title: Assessment of neonatal care in clinical training facilities in Kenya.
abstract: OBJECTIVE
  An audit of neonatal care services provided by clinical training centres was undertaken to identify areas requiring improvement as part of wider efforts to improve newborn survival in Kenya.
  
  
  METHODS
  Cross-sectional study using indicators based on prior work in Kenya. Statistical analyses were descriptive with adjustment for clustering of data.
  
  
  METHODS
  Neonatal units of 22 public hospitals.
  
  
  METHODS
  Neonates aged <7 days.
  
  
  METHODS
  Quality of care was assessed in terms of availability of basic resources (principally equipment and drugs) and audit of case records for documentation of patient assessment and treatment at admission.
  
  
  RESULTS
  All hospitals had oxygen, 19/22 had resuscitation and phototherapy equipment, but some key resources were missing—for example kangaroo care was available in 14/22. Out of 1249 records, 56.9% (95% CI 36.2% to 77.6%) had a standard neonatal admission form. A median score of 0 out of 3 for symptoms of severe illness (IQR 0-3) and a median score of 6 out of 8 for signs of severe illness (IQR 4-7) were documented. Maternal HIV status was documented in 674/1249 (54%, 95% CI 41.9% to 66.1%) cases. Drug doses exceeded recommendations by >20% in prescriptions for penicillin (11.6%, 95% CI 3.4% to 32.8%) and gentamicin (18.5%, 95% CI 13.4% to 25%), respectively.
  
  
  CONCLUSIONS
  Basic resources are generally available, but there are deficiencies in key areas. Poor documentation limits the use of routine data for quality improvement. Significant opportunities exist for improvement in service delivery and adherence to guidelines in hospitals providing professional training.
authors.affiliation: Ministry of Health, Government of Kenya, Nairobi, Kenya Department of Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya.
authors.forename: Jalemba
authors.initials: J
authors.lastname: Aluvaala
authors.affiliation: Ministry of Health, Government of Kenya, Nairobi, Kenya.
authors.forename: Rachael
authors.initials: R
authors.lastname: Nyamai
authors.affiliation: Department of Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya.
authors.forename: Fred
authors.initials: F
authors.lastname: Were
authors.affiliation: Department of Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya.
authors.forename: Aggrey
authors.initials: A
authors.lastname: Wasunna
authors.affiliation: Department of Obstetrics and Gynecology, University of Nairobi, Nairobi, Kenya.
authors.forename: Rose
authors.initials: R
authors.lastname: Kosgei
authors.affiliation: Ministry of Health, Government of Kenya, Nairobi, Kenya KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya.
authors.forename: Jamlick
authors.initials: J
authors.lastname: Karumbi
authors.affiliation: KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya.
authors.forename: David
authors.initials: D
authors.lastname: Gathara
authors.affiliation: KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya Nuffield Department of Medicine & Department of Paediatrics, University of Oxford, Oxford, UK.
authors.forename: Mike
authors.initials: M
authors.lastname: English
mesh_terms: D003430:Cross-Sectional Studies; D005260:Female; D006302:Health Services Research; D006779:Hospitals, Public / Q000592:standards*; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal / Q000592:standards*; D007630:Kenya; D008297:Male; D008485:Medical Audit; D058996:Quality Improvement; D011787:Quality of Health Care / Q000592:standards*
keywords: Data Collection; Evidence Based Medicine; Health services research; Measurement; Neonatology