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Kenya, in common with many developing countries, has committed itself to Millennium Development Goal (MDG)-4, which calls for a two-third reduction in 1990 mortality levels in under 5-year-old children by 2015.1 Improving the management of common severe childhood illnesses is one of many strategies likely to be needed to achieve this goal since hospital mortality rates as high as 15% are reported.2 3 Two further points also suggest the potential value of improved basic care to improve outcomes. First, the majority of deaths are attributable to a handful of illnesses and second, assessments demonstrate that the quality of care provided to children in low-income countries is often poor and has considerable scope for improvement.3 4
Clinical practice guidelines (CPGs) are intended to assist the health provider in evidence-based decision making and promote the provision of optimal care. Previous studies have shown that adherence to such evidence-based guidelines is associated with improved health outcomes.5–7 For some conditions such as pneumonia8 and diarrhoea,9 10 the World Health Organization has made CPGs available for many years. In 2000 evidence and expert opinion were used to provide comprehensive advice on the care of sick children in hospital with common conditions.11 However, few hospitals or health workers in Kenya have access to either the WHO recommendations or modern local practice guidelines3 and it is known that a wide range of factors affect the actual ability to improve care and outcomes.12–15
We therefore aimed to develop simple CPGs for conditions commonly associated with mortality in Kenyan hospitals and an in-service training package to facilitate their implementation. The effect on quality of hospital care of a multifaceted intervention project (including these CPGs and training) is the subject of ongoing research. Here we report the …
Contributors: AW, FW, AW and NP helped oversee the development of the CPGs, participated in their review and production and helped co-ordinate key activities at each stage of the process. In addition, AW acted as the link between the project and the Ministry of Health. SN, PA and NO contributed to evidence reviews, production of the CPGs, development and refinement of ETAT+ training materials and (for SN) took part in ETAT+ course development and implementation. GI helped oversee the development of the CPGs, participated in their review and production, worked on the development and refinement of ETAT+ training materials, took part in ETAT+ course implementation and end of course evaluation and wrote the draft manuscript. ME conceived the idea for the major study, obtained funding for this work, helped oversee evidence synthesis and the development of the CPGs, participated in the review and production of the CPGs, produced the draft ETAT+ course and worked on its development and refinement, took part in ETAT+ implementation and end of course evaluation and oversaw the development of the manuscript. All authors reviewed and approved the final version of the manuscript.
Funding: This work was supported by The Wellcome Trust through a Senior Fellowship awarded to Dr Mike English (#076827). Support for the Child Health Evidence Week was provided by a grant from the David Baum International Foundation of the Royal College of Paediatrics and Child Health. The funders had no role in the design or conduct of the work reported and no role in preparing this report or the decision to publish.
Competing interests: None.