KEMRI/Wellcome Trust Research Programme, Nairobi, Kenya.
BMC Health Serv Res. 2011 Nov 11;11:307. doi: 10.1186/1472-6963-11-307.
Given the high mortality associated with neonatal illnesses and severe malnutrition and the development of packages of interventions that provide similar challenges for service delivery mechanisms we set out to explore how well such services are provided in Kenya.
As a sub-component of a larger study we evaluated care during surveys conducted in 8 rural district hospitals using convenience samples of case records. After baseline hospitals received either a full multifaceted intervention (intervention hospitals) or a partial intervention (control hospitals) aimed largely at improving inpatient paediatric care for malaria, pneumonia and diarrhea/dehydration. Additional data were collected to: i) examine the availability of routine information at baseline and their value for morbidity, mortality and quality of care reporting, and ii) compare the care received against national guidelines disseminated to all hospitals.
Clinical documentation for neonatal and malnutrition admissions was often very poor at baseline with case records often entirely missing. Introducing a standard newborn admission record (NAR) form was associated with an increase in median assessment (IQR) score to 25/28 (22-27) from 2/28 (1-4) at baseline. Inadequate and incorrect prescribing of penicillin and gentamicin were common at baseline. For newborns considerable improvements in prescribing in the post baseline period were seen for penicillin but potentially serious errors persisted when prescribing gentamicin, particularly to low-birth weight newborns in the first week of life. Prescribing essential feeds appeared almost universally inadequate at baseline and showed limited improvement after guideline dissemination.
Routine records are inadequate to assess newborn care and thus for monitoring newborn survival interventions. Quality of documented inpatient care for neonates and severely malnourished children is poor with limited improvement after the dissemination of clinical practice guidelines. Further research evaluating approaches to improving care for these vulnerable groups is urgently needed. We also suggest pre-service training curricula should be better aligned to help improve newborn survival particularly.
鉴于新生儿疾病和严重营养不良相关的高死亡率，以及提供类似服务提供挑战的干预措施包的发展，我们着手探索肯尼亚的服务提供情况如何。
作为一项更大研究的子组件，我们使用病例记录的便利样本评估了在 8 家农村地区医院进行的调查期间的护理情况。基线后，医院要么接受全面的多方面干预（干预医院），要么接受部分干预（对照医院），主要目的是改善疟疾、肺炎和腹泻/脱水的住院儿科护理。收集了额外的数据：i）检查基线时常规信息的可用性及其对发病率、死亡率和护理质量报告的价值，ii）比较收到的护理与所有医院分发的国家指南。
新生儿和营养不良入院的临床记录在基线时通常非常差，病例记录经常完全缺失。引入标准新生儿入院记录（NAR）表后，中位数评估（IQR）评分从基线时的 2/28（1-4）增加到 25/28（22-27）。基线时，青霉素和庆大霉素的处方不足和不正确很常见。在基线后时期，青霉素的处方有了相当大的改进，但庆大霉素的处方仍存在潜在的严重错误，特别是对生命第一周的低出生体重新生儿。基本喂养的处方在基线时几乎普遍不足，在指南发布后仅略有改善。
常规记录不足以评估新生儿护理，因此无法监测新生儿的生存干预措施。新生儿和严重营养不良儿童住院护理的书面记录质量很差，在临床实践指南发布后，改善有限。迫切需要进一步研究评估改善这些弱势群体护理的方法。我们还建议，职前培训课程应更好地协调，以特别帮助提高新生儿的生存率。
