Comprehensive approach to hospital care improves survival rates for Kenyan children

6 April 2011

New research in Kenya has demonstrated that addressing deficiencies in clinical knowledge and hospital organisation results in improvements in medical practice for young children in rural areas.

Illnesses such as pneumonia, malaria and diarrhoea are major causes of mortality in developing countries. In Kenya, 74 in every 1000 children die before their fifth birthday.

In the new study, a team including Wellcome Trust Senior Research Fellow Mike English and Philip Ayieko from the KEMRI-Wellcome Trust Research Programme, Nairobi, showed that a comprehensive approach to hospital care can improve survival rates and clinical care for Kenyan children.

The researchers randomly assigned eight Kenyan district hospitals to a 'full' or 'control' intervention group. Those in the full intervention received clinical practice guidelines and training in their use, as well as other training aids and external supervision. Those in the control group received the same clinical practice guidelines, but no training or hands-on supervision.

During the 18-month trial, the performance of both groups of hospitals improved. However, those in the intervention group completed more admission assessment tasks and incorporated more of the clinical practices detailed in the guidelines than those in the control hospitals. In addition, a lower proportion of children received inappropriate doses of drugs (such as quinine for malaria) in the intervention hospitals than in the control hospitals.

The authors say: "Our data... to our knowledge represent the first major report examining national adaptation and implementation of a broad set of rural hospital care recommendations. They are relevant to many of the 100 countries with [Integrated Management of Childhood Illnesses] programmes where rural hospitals have important roles supporting primary health care systems and in helping to reduce child mortality."

Image: A girl at Wamba Catholic Hospital, Kenya. Credit: alaina.buzas on Flickr.

Reference

Ayieko P et al. A multifaceted intervention to implement guidelines and improve admission paediatric care in Kenyan district hospitals: a cluster randomised trial. PLOS Medicine [epub ahead of print]