36 results on '"English, Mike"'
Search Results
2. Pulse oximetry values of neonates admitted for care and receiving routine oxygen therapy at a resource-limited hospital in Kenya.
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Morgan, Melissa, Maina, Beth, Waiyego, Mary, Mutinda, Catherine, Aluvaala, Jalemba, Maina, Michuki, and English, Mike
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Kenya ,neonate ,oxygen saturation ,oxygen therapy ,pulse oximetry ,Female ,Health Resources ,Hospitals ,Maternity ,Humans ,Hypoxia ,Infant ,Newborn ,Infant ,Newborn ,Diseases ,Kenya ,Male ,Odds Ratio ,Oximetry ,Oxygen ,Oxygen Inhalation Therapy ,Prevalence ,Prospective Studies - Abstract
AIM: There are 2.7 million neonatal deaths annually, 75% of which occur in sub-Saharan Africa and South Asia. Effective treatment of hypoxaemia through tailored oxygen therapy could reduce neonatal mortality and prevent oxygen toxicity. METHODS: We undertook a two-part prospective study of neonates admitted to a neonatal unit in Nairobi, Kenya, between January and December 2015. We determined the prevalence of hypoxaemia and explored associations of clinical risk factors and signs of respiratory distress with hypoxaemia and mortality. After staff training on oxygen saturation (SpO2 ) target ranges, we enrolled a consecutive sample of neonates admitted for oxygen and measured SpO2 at 0, 6, 12, 18 and 24 h post-admission. We estimated the proportion of neonates outside the target range (≥34 weeks: ≥92%;
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- 2018
3. Perspectives and practices of health workers around diagnosis of paediatric tuberculosis in hospitals in a resource-poor setting – modern diagnostics meet age-old challenges
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Oliwa, Jacquie Narotso, Odero, Sabina Adhiambo, Nzinga, Jacinta, van Hensbroek, Michaël Boele, Jones, Caroline, English, Mike, and van’t Hoog, Anja
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- 2020
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4. Digital health Systems in Kenyan Public Hospitals: a mixed-methods survey
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Muinga, Naomi, Magare, Steve, Monda, Jonathan, English, Mike, Fraser, Hamish, Powell, John, and Paton, Chris
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- 2020
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5. Effective coverage of essential inpatient care for small and sick newborns in a high mortality urban setting: a cross-sectional study in Nairobi City County, Kenya
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Murphy, Georgina A. V., Gathara, David, Mwachiro, Jacintah, Abuya, Nancy, Aluvaala, Jalemba, English, Mike, and on behalf of the Health Services that Deliver for Newborns Expert Group
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- 2018
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6. Signs of illness in Kenyan infants aged less than 60 days
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English Mike, Ngama Mwanajuma, Mwalekwa Laura, and Peshu Norbert
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Critical illness ,Infant, Newborn, Diseases/diagnosis ,Severity of illness index ,Infant, Newborn ,Infant care/methods ,Delivery of health care, Integrated ,Practice guidelines ,Sensitivity and specificity ,Prospective studies ,Kenya ,Public aspects of medicine ,RA1-1270 - Abstract
OBJECTIVE: Little data has been published on the presenting symptoms and signs among ill infants aged 1.5 kg and were admitted over an 18-month period. The same data were collected prospectively from infants recruited to a contemporaneous hospital birth cohort who became ill and were assessed and treated as outpatients at the same hospital. FINDINGS: Data on 467 outpatient consultations and 769 inpatient episodes were available for analysis. These data highlighted the importance of findings in the history, particularly breathing difficulties, abnormal feeding, and abnormal behaviour, as well as clinical signs in the evaluation of young infants. They indicated possible important differences in the panel of signs useful for detecting severe illness in infants aged 0-6 days and those aged 7-59 days. They also showed that some simplification of current guidelines that still preserved the sensitivity and specificity for detecting very severe disease might be possible. CONCLUSION: Simple clinical features may allow distinction between severe and non-severe illness to be made with reasonable confidence. Prospective studies on an adequate scale are needed urgently to provide current integrated management of childhood illness guidelines for young infants with an adequate evidence base.
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- 2004
7. Hypothetical performance of syndrome-based management of acute paediatric admissions of children aged more than 60 days in a Kenyan district hospital
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English Mike, Berkley James, Mwangi Isiah, Mohammed Shebbe, Ahmed Maimuna, Osier Faith, Muturi Neema, Ogutu Bernhards, Marsh Kevin, and Newton Charles R.J.C.
