-00100, Nairobi, Kenya; jaluvaala{at}kemri-wellcome.org

Abstract

Objective An 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.

Design Cross-sectional study using indicators based on prior work in Kenya. Statistical analyses were descriptive with adjustment for clustering of data.

Setting Neonatal units of 22 public hospitals.

Patients Neonates aged <7 days.

Main outcome measures Quality 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.

Results All 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.

Conclusions Basic 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.

  • Neonatology
  • Health services research
  • Measurement
  • Evidence Based Medicine
  • Data Collection

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/

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