Quality of hospital care for sick newborns and severely malnourished children in Kenya: A two-year descriptive study in 8 hospitals
Quality of hospital care for sick newborns and severely malnourished children in Kenya: A two-year descriptive study in 8 hospitals
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DOI：
10.1186/1472-6963-11-307
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发表时间：
2011-11-11
影响因子：
2.8
通讯作者：
English, Mike
中科院分区：
文献类型：
--
作者：
Gathara, David;Opiyo, Newton;English, Mike
背景资料：鉴于新生儿疾病和严重营养不良的高死亡率和一揽子干预措施，提供类似的挑战，为服务提供机制，我们着手探讨如何以及这样的服务提供在Keny.Methods：作为一个更大的研究的一个子组成部分，我们评估了护理在8个农村地区医院使用方便的病例记录样本进行的调查。基线后，医院接受全面的多方面干预（干预医院）或部分干预（对照医院），主要目的是改善住院的疟疾，肺炎和腹泻/脱水的儿科护理。额外的数据收集：i）检查常规信息的可用性在基线和他们的发病率，死亡率和护理报告的质量的价值，和ii）比较收到的护理对国家指导方针分发到所有hospital.Results：新生儿和营养不良入院的临床文件往往是非常差的基线与病例记录往往完全缺失。引入标准新生儿入院记录（NAR）表与中位数评估（IQR）评分从基线时的2/28（1-4）增加至25/28（22-27）相关。基线时青霉素和庆大霉素处方不足和不正确是常见的。对于新生儿，在基线后阶段，青霉素的处方有相当大的改善，但在庆大霉素处方时，潜在的严重错误仍然存在，特别是对出生后第一周的低出生体重新生儿。处方基本饲料出现几乎普遍不足，在基线，并显示有限的改善后，指南dissemination.Conclusion：常规记录是不够的，以评估新生儿护理，从而监测新生儿的生存干预措施。有记录的新生儿和严重营养不良儿童住院护理质量很差，在临床实践指南传播后改善有限。迫切需要开展进一步的研究，评估改善对这些弱势群体的照顾的方法。我们还建议，职前培训课程应更好地协调，以帮助提高新生儿的生存，特别是。
Background: 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.Methods: 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.Results: 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.Conclusion: 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.