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Acute disease/therapy ,Critical illness/therapy ,Syndrome ,Pneumonia/diagnosis ,Pneumonia/drug therapy ,Malaria/diagnosis ,Malaria/drug therapy ,Diarrhea/diagnosis ,Diarrhea/drug therapy ,Child nutrition disorders/diagnosis ,Child nutrition disorders/therapy ,Meningitis/diagnosis ,Meningitis/drug therapy ,Bacteremia/diagnosis ,Bacteremia/drug therapy ,Infant ,Child ,Preschool ,Models ,Theoretical ,Prospective studies ,Kenya ,Public aspects of medicine ,RA1-1270 - Abstract
OBJECTIVE: To investigate whether the outpatient, syndrome-based approach of the Integrated Management of Childhood Illness (IMCI) protocol could be extended to the inpatient arena to give clear and simple minimum standards of care for poorly resourced facilities. METHODS: A prospective, one-year admission cohort retrospectively compared hypothetical performance of syndrome-based management with paediatrician-defined final diagnosis. Admission syndrome definitions were based on local adaptations to the IMCI protocol that encompassed 20 clinical features, measurement of oxygen saturation, and malaria microscopy. FINDINGS: After 315 children with clinically obvious diagnoses (e.g. sickle cell disease and burns) were excluded, 3705 admission episodes were studied. Of these, 2334 (63%) met criteria for at least one severe syndrome (mortality 8% vs 95%) for severe pneumonia, severe malaria, and diarrhoea with severe dehydration, and probably for severe malnutrition (sensitivity 71%). Syndrome-directed treatment suggested the use of broad-spectrum antibiotics in 75/133 (56% sensitivity) children with bacteraemic and 63/71 (89% sensitivity) children with meningitis. CONCLUSIONS: Twenty clinical features, oxygen saturation measurements, and results of malaria blood slides could be used for inpatient, syndrome-based management of acute paediatric admissions. The addition of microscopy of the cerebrospinal fluid and haemoglobin measurements would improve syndrome-directed treatment considerably. This approach might rationalize admission policy and standardize inpatient paediatric care in resource-poor countries, although the clinical detection of bacteraemia remains a problem.
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- 2003
8. Pulse oximetry values of neonates admitted for care and receiving routine oxygen therapy at a resource-limited hospital in Kenya
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Morgan, Melissa C, Maina, Beth, Waiyego, Mary, Mutinda, Catherine, Aluvaala, Jalemba, Maina, Michuki, and English, Mike
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Male ,Infant, Newborn ,Oxygen Inhalation Therapy ,Original Articles ,oxygen therapy ,Hospitals, Maternity ,Kenya ,oxygen saturation ,Infant, Newborn, Diseases ,pulse oximetry ,Oxygen ,Odds Ratio ,Prevalence ,Health Resources ,Humans ,Original Article ,Female ,Oximetry ,Prospective Studies ,neonate ,Hypoxia - Abstract
Aim There are 2.7 million neonatal deaths annually, 75% of which occur in sub-Saharan Africa and South Asia. Effective treatment of hypoxaemia through tailored oxygen therapy could reduce neonatal mortality and prevent oxygen toxicity. Methods We undertook a two-part prospective study of neonates admitted to a neonatal unit in Nairobi, Kenya, between January and December 2015. We determined the prevalence of hypoxaemia and explored associations of clinical risk factors and signs of respiratory distress with hypoxaemia and mortality. After staff training on oxygen saturation (SpO2) target ranges, we enrolled a consecutive sample of neonates admitted for oxygen and measured SpO2 at 0, 6, 12, 18 and 24 h post-admission. We estimated the proportion of neonates outside the target range (≥34 weeks: ≥92%; Results A total of 477 neonates were enrolled. Prevalence of hypoxaemia was 29.2%. Retractions (odds ratio (OR) 2.83, 95% CI 1.47–5.47), nasal flaring (OR 2.68, 95% CI 1.51–4.75), and grunting (OR 2.47, 95% CI 1.27–4.80) were significantly associated with hypoxaemia. Nasal flaring (OR 2.85, 95% CI 1.25–6.54), and hypoxaemia (OR 3.06, 95% CI 1.54–6.07) were significantly associated with mortality; 64% of neonates receiving oxygen were out of range at ≥2 time points and 43% at ≥3 time points. Conclusion There is a high prevalence of hypoxaemia at admission and a strong association between hypoxaemia and mortality in this Kenyan neonatal unit. Many neonates had out of range SpO2 values while receiving oxygen. Further research is needed to test strategies aimed at improving the accuracy of oxygen provision in low-resource settings.
