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In 2002, we identified major shortcomings in the management of sick newborns and children at the first referral or district hospital level in Kenya.1 Failure in the dissemination of knowledge and skills (and thus of translation of evidence informed policy) was a fundamental problem. To address this challenge between 2005 and 2012 we developed, implemented and studied: 1. the national evidence-based clinical practice guidelines in the form of protocol booklets that can be disseminated at scale (and have recently described how this process matured over more than a decade)2 3; 2. the Emergency Triage Assessment and Treatment plus Admission Care course4 (that has been updated over time); 3. the standardised medical record forms including checklists of key symptoms and signs that are key elements of the protocols and help define the nature and severity of common illnesses5 (also updated over time). The effect of implementing these tools as part of a multifaceted strategy including outreach, audit and feedback to improve guideline adherence was tested between 2006 and 2009 and proven effective in a cluster randomised trial.6 In recent years, we have been able to document wider adoption of the protocols, training and record forms (including uptake outside Kenya) with some evidence of improvements in the quality of district hospital care, measured as adherence to guidelines, beyond centres directly engaged in research.7–10 In the last 4 years (2013–2017) we have adopted a new strategy, building on these earlier experiences, to continue efforts to improve hospital care for children in Kenya with a focus on adoption of agreed practice guidelines and uptake of basic technologies. At the heart of this new strategy is a Clinical Information Network (CIN). Here we outline the rationale for and philosophy of the CIN and how we suggest it helps Kenya as a low-income country (LIC) meet …

BackgroundLack 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.MethodsData 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.ResultsData 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.ConclusionDeveloping 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.