title: Nairobi Newborn Study: a protocol for an observational study to estimate the gaps in provision and quality of inpatient newborn care in Nairobi City County, Kenya.
abstract: Progress has been made in Kenya towards reducing child mortality as part of efforts aligned with the fourth Millennium Development Goal. However, little advancement has been made in reducing mortality among newborns, which now accounts for 45% of all child deaths. The frequently unanticipated nature of neonatal illness, its severity and the high dependency of sick newborns on skilled care make the provision of inpatient hospital services one key component of strategies to improve newborn survival.
  
  
  
  This project aims to assess the availability and quality of inpatient newborn care in hospitals in Nairobi City County across the public, private and not-for-profit sectors and align this to the estimated need for such services, providing a description of the quantity and quality gaps between capacity and demand. The population level burden of disease will be estimated using morbidity incidence estimates from a literature review applied to subcounty estimates of population-adjusted births, providing a spatially disaggregated estimate of need within the county. This will be followed by a survey of neonatal services across all health facilities providing 24/7 inpatient newborn care in the county. The survey will include: a retrospective audit of admission registers to estimate the usage of facilities and case-mix of patients; a structural assessment of facilities to gain insight into capacity; a questionnaire to nursing staff focusing on the process of delivering key obstetric and neonatal interventions; and a retrospective case audit to assess adherence to guidelines by clinicians.
  
  
  
  This study has been approved by the Kenya Medical Research Institute Scientific and Ethics Review Unit (SSC protocol No.2999). Results will be disseminated: to participating facilities through individualised reports and a joint workshop; to local and national stakeholders through meetings and a summary report; and to the international community through peer-review publication and international meetings.
authors.affiliation: Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK.|Kenya Medical Research Institute/Wellcome Trust Research Programme, Nairobi, Kenya.
authors.forename: Georgina A V
authors.initials: GA
authors.lastname: Murphy
authors.affiliation: Kenya Medical Research Institute/Wellcome Trust Research Programme, Nairobi, Kenya.
authors.forename: David
authors.initials: D
authors.lastname: Gathara
authors.affiliation: Kenya Medical Research Institute/Wellcome Trust Research Programme, Nairobi, Kenya.|Department of Paediatrics and Child Health, College of Health Sciences, University of Nairobi, Nairobi, Kenya.
authors.forename: Jalemba
authors.initials: J
authors.lastname: Aluvaala
authors.affiliation: Kenya Medical Research Institute/Wellcome Trust Research Programme, Nairobi, Kenya.
authors.forename: Jacintah
authors.initials: J
authors.lastname: Mwachiro
authors.affiliation: Kenya Medical Research Institute/Wellcome Trust Research Programme, Nairobi, Kenya.|Nairobi City County Government, Nairobi, Kenya.
authors.forename: Nancy
authors.initials: N
authors.lastname: Abuya
authors.affiliation: Kenya Medical Research Institute/Wellcome Trust Research Programme, Nairobi, Kenya.
authors.forename: Paul
authors.initials: P
authors.lastname: Ouma
authors.affiliation: Kenya Medical Research Institute/Wellcome Trust Research Programme, Nairobi, Kenya.|Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK.
authors.forename: Robert W
authors.initials: RW
authors.lastname: Snow
authors.affiliation: Kenya Medical Research Institute/Wellcome Trust Research Programme, Nairobi, Kenya.|Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK.
authors.forename: Mike
authors.initials: M
authors.lastname: English
mesh_terms: D017281:Cost of Illness; D005260:Female; D019983:Guideline Adherence; D019538:Health Care Surveys; D006297:Health Services Accessibility; D006301:Health Services Needs and Demand; D006760:Hospitalization; D006761:Hospitals; D006801:Humans; D007231:Infant, Newborn; D007630:Kenya; D009741:Nursing Staff, Hospital; D010342:Patient Acceptance of Health Care; D018743:Perinatal Care / Q000592:standards*; D054238:Perinatal Mortality; D010820:Physicians; D011247:Pregnancy; D017149:Private Sector; D017150:Public Sector; D011787:Quality of Health Care; D012107:Research Design; D011795:Surveys and Questionnaires
keywords: Africa; EPIDEMIOLOGY; Newborns