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- 2017
9. Information asymmetry in the Kenyan medical laboratory sector.
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Bahati, Felix, English, Mike, Sayed, Shahin, Horton, Susan, Odhiambo, Onyango Abel, Samatar, Abdulatif A, and McKnight, Jacob
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PATHOLOGICAL laboratories , *DATABASES , *CLINICAL pathology , *HOSPITALS , *HEALTH services accessibility , *CROSS-sectional method , *MEDICAL care costs , *INTERVIEWING , *PRIVATE sector , *PATIENTS' attitudes , *HEALTH , *ACCESS to information , *DESCRIPTIVE statistics , *NEEDS assessment , *INFORMATION needs , *ROUTINE diagnostic tests , *STATISTICAL sampling - Abstract
Important information about medical laboratory providers is not readily available to all patients, clinicians nor regulators in Kenya. This study was conducted as part of a wider project aiming to improve access to high quality diagnostics by addressing information asymmetries in the Kenyan market for laboratory services. The purpose of this study was to: 1) Gather pricing information for 49 common laboratory tests from medical laboratories in Nairobi, Kenya, noting where these prices were publicly available or withheld. 2) Assess patients' knowledge of testing information including: turnaround time, price, and test availability. This was a cross-sectional study where a mystery caller approach was used to survey 49 tests for turnaround time, price, and availability across 13 laboratories selected purposively. The mystery shopper survey was complemented by 251 patient exit interviews at two Kenyan hospitals to understand whether patients seeking laboratory tests in Nairobi had access to such information. All 251 patients were selected by convenience sampling. We noted that 85% of the private laboratories did not disclose test prices and turnaround times to their patients. There was a wide range of prices on several key tests, with private in-facility laboratories charging an average test price of 468% of the average test price in public laboratories across all the 49 tests. We also found that many patients lacked key information regarding the tests they needed: 65% did not know the purpose of the test while 41% did not know the test price at all. Under the current system, patients have limited access to information regarding the key criteria required to make a rational decision. This has a significant impact on the quality, price, and turnaround time (TAT) offered by the medical laboratories that operate in this dysfunctional market. [ABSTRACT FROM AUTHOR]
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- 2021
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10. The Clinical Profile of Severe Pediatric Malaria in an Area Targeted for Routine RTS,S/AS01 Malaria Vaccination in Western Kenya.
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Akech, Samuel, Chepkirui, Mercy, Ogero, Morris, Agweyu, Ambrose, Irimu, Grace, English, Mike, and Snow, Robert W
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CAUSES of death ,IMMUNIZATION of children ,MALARIA ,PEDIATRICS ,PHENOTYPES ,SECONDARY analysis ,SEVERITY of illness index ,DESCRIPTIVE statistics ,CHILDREN - Abstract
Background The malaria prevalence has declined in western Kenya, resulting in the risk of neurological phenotypes in older children. This study investigates the clinical profile of pediatric malaria admissions ahead of the introduction of the RTS,S/AS01 vaccine. Methods Malaria admissions in children aged 1 month to 15 years were identified from routine, standardized, inpatient clinical surveillance data collected between 2015 and 2018 from 4 hospitals in western Kenya. Malaria phenotypes were defined based on available data. Results There were 5766 malaria admissions documented. The median age was 36 months (interquartile range, 18–60): 15% were aged between 1–11 months of age, 33% were aged 1–23 months of age, and 70% were aged 1 month to 5 years. At admission, 2340 (40.6%) children had severe malaria: 421/2208 (19.1%) had impaired consciousness, 665/2240 (29.7%) had an inability to drink or breastfeed, 317/2340 (13.6%) had experienced 2 or more convulsions, 1057/2340 (45.2%) had severe anemia, and 441/2239 (19.7%) had severe respiratory distress. Overall, 211 (3.7%) children admitted with malaria died; 163/211 (77% deaths, case fatality rate 7.0%) and 48/211 (23% deaths, case fatality rate 1.4%) met the criteria for severe malaria and nonsevere malaria at admission, respectively. The median age for fatal cases was 33 months (interquartile range, 12–72) and the case fatality rate was highest in those unconscious (44.4%). Conclusions Severe malaria in western Kenya is still predominantly seen among the younger pediatric age group and current interventions targeted for those <5 years are appropriate. However, there are increasing numbers of children older than 5 years admitted with malaria, and ongoing hospital surveillance would identify when interventions should target older children. [ABSTRACT FROM AUTHOR]
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- 2020
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11. Evaluating the foundations that help avert antimicrobial resistance: Performance of essential water sanitation and hygiene functions in hospitals and requirements for action in Kenya.
