title: Characteristics of admissions and variations in the use of basic investigations, treatments and outcomes in Kenyan hospitals within a new Clinical Information Network.
abstract: BACKGROUND
  Lack of detailed information about hospital activities, processes and outcomes hampers planning, performance monitoring and improvement in low-income countries (LIC). Clinical networks offer one means to advance methods for data collection and use, informing wider health system development in time, but are rare in LIC. We report baseline data from a new Clinical Information Network (CIN) in Kenya seeking to promote data-informed improvement and learning.
  
  
  METHODS
  Data from 13 hospitals engaged in the Kenyan CIN between April 2014 and March 2015 were captured from medical and laboratory records. We use these data to characterise clinical care and outcomes of hospital admission.
  
  
  RESULTS
  Data were available for a total of 30 042 children aged between 2 months and 15 years. Malaria (in five hospitals), pneumonia and diarrhoea/dehydration (all hospitals) accounted for the majority of diagnoses and comorbidity was found in 17 710 (59%) patients. Overall, 1808 deaths (6%) occurred (range per hospital 2.5%-11.1%) with 1037 deaths (57.4%) occurring by day 2 of admission (range 41%-67.8%). While malaria investigations are commonly done, clinical health workers rarely investigate for other possible causes of fever, test for blood glucose in severe illness or ascertain HIV status of admissions. Adherence to clinical guideline-recommended treatment for malaria, pneumonia, meningitis and acute severe malnutrition varied widely across hospitals.
  
  
  CONCLUSIONS
  Developing clinical networks is feasible with appropriate support. Early data demonstrate that hospital mortality remains high in Kenya, that resources to investigate severe illness are limited, that care provided and outcomes vary widely and that adoption of effective interventions remains slow. Findings suggest considerable scope for improving care within and across sites.
authors.affiliation: Kenya Medical Research Institute/Wellcome Trust Research Programme, Nairobi, Kenya.
authors.forename: Philip
authors.initials: P
authors.lastname: Ayieko
authors.affiliation: Kenya Medical Research Institute/Wellcome Trust Research Programme, Nairobi, Kenya.
authors.forename: Morris
authors.initials: M
authors.lastname: Ogero
authors.affiliation: Kenya Medical Research Institute/Wellcome Trust Research Programme, Nairobi, Kenya.
authors.forename: Boniface
authors.initials: B
authors.lastname: Makone
authors.affiliation: Kenya Medical Research Institute/Wellcome Trust Research Programme, Nairobi, Kenya.
authors.forename: Thomas
authors.initials: T
authors.lastname: Julius
authors.affiliation: Kenya Medical Research Institute/Wellcome Trust Research Programme, Nairobi, Kenya.
authors.forename: George
authors.initials: G
authors.lastname: Mbevi
authors.affiliation: Kenya Medical Research Institute/Wellcome Trust Research Programme, Nairobi, Kenya.
authors.forename: Wycliffe
authors.initials: W
authors.lastname: Nyachiro
authors.affiliation: Division of Maternal, Newborn, Child and Adolescent Health, Ministry of Health, Nairobi, Kenya.
authors.forename: Rachel
authors.initials: R
authors.lastname: Nyamai
authors.affiliation: School of Medicine, University of Nairobi, Nairobi, Kenya.
authors.forename: Fred
authors.initials: F
authors.lastname: Were
authors.affiliation: Kenya Paediatric Association, Nairobi, Kenya.
authors.forename: David
authors.initials: D
authors.lastname: Githanga
authors.affiliation: Kenya Medical Research Institute/Wellcome Trust Research Programme, Nairobi, Kenya Department of Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya.
authors.forename: Grace
authors.initials: G
authors.lastname: Irimu
authors.affiliation: Kenya Medical Research Institute/Wellcome Trust Research Programme, Nairobi, Kenya Nuffield Department of Medicine, Oxford University, UK.
authors.forename: Mike
authors.initials: M
authors.lastname: English
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003967:Diarrhea / Q000453:epidemiology; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007255:Information Services; D007630:Kenya / Q000453:epidemiology; D008288:Malaria / Q000453:epidemiology; D008297:Male; D044342:Malnutrition / Q000453:epidemiology; D008581:Meningitis / Q000453:epidemiology; D010343:Patient Admission / Q000706:statistics & numerical data*; D011014:Pneumonia / Q000453:epidemiology
keywords: Epidemiology; Health services research; Mortality; Paediatric Practice; Tropical Paediatrics