title: Moving towards routine evaluation of quality of inpatient pediatric care in Kenya.
abstract: BACKGROUND
  Regular assessment of quality of care allows monitoring of progress towards system goals and identifies gaps that need to be addressed to promote better outcomes. We report efforts to initiate routine assessments in a low-income country in partnership with government.
  
  
  METHODS
  A cross-sectional survey undertaken in 22 'internship training' hospitals across Kenya that examined availability of essential resources and process of care based on review of 60 case-records per site focusing on the common childhood illnesses (pneumonia, malaria, diarrhea/dehydration, malnutrition and meningitis).
  
  
  RESULTS
  Availability of essential resources was 75% (45/61 items) or more in 8/22 hospitals. A total of 1298 (range 54-61) case records were reviewed. HIV testing remained suboptimal at 12% (95% CI 7-19). A routinely introduced structured pediatric admission record form improved documentation of core admission symptoms and signs (median score for signs 22/22 and 8/22 when form used and not used respectively). Correctness of penicillin and gentamicin dosing was above 85% but correctness of prescribed intravenous fluid or oral feed volumes for severe dehydration and malnutrition were 54% and 25% respectively. Introduction of Zinc for diarrhea has been relatively successful (66% cases) but use of artesunate for malaria remained rare. Exploratory analysis suggests considerable variability of the quality of care across hospitals.
  
  
  CONCLUSIONS
  Quality of pediatric care in Kenya has improved but can improve further. The approach to monitoring described in this survey seems feasible and provides an opportunity for routine assessments across a large number of hospitals as part of national efforts to sustain improvement. Understanding variability across hospitals may help target improvement efforts.
authors.affiliation: KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya.
authors.forename: David
authors.initials: D
authors.lastname: Gathara
authors.affiliation: Ministry of Health, Government of Kenya, Nairobi, Kenya.
authors.forename: Rachael
authors.initials: R
authors.lastname: Nyamai
authors.affiliation: Department of Pediatrics and Child Health, University of Nairobi, Nairobi, Kenya.
authors.forename: Fred
authors.initials: F
authors.lastname: Were
authors.affiliation: Ministry of Health, Government of Kenya, Nairobi, Kenya.
authors.forename: Wycliffe
authors.initials: W
authors.lastname: Mogoa
authors.affiliation: Ministry of Health, Government of Kenya, Nairobi, Kenya.
authors.forename: Jamlick
authors.initials: J
authors.lastname: Karumbi
authors.affiliation: Ministry of Health, Government of Kenya, Nairobi, Kenya.
authors.forename: Elesban
authors.initials: E
authors.lastname: Kihuba
authors.affiliation: Ministry of Health, Government of Kenya, Nairobi, Kenya.
authors.forename: Stephen
authors.initials: S
authors.lastname: Mwinga
authors.affiliation: Ministry of Health, Government of Kenya, Nairobi, Kenya; Department of Pediatrics and Child Health, University of Nairobi, Nairobi, Kenya.
authors.forename: Jalemba
authors.initials: J
authors.lastname: Aluvaala
authors.affiliation: School of Pharmacy, University of Nairobi, Nairobi, Kenya.
authors.forename: Mercy
authors.initials: M
authors.lastname: Mulaku
authors.affiliation: Department of Obstetrics and Gynecology, University of Nairobi, Nairobi, Kenya.
authors.forename: Rose
authors.initials: R
authors.lastname: Kosgei
authors.affiliation: Department of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom.
authors.forename: Jim
authors.initials: J
authors.lastname: Todd
authors.affiliation: Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Allen
authors.affiliation: KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya; Nuffield Department of Medicine & Department of Pediatrics, University of Oxford, Oxford, United Kingdom.
authors.forename: Mike
authors.initials: M
authors.lastname: English
mesh_terms: D003430:Cross-Sectional Studies; D004282:Documentation; D019983:Guideline Adherence; D006784:Hospitals, Teaching; D006801:Humans; D007297:Inpatients; D007396:Internship and Residency; D007630:Kenya; D010372:Pediatrics; D011216:Practice Management, Medical; D011785:Quality Assurance, Health Care; D011787:Quality of Health Care; D011795:Surveys and Questionnaires
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