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Maina, Michuki, Tosas-Auguet, Olga, McKnight, Jacob, Zosi, Mathias, Kimemia, Grace, Mwaniki, Paul, Schultsz, Constance, and English, Mike
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PUBLIC hospitals ,SANITATION ,HEALTH facilities ,BUILT environment ,HYGIENE ,HOSPITAL administration ,ENVIRONMENTAL exposure prevention - Abstract
Background: Water Sanitation and Hygiene (WASH) in healthcare facilities is critical in the provision of safe and quality care. Poor WASH increases hospital-associated infections and contributes to the rise of antimicrobial resistance (AMR). It is therefore essential for governments and hospital managers to know the state of WASH in these facilities to set priorities and allocate resources. Methods: Using a recently developed survey tool and scoring approach, we assessed WASH across four domains in 14 public hospitals in Kenya (65 indicators) with specific assessments of individual wards (34 indicators). Aggregate scores were generated for whole facilities and individual wards and used to illustrate performance variation and link findings to specific levels of health system accountability. To help interpret and contextualise these scores, we used data from key informant interviews with hospital managers and health workers. Results: Aggregate hospital performance ranged between 47 and 71% with five of the 14 hospitals scoring below 60%. A total of 116 wards were assessed within these facilities. Linked to specific domains, ward scores varied within and across hospitals and ranged between 20% and 80%. At ward level, some critical indicators, which affect AMR like proper waste segregation and hand hygiene compliance activities had pooled aggregate scores of 45 and 35% respectively. From 31 interviews conducted, the main themes that explained this heterogenous performance across facilities and wards included differences in the built environment, resource availability, leadership and the degree to which local managers used innovative approaches to cope with shortages. Conclusion: Significant differences and challenges exist in the state of WASH within and across hospitals. Whereas the senior hospital management can make some improvements, input and support from the national and regional governments are essential to improve WASH as a basic foundation for averting nosocomial infections and the spread of AMR as part of safe, quality hospital care in Kenya. [ABSTRACT FROM AUTHOR]
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- 2019
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12. Diagnostic practices and estimated burden of tuberculosis among children admitted to 13 government hospitals in Kenya: An analysis of two years’ routine clinical data.
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Oliwa, Jacquie Narotso, Gathara, David, Ogero, Morris, van Hensbroek, Michaël Boele, English, Mike, van’t Hoog, Anja, and null, null
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CHILDREN'S hospitals ,PUBLIC hospitals ,HEALTH facilities ,TUBERCULOSIS ,TUBERCULIN test ,CHILDREN ,AIDS-related opportunistic infections - Abstract
Background: True burden of tuberculosis (TB) in children is unknown. Hospitalised children are low-hanging fruit for TB case detection as they are within the system. We aimed to explore the process of recognition and investigation for childhood TB using a guideline-linked cascade of care. Methods: This was an observational study of 42,107 children admitted to 13 county hospitals in Kenya from 01Nov 15-31Oct 16, and 01Nov 17-31Oct 18. We estimated those that met each step of the cascade, those with an apparent (or “Working”) TB diagnosis and modelled associations with TB tests amongst guideline-eligible children. Results: 23,741/42,107 (56.4%) met step 1 of the cascade (≥2 signs and symptoms suggestive of TB). Step 2(further screening of history of TB contact/full respiratory exam) was documented in 14,873/23,741 (62.6%) who met Step 1. Step 3(chest x-ray or Mantoux test) was requested in 2,451/14,873 (16.5%) who met Step 2. Step 4(≥1 bacteriological test) was requested in 392/2,451 (15.9%) who met Step 3. Step 5(“Working TB” diagnosis) was documented in 175/392 (44.6%) who met Step 4. Factors associated with request of TB tests in patients who met Step 1 included: i) older children [AOR 1.19(CI 1.09–1.31)]; ii) co-morbidities of HIV, malnutrition or pneumonia [AOR 3.81(CI 3.05–4.75), 2.98(CI 2.69–3.31) and 2.98(CI 2.60–3.40) respectively]; iii) sicker children, readmitted/referred [AOR 1.24(CI 1.08–1.42) and 1.15(CI 1.04–1.28) respectively]. “Working TB” diagnosis was made in 2.9%(1,202/42,107) of all admissions and 0.2%(89/42,107) were bacteriologically-confirmed. Conclusions: More than half of all paediatric admissions had symptoms associated with TB and nearly two-thirds had more specific history documented. Only a few amongst them got TB tests requested. TB was diagnosed in 2.9% of all admissions but most were inadequately investigated. Major challenges remain in identifying and investigating TB in children in hospitals with access to Xpert MTB/RIF and a review is needed of existing guidelines. [ABSTRACT FROM AUTHOR]
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- 2019
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13. Assessment of neonatal care in clinical training facilities in Kenya
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Aluvaala, Jalemba, Nyamai, Rachael, Were, Fred, Wasunna, Aggrey, Kosgei, Rose, Karumbi, Jamlick, Gathara, David, and English, Mike
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Male ,Measurement ,Medical Audit ,Hospitals, Public ,Data Collection ,Infant, Newborn ,Kenya ,Quality Improvement ,Cross-Sectional Studies ,Evidence Based Medicine ,Intensive Care Units, Neonatal ,Health services research ,Humans ,Original Article ,Female ,Neonatology ,Quality of Health Care - Abstract
OBJECTIVE: An audit of neonatal care services provided by clinical training centres was undertaken to identify areas requiring improvement as part of wider efforts to improve newborn survival in Kenya. DESIGN: Cross-sectional study using indicators based on prior work in Kenya. Statistical analyses were descriptive with adjustment for clustering of data. SETTING: Neonatal units of 22 public hospitals. PATIENTS: Neonates aged 20% in prescriptions for penicillin (11.6%, 95% CI 3.4% to 32.8%) and gentamicin (18.5%, 95% CI 13.4% to 25%), respectively. CONCLUSIONS: Basic resources are generally available, but there are deficiencies in key areas. Poor documentation limits the use of routine data for quality improvement. Significant opportunities exist for improvement in service delivery and adherence to guidelines in hospitals providing professional training.
