title: Quality of hospital care for sick newborns and severely malnourished children in Kenya: a two-year descriptive study in 8 hospitals.
abstract: BACKGROUND
  Given the high mortality associated with neonatal illnesses and severe malnutrition and the development of packages of interventions that provide similar challenges for service delivery mechanisms we set out to explore how well such services are provided in Kenya.
  
  
  METHODS
  As a sub-component of a larger study we evaluated care during surveys conducted in 8 rural district hospitals using convenience samples of case records. After baseline hospitals received either a full multifaceted intervention (intervention hospitals) or a partial intervention (control hospitals) aimed largely at improving inpatient paediatric care for malaria, pneumonia and diarrhea/dehydration. Additional data were collected to: i) examine the availability of routine information at baseline and their value for morbidity, mortality and quality of care reporting, and ii) compare the care received against national guidelines disseminated to all hospitals.
  
  
  RESULTS
  Clinical documentation for neonatal and malnutrition admissions was often very poor at baseline with case records often entirely missing. Introducing a standard newborn admission record (NAR) form was associated with an increase in median assessment (IQR) score to 25/28 (22-27) from 2/28 (1-4) at baseline. Inadequate and incorrect prescribing of penicillin and gentamicin were common at baseline. For newborns considerable improvements in prescribing in the post baseline period were seen for penicillin but potentially serious errors persisted when prescribing gentamicin, particularly to low-birth weight newborns in the first week of life. Prescribing essential feeds appeared almost universally inadequate at baseline and showed limited improvement after guideline dissemination.
  
  
  CONCLUSIONS
  Routine records are inadequate to assess newborn care and thus for monitoring newborn survival interventions. Quality of documented inpatient care for neonates and severely malnourished children is poor with limited improvement after the dissemination of clinical practice guidelines. Further research evaluating approaches to improving care for these vulnerable groups is urgently needed. We also suggest pre-service training curricula should be better aligned to help improve newborn survival particularly.
authors.affiliation: KEMRI/Wellcome Trust Research Programme, Nairobi, Kenya. dgathara@nairobi.kemri-wellcome.org
authors.forename: David
authors.initials: D
authors.lastname: Gathara
authors.forename: Newton
authors.initials: N
authors.lastname: Opiyo
authors.forename: John
authors.initials: J
authors.lastname: Wagai
authors.forename: Stephen
authors.initials: S
authors.lastname: Ntoburi
authors.forename: Philip
authors.initials: P
authors.lastname: Ayieko
authors.forename: Charles
authors.initials: C
authors.lastname: Opondo
authors.forename: Annah
authors.initials: A
authors.lastname: Wamae
authors.forename: Santau
authors.initials: S
authors.lastname: Migiro
authors.forename: Wycliffe
authors.initials: W
authors.lastname: Mogoa
authors.forename: Aggrey
authors.initials: A
authors.lastname: Wasunna
authors.forename: Fred
authors.initials: F
authors.lastname: Were
authors.forename: Grace
authors.initials: G
authors.lastname: Irimu
authors.forename: Mike
authors.initials: M
authors.lastname: English
mesh_terms: D002662:Child Health Services / Q000592:standards*; D002675:Child, Preschool; D019538:Health Care Surveys; D006302:Health Services Research; D006780:Hospitals, Rural / Q000592:standards*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007630:Kenya / Q000453:epidemiology; D044342:Malnutrition / Q000401:mortality / Q000628:therapy*; D011787:Quality of Health Care; D019035:Rural Health Services / Q000592:standards*; D012720:Severity of Illness Index
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