Characteristics of admissions and variations in the use of basic investigations, treatments and outcomes in Kenyan hospitals within a new Clinical Information Network. Issue 3 (10th December 2015)

• Record Type: Journal Article
• Authors: Ayieko, Philip; Ogero, Morris; Makone, Boniface; Julius, Thomas; Mbevi, George; Nyachiro, Wycliffe; Nyamai, Rachel; Were, Fred; Githanga, David; Irimu, Grace; English, Mike
• Other Names: author non-byline.; Tuti Timothy author non-byline.; Gathara David author non-byline.; Gachau Susan author non-byline.; N'gar N'gar Samuel author non-byline.; Aduro Nick author non-byline.; Mutai Beatrice author non-byline.; Mutai Loice author non-byline.; Emadau Caren author non-byline.; Mutiso Cecilia author non-byline.; Nzioki Charles author non-byline.; Chabi Martin author non-byline.; Kanyingi Francis author non-byline.; Mithamo Agnes author non-byline.; Kuria Margaret author non-byline.; Otido Sam author non-byline.; Kariuki Alice author non-byline.; Njiiri Peris author non-byline.; Inginia Rachel author non-byline.; Musabi Melab author non-byline.; Kigen Barnabas author non-byline.; Ochieng Grace author non-byline.; Thuranira Lydia author non-byline.
• Is Part Of: Archives of disease in childhood. Volume 101:Issue 3(2016)
• Page Start: 223
• Page End: 229
• Publication Date: 2015-12-10
• Subjects: Epidemiology -- Tropical Paediatrics -- Health services research -- Mortality -- Paediatric Practice; Children -- Diseases -- Periodicals; Infants -- Diseases -- Periodicals; 618.920005
• DOI: 10.1136/archdischild-2015-309269
• Languages: English
• ISSNs: 0003-9888

Abstract

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. Conclusion: 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.