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- 2016
14. Assessing the ability of health information systems in hospitals to support evidence-informed decisions in Kenya
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Kihuba, Elesban, Gathara, David, Mwinga, Stephen, Mulaku, Mercy, Kosgei, Rose, Mogoa, Wycliffe, Nyamai, Rachel, English, Mike, and Wellcome Trust
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Evidence-Based Medicine ,lcsh:Public aspects of medicine ,lcsh:RA1-1270 ,health information system ,Kenya ,hospital management information system ,Cross-Sectional Studies ,Hospital Administration ,data quality ,Research Design ,Hospital Information Systems ,Electronic Health Records ,Humans ,Original Article ,Health systems ,Public Health ,RA - Abstract
Background: Hospital management information systems (HMIS) is a key component of national health information systems (HIS), and actions required of hospital management to support information generation in Kenya are articulated in specific policy documents. We conducted an evaluation of core functions of data generation and reporting within hospitals in Kenya to facilitate interpretation of national reports and to provide guidance on key areas requiring improvement to support data use in decision making.Design: The survey was a cross-sectional, cluster sample study conducted in 22 hospitals in Kenya. The statistical analysis was descriptive with adjustment for clustering.Results: Most of the HMIS departments complied with formal guidance to develop departmental plans. However, only a few (3/22) had carried out a data quality audit in the 12 months prior to the survey. On average 3% (range 1–8%) of the total hospital income was allocated to the HMIS departments. About half of the records officer positions were filled and about half (13/22) of hospitals had implemented some form of electronic health record largely focused on improving patient billing and not linked to the district HIS. Completeness of manual patient registers varied, being 90% (95% CI 80.1–99.3%), 75.8% (95% CI 68.7–82.8%), and 58% (95% CI 50.4–65.1%) in maternal child health clinic, maternity, and pediatric wards, respectively. Vital events notification rates were low with 25.7, 42.6, and 71.3% of neonatal deaths, infant deaths, and live births recorded, respectively. Routine hospital reports suggested slight over-reporting of live births and under-reporting of fresh stillbirths and neonatal deaths.Conclusions: Study findings indicate that the HMIS does not deliver quality data. Significant constraints exist in data quality assurance, supervisory support, data infrastructure in respect to information and communications technology application, human resources, financial resources, and integration.Keywords: health information system; hospital management information system; data quality(Published: 31 July 2014)Citation: Glob Health Action 2014, 7: 24859 - http://dx.doi.org/10.3402/gha.v7.24859
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- 2016
15. Moving towards routine evaluation of quality of inpatient pediatric care in Kenya
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Gathara, David, Nyamai, Rachael, Were, Fred, Mogoa, Wycliffe, Karumbi, Jamlick, Kihuba, Elesban, Mwinga, Stephen, Aluvaala, Jalemba, Mulaku, Mercy, Kosgei, Rose, Todd, Jim, Allen, Elizabeth, English, Mike, and SIRCLE/Ministry of Health Hospital Survey Group
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medicine.medical_specialty ,Quality Assurance, Health Care ,Cross-sectional study ,MEDLINE ,lcsh:Medicine ,Documentation ,Pediatrics ,Surveys and Questionnaires ,Health care ,medicine ,Practice Management, Medical ,Humans ,Dosing ,Intensive care medicine ,Hospitals, Teaching ,lcsh:Science ,Quality of Health Care ,Inpatients ,Multidisciplinary ,business.industry ,lcsh:R ,Internship and Residency ,medicine.disease ,Kenya ,3. Good health ,Malnutrition ,Diarrhea ,Cross-Sectional Studies ,lcsh:Q ,Guideline Adherence ,medicine.symptom ,business ,Quality assurance ,Malaria ,Research Article - Abstract
© 2015 Gathara et al. Background: Regular assessment of quality of care allows monitoring of progress towards system goals and identifies gaps that need to be addressed to promote better outcomes.We report efforts to initiate routine assessments in a low-income country in partnership with government. Methods: A cross-sectional survey undertaken in 22 'internship training' hospitals across Kenya that examined availability of essential resources and process of care based on review of 60 case-records per site focusing on the common childhood illnesses (pneumonia, malaria, diarrhea/dehydration, malnutrition and meningitis). Results: Availability of essential resources was 75% (45/61 items) or more in 8/22 hospitals. A total of 1298 (range 54-61) case records were reviewed. HIV testing remained suboptimal at 12% (95% CI 7-19). A routinely introduced structured pediatric admission record form improved documentation of core admission symptoms and signs (median score for signs 22/ 22 and 8/22 when form used and not used respectively). Correctness of penicillin and gentamicin dosing was above 85% but correctness of prescribed intravenous fluid or oral feed volumes for severe dehydration and malnutrition were 54% and 25% respectively. Introduction of Zinc for diarrhea has been relatively successful (66% cases) but use of artesunate for malaria remained rare. Exploratory analysis suggests considerable variability of the quality of care across hospitals. Conclusion: Quality of pediatric care in Kenya has improved but can improve further. The approach to monitoring described in this survey seems feasible and provides an opportunity for routine assessments across a large number of hospitals as part of national efforts to sustain improvement. Understanding variability across hospitals may help target improvement efforts.
