Adoption of recommended practices and basic technologies in a low-income setting.
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.


METHODS
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).


METHODS
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.
KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya.
Mike
M
English
David
D
Gathara
Stephen
S
Mwinga
Philip
P
Ayieko
Charles
C
Opondo
Jalemba
J
Aluvaala
Elesban
E
Kihuba
Paul
P
Mwaniki
Fred
F
Were
Grace
G
Irimu
Aggrey
A
Wasunna
Wycliffe
W
Mogoa
Rachel
R
Nyamai
D002648:Child; D003430:Cross-Sectional Studies; D003695:Delivery of Health Care / Q000706:statistics & numerical data*; D003906:Developing Countries; D003955:Diagnostic Tests, Routine / Q000379:methods* / Q000706:statistics & numerical data; D007722:Health Knowledge, Attitudes, Practice; D006306:Health Surveys; D006761:Hospitals; D006801:Humans; D007630:Kenya; D011203:Poverty / Q000706:statistics & numerical data*
Health services research; Tropical Paediatrics