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Adoption of recommended practices and basic technologies in a low-income setting
  1. Mike English1,2,
  2. David Gathara1,
  3. Stephen Mwinga3,4,
  4. Philip Ayieko1,
  5. Charles Opondo1,
  6. Jalemba Aluvaala3,4,
  7. Elesban Kihuba3,4,
  8. Paul Mwaniki1,
  9. Fred Were5,
  10. Grace Irimu5,
  11. Aggrey Wasunna5,
  12. Wycliffe Mogoa4,
  13. Rachel Nyamai4
  1. 1KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
  2. 2Nuffield Department of Medicine & Department of Paediatrics, University of Oxford, UK
  3. 3Health Services, Implementation Research and Clinical Excellence (SIRCLE) Collaboration, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
  4. 4Ministry of Health, Nairobi, Kenya
  5. 5Department of Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya
  1. Correspondence to Professor Mike English, KEMRI-Wellcome Trust Research Programme, P.O. Box 43640, Nairobi 00100, Kenya; menglish{at}


Objective In global health considerable attention is focused on the search for innovations; however, reports tracking their adoption in routine hospital settings from low-income countries are absent.

Design and setting We used data collected on a consistent panel of indicators during four separate cross-sectional, hospital surveys in Kenya to track changes over a period of 11 years (2002–2012).

Main outcome measures Basic resource availability, use of diagnostics and uptake of recommended practices.

Results There appeared little change in availability of a panel of 28 basic resources (median 71% in 2002 to 82% in 2012) although availability of specific feeds for severe malnutrition and vitamin K improved. Use of blood glucose and HIV testing increased but remained inappropriately low throughout. Commonly (malaria) and uncommonly (lumbar puncture) performed diagnostic tests frequently failed to inform practice while pulse oximetry, a simple and cheap technology, was rarely available even in 2012. However, increasing adherence to prescribing guidance occurred during a period from 2006 to 2012 in which efforts were made to disseminate guidelines.

Conclusions Findings suggest changes in clinical practices possibly linked to dissemination of guidelines at reasonable scale. However, full availability of basic resources was not attained and major gaps likely exist between the potential and actual impacts of simple diagnostics and technologies representing problems with availability, adoption and successful utilisation. These findings are relevant to debates on scaling up in low-income settings and to those developing novel therapeutic or diagnostic interventions.

  • Health services research
  • Tropical Paediatrics

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 3.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See:

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