Murphy Georgina A V, Gathara David, Aluvaala Jalemba, Mwachiro Jacintah, Abuya Nancy, Ouma Paul, Snow Robert W, English Mike
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.
BMJ Open. 2016 Dec 21;6(12):e012448. doi: 10.1136/bmjopen-2016-012448.
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.
作为与第四个千年发展目标相一致的努力的一部分，肯尼亚在降低儿童死亡率方面取得了进展。然而，在降低新生儿死亡率方面进展甚微，目前新生儿死亡占所有儿童死亡的45%。新生儿疾病往往具有不可预测性，病情严重，患病新生儿对专业护理的高度依赖使得提供住院医院服务成为提高新生儿存活率战略的一个关键组成部分。
本项目旨在评估内罗毕市县公立、私立和非营利性部门医院中住院新生儿护理的可及性和质量，并使其与此类服务的估计需求相匹配，描述能力与需求之间在数量和质量上的差距。将使用文献综述中的发病率估计值，并应用于经人口调整的次县出生估计数，来估计疾病的人群负担水平，从而在县内提供需求的空间细分估计数。随后将对全县所有提供全天候住院新生儿护理的医疗机构的新生儿服务进行调查。该调查将包括：对入院登记册进行回顾性审核，以估计设施的使用情况和患者的病例组合；对设施进行结构评估，以深入了解其能力；向护理人员发放一份问卷，重点关注关键产科和新生儿干预措施的实施过程；以及进行回顾性病例审核，以评估临床医生对指南的遵守情况。
本研究已获得肯尼亚医学研究所科学与伦理审查部门的批准（SSC协议编号2999）。研究结果将通过以下方式传播：通过个性化报告和联合研讨会传达给参与研究的机构；通过会议和总结报告传达给地方和国家利益相关者；通过同行评审出版物和国际会议传达给国际社会。
