title: Delivery of paediatric care at the first-referral level in Kenya.
abstract: We aimed to investigate provision of paediatric care in government district hospitals in Kenya. We surveyed 14 first-referral level hospitals from seven of Kenya's eight provinces and obtained data for workload, outcome of admission, infrastructure, and resources and the views of hospital staff and caretakers of admitted children. Paediatric admission rates varied almost ten-fold. Basic anti-infective drugs, clinical supplies, and laboratory tests were available in at least 12 hospitals, although these might be charged for on discharge. In at least 11 hospitals, antistaphylococcal drugs, appropriate treatment for malnutrition, newborn feeds, and measurement of bilirubin were rarely or never available. Staff highlighted infrastructure and human and consumable resources as problems. However, a strong sense of commitment, support for the work of the hospital, and a desire for improvement were expressed. Caretakers' views were generally positive, although dissatisfaction with the physical environment in which care took place was common. The capacity of the district hospital in Kenya needs strengthening by comprehensive policies that address real needs if current or new interventions and services at this level of care are to enhance child survival.
authors.affiliation: KEMRI Centre for Geographic Medicine Research-Coast, PO Box 230, Kilifi, Kenya. menglish@wtnairobi.mimcom.net
authors.forename: Mike
authors.initials: M
authors.lastname: English
authors.forename: Fabian
authors.initials: F
authors.lastname: Esamai
authors.forename: Aggrey
authors.initials: A
authors.lastname: Wasunna
authors.forename: Fred
authors.initials: F
authors.lastname: Were
authors.forename: Bernhards
authors.initials: B
authors.lastname: Ogutu
authors.forename: Annah
authors.initials: A
authors.lastname: Wamae
authors.forename: Robert W
authors.initials: RW
authors.lastname: Snow
authors.forename: Norbert
authors.initials: N
authors.lastname: Peshu
mesh_terms: D001291:Attitude of Health Personnel; D002648:Child; D002662:Child Health Services / Q000592:standards*; D006760:Hospitalization / Q000706:statistics & numerical data; D006767:Hospitals, District / Q000592:standards*; D006801:Humans; D007630:Kenya; D011787:Quality of Health Care; D012017:Referral and Consultation