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- 2015
16. Nursing knowledge of essential maternal and newborn care in a high‐mortality urban African setting: A cross‐sectional study.
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Murphy, Georgina A. V., Gathara, David, Mwaniki, Ann, Nabea, Grace, Mwachiro, Jacintah, Abuya, Nancy, and English, Mike
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NURSING audit ,INFANT mortality ,INTERVIEWING ,MATERNAL health services ,CASE studies ,MEDICAL quality control ,METROPOLITAN areas ,MATERNAL mortality ,NURSES ,QUESTIONNAIRES ,REGRESSION analysis ,JOB performance ,CROSS-sectional method ,NEONATAL nursing - Abstract
Aims: To assess the knowledge of nurses of national guidelines for emergency maternity, routine newborn and small and sick newborn care in Nairobi County, Kenya. Background: The vast majority of women deliver in a health facility in Nairobi. Yet, maternal and neonatal mortality remain high. Ensuring competency of health workers, in providing essential maternal and newborn interventions in health facilities will be key if further progress is to be made in reducing maternal and neonatal mortality in low‐resource settings. Design: Cross‐sectional survey. Methods: Questionnaires comprised of clinical vignettes and direct questions and were administered in 2015–2016 to nurses (n = 125 in 31 facilities) on duty in maternity and newborn units in public and private facilities providing 24/7 inpatient neonatal services. Composite knowledge scores were calculated and presented as weighted means. Associations were explored using regression. STROBE guidelines were followed. Results: Nurses scored best for knowledge on active management of the mother after birth and immediate routine newborn care. Performance was worst for questions on infant resuscitation, checking signs and symptoms of sick newborns, and managing hypertension in pregnancy. Overall knowledge of care for sick newborns was particularly low (score 0.62 of 1). Across all areas assessed, nurses who had received training since qualifying performed better than those who had not. Poorly resourced and low case‐load facilities had lower average knowledge scores compared with better‐resourced and busier facilities. Conclusion: Overall, we estimate that 31% of maternity patients, 3% of newborns and 39% of small and sick newborns are being cared for in an environment where nursing knowledge is very low (score <0.6). Relevance to clinical practice: Focus on periodic training, ensuring retention of knowledge and skills among health workers in low‐case load setting, and bridging the know‐do gap may help to improve the quality of care delivered to mothers and newborns in Kenya. [ABSTRACT FROM AUTHOR]
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- 2019
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17. The Prevalence and Management of Dehydration amongst Neonatal Admissions to General Paediatric Wards in Kenya-A Clinical Audit.
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Akech, Samuel, Rotich, Beatrice, Chepkirui, Mercy, Ayieko, Philip, Irimu, Grace, English, Mike, authors, Clinical Information Network, and Clinical Information Network authors
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DEHYDRATION in children ,WEIGHT loss ,CREATININE ,ELECTROLYTES ,DEXTROSE ,HALOTHERAPY ,COMPARATIVE studies ,DEHYDRATION ,FLUID therapy ,HOSPITAL care ,INTRAVENOUS therapy ,RESEARCH methodology ,MEDICAL cooperation ,PHYSIOLOGIC salines ,RESEARCH ,SALT ,EVALUATION research ,TREATMENT effectiveness ,DISEASE prevalence - Abstract
An audit of randomly selected case records of 810 patients admitted to 13 hospitals between December 2015 and November 2016 was done. Prevalence of dehydration was 19.7% (2293 of 11 636) [95% CI: 17.1-22.6%], range across hospitals was 9.4% to 27.0%. Most cases with dehydration were clinically diagnosed (82 of 153; 53.6%), followed by excessive weight loss (54 of 153; 35.3%) and abnormal urea/electrolytes/creatinine (23 of 153; 15.0%). Documentation of fluids prescribed was poor but, where data were available, Ringers lactate (30 of 153; 19.6%) and 10% dextrose (18 of 153; 11.8%) were mostly used. Only 17 of 153 (11.1%) children had bolus fluid prescription, and Ringer's lactate was most commonly used for bolus at a median volume per kilogram body weight of 20 ml/kg (interquartile range, 12-30 ml/kg). Neonatal dehydration is common, but current documentation may underestimate the burden. Heterogeneity in practice likely reflects the absence of guidelines that in turn reflects a lack of research informing practical treatment guidelines. [ABSTRACT FROM AUTHOR]
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- 2018
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18. Assessment of paediatric inpatient care during a multifaceted quality improvement intervention in Kenyan district hospitals--use of prospectively collected case record data
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Mwaniki, Paul, Ayieko, Philip, Todd, Jim, and English, Mike
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Male ,Health Policy ,Hospitals, Rural ,Retrospective ,Infant ,Paediatrics ,Hospitals, District ,Kenya ,Pediatrics ,Quality Improvement ,humanities ,Prospective ,Health services research ,Humans ,Female ,Prospective Studies ,Child, Hospitalized ,Research Article ,Quality Indicators, Health Care ,Retrospective Studies - Abstract
Background: In assessing quality of care in developing countries, retrospectively collected data are usually used given their availability. Retrospective data however suffer from such biases as recall bias and non-response bias. Comparing results obtained using prospectively and retrospectively collected data will help validate the use of the easily available retrospective data in assessing quality of care in past and future studies. Methods: Prospective and retrospective datasets were obtained from a cluster randomized trial of a multifaceted intervention aimed at improving paediatric inpatient care conducted in eight rural Kenyan district hospitals by improving management of children admitted with pneumonia, malaria and diarrhea and/or dehydration. Four hospitals received a full intervention and four a partial intervention. Data were collected through 3 two weeks surveys conducted at baseline, after 6 and 18 months. Retrospective data was sampled from paediatric medical records of patients discharged in the preceding six months of the survey while prospective data was collected from patients discharged during the two week period of each survey. Risk Differences during post-intervention period of16 quality of care indicators were analyzed separately for prospective and retrospective datasets and later plotted side by side for comparison. Results: For the prospective data there was strong evidence of an intervention effect for 8 of the indicators and weaker evidence of an effect for one indicator, with magnitude of effect sizes varying from 23% to 60% difference. For the retrospective data, 10 process (these include the 8 indicators found to be statistically significant in prospective data analysis) indicators had statistically significant differences with magnitude of effects varying from 10% to 42%. The bar-graph comparing results from the prospective and retrospective datasets showed similarity in terms of magnitude of effects and statistical significance for all except two indicators. Conclusion: Multifaceted interventions can help improve adoption of clinical guidelines and hence improve the quality of care. The similar inference reached after analyses based on prospective assessment of case management is a useful finding as it supports the utility of work based on examination of retrospectively assembled case records allowing longer time periods to be studied while constraining costs. Trial registration: Current Controlled Trials ISRCTN42996612. Trial registration date: 20/11/2008
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- 2014
19. What capacity exists to provide essential inpatient care to small and sick newborns in a high mortality urban setting? - A cross-sectional study in Nairobi City County, Kenya.
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Murphy, Georgina A. V., Gathara, David, Abuya, Nancy, Mwachiro, Jacintah, Ochola, Sam, Ayisi, Robert, English, Mike, and null, null
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NEONATAL death ,NEWBORN infant health ,MEDICAL care ,PUBLIC health ,COMMUNITY health services - Abstract
Introduction: Appropriate demand for, and supply of, high quality essential neonatal care is key to improving newborn survival but evaluating such provision has received limited attention in low- and middle-income countries. Moreover, specific local data are needed to support healthcare planning for this vulnerable population. Methods: We conducted health facility assessments between July 2015-April 2016, with retrospective review of admission events between 1
st July 2014 and 30th June 2015, and used estimates of population-based incidence of neonatal conditions in Nairobi to explore access and evaluate readiness of public, private not-for-profit (mission), and private-for-profit (private) sector facilities providing 24/7 inpatient neonatal care in Nairobi City County. Results: In total, 33 (4 public, 6 mission, and 23 private) facilities providing 24/7 inpatient neonatal care in Nairobi City County were identified, 31 were studied in detail. Four public sector facilities, including the only three facilities in which services were free, accounted for 71% (8,630/12,202) of all neonatal admissions. Large facilities (>900 annual admissions) with adequate infrastructure tended to have high bed occupancy (over 100% in two facilities), high mortality (15%), and high patient to nurse ratios (7–15 patients per nurse). Twenty-one smaller, predominantly private, facilities were judged insufficiently resourced to provide adequate care. In many of these, nurses provided newborn and maternity care simultaneously using resources shared across settings, newborn care experience was likely to be limited (<50 cases per year), there was often no resident clinician, and sick babies were often referred onwards. Results suggest 44% (9,764/21,966) of Nairobi’s small and sick newborns may not access any of the identified facilities and a further 9% (2,026/21,966) access facilities judged to be inadequately equipped. Conclusion: Over 50% of Nairobi’s sick newborns may not access a facility with adequate resources to provide essential care. A very high proportion of care accessed is provided by four public and one low cost mission facility; these face major challenges of high patient acuity (high mortality), high patient to nurse ratios, and often overcrowding. Reducing high neonatal mortality in this urban, predominantly poor, population will require effective long-term, multi-sectoral planning and investment. [ABSTRACT FROM AUTHOR]- Published
- 2018
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20. Setting healthcare priorities: a description and evaluation of the budgeting and planning process in county hospitals in Kenya.
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Barasa, Edwine W., Cleary, Susan, Molyneux, Sassy, and English, Mike
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BUDGET management ,FINANCIAL planning ,CONSEQUENTIALISM (Ethics) ,RESOURCE allocation ,DELIBERATIVE democracy ,HOSPITALS ,ASSOCIATIONS, institutions, etc. ,BUDGET ,GROUP decision making ,HEALTH planning ,INTERVIEWING ,MEDICAL quality control ,PUBLIC hospitals ,RESEARCH funding ,QUALITATIVE research - Abstract
This paper describes and evaluates the budgeting and planning processes in public hospitals in Kenya. We used a qualitative case study approach to examine these processes in two hospitals in Kenya. We collected data by in-depth interviews of national level policy makers, hospital managers, and frontline practitioners in the case study hospitals (n = 72), a review of documents, and non-participant observations within the hospitals over a 7 month period. We applied an evaluative framework that considers both consequentialist and proceduralist conditions as important to the quality of priority-setting processes. The budgeting and planning process in the case study hospitals was characterized by lack of alignment, inadequate role clarity and the use of informal priority-setting criteria. With regard to consequentialist conditions, the hospitals incorporated economic criteria by considering the affordability of alternatives, but rarely considered the equity of allocative decisions. In the first hospital, stakeholders were aware of - and somewhat satisfied with - the budgeting and planning process, while in the second hospital they were not. Decision making in both hospitals did not result in reallocation of resources. With regard to proceduralist conditions, the budgeting and planning process in the first hospital was more inclusive and transparent, with the stakeholders more empowered compared to the second hospital. In both hospitals, decisions were not based on evidence, implementation of decisions was poor and the community was not included. There were no mechanisms for appeals or to ensure that the proceduralist conditions were met in both hospitals. Public hospitals in Kenya could improve their budgeting and planning processes by harmonizing these processes, improving role clarity, using explicit priority-setting criteria, and by incorporating both consequentialist (efficiency, equity, stakeholder satisfaction and understanding, shifted priorities, implementation of decisions), and proceduralist (stakeholder engagement and empowerment, transparency, use of evidence, revisions, enforcement, and incorporating community values) conditions. [ABSTRACT FROM AUTHOR]
- Published
- 2017
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21. Inappropriate prescription of cough remedies among children hospitalised with respiratory illness over the period 2002-2015 in Kenya.
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Maina, Michuki, Akech, Samuel, Mwaniki, Paul, Gachau, Susan, Ogero, Morris, Julius, Thomas, Ayieko, Phillip, Irimu, Grace, and English, Mike
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DRUG prescribing ,ANTITUSSIVE agents ,COUGH treatment ,PEDIATRIC respiratory diseases ,MEDICAL care ,THERAPEUTICS ,ANTIHISTAMINES ,BRONCHODILATOR agents ,NASAL vasoconstrictors ,EXPECTORANTS ,COUGH ,DYSPNEA ,HOSPITAL care ,MEDICAL prescriptions ,RESEARCH funding ,RESPIRATION ,RESPIRATORY infections ,CROSS-sectional method ,INAPPROPRIATE prescribing (Medicine) - Abstract
Copyright of Tropical Medicine & International Health is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
- Published
- 2017
- Full Text
- View/download PDF
22. Prevalence, aetiology, treatment and outcomes of shock in children admitted to Kenyan hospitals.
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Mbevi, George, Ayieko, Philip, Irimu, Grace, Akech