Article Text

Download PDFPDF

Characteristics of admissions and variations in the use of basic investigations, treatments and outcomes in Kenyan hospitals within a new Clinical Information Network
  1. Philip Ayieko1,
  2. Morris Ogero1,
  3. Boniface Makone1,
  4. Thomas Julius1,
  5. George Mbevi1,
  6. Wycliffe Nyachiro1,
  7. Rachel Nyamai2,
  8. Fred Were3,
  9. David Githanga4,
  10. Grace Irimu1,5,
  11. Mike English1,6
  12. on behalf of the Clinical Information Network authors
    1. 1Kenya Medical Research Institute/Wellcome Trust Research Programme, Nairobi, Kenya
    2. 2Division of Maternal, Newborn, Child and Adolescent Health, Ministry of Health, Nairobi, Kenya
    3. 3School of Medicine, University of Nairobi, Nairobi, Kenya
    4. 4Kenya Paediatric Association, Nairobi, Kenya
    5. 5Department of Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya
    6. 6Nuffield Department of Medicine, Oxford University, UK
    1. Correspondence to Dr Philip Ayieko, KEMRI/ Wellcome Trust Research Programme, P.O. Box 43640-GPO 00100, Nairobi, Kenya; payieko{at}kemri-wellcome.org

    Abstract

    Background Lack of detailed information about hospital activities, processes and outcomes hampers planning, performance monitoring and improvement in low-income countries (LIC). Clinical networks offer one means to advance methods for data collection and use, informing wider health system development in time, but are rare in LIC. We report baseline data from a new Clinical Information Network (CIN) in Kenya seeking to promote data-informed improvement and learning.

    Methods Data from 13 hospitals engaged in the Kenyan CIN between April 2014 and March 2015 were captured from medical and laboratory records. We use these data to characterise clinical care and outcomes of hospital admission.

    Results Data were available for a total of 30 042 children aged between 2 months and 15 years. Malaria (in five hospitals), pneumonia and diarrhoea/dehydration (all hospitals) accounted for the majority of diagnoses and comorbidity was found in 17 710 (59%) patients. Overall, 1808 deaths (6%) occurred (range per hospital 2.5%–11.1%) with 1037 deaths (57.4%) occurring by day 2 of admission (range 41%–67.8%). While malaria investigations are commonly done, clinical health workers rarely investigate for other possible causes of fever, test for blood glucose in severe illness or ascertain HIV status of admissions. Adherence to clinical guideline-recommended treatment for malaria, pneumonia, meningitis and acute severe malnutrition varied widely across hospitals.

    Conclusion Developing clinical networks is feasible with appropriate support. Early data demonstrate that hospital mortality remains high in Kenya, that resources to investigate severe illness are limited, that care provided and outcomes vary widely and that adoption of effective interventions remains slow. Findings suggest considerable scope for improving care within and across sites.

    • Epidemiology
    • Tropical Paediatrics
    • Health services research
    • Mortality
    • Paediatric Practice

    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/

    View Full Text

    Statistics from Altmetric.com

    Supplementary materials

    • Supplementary Data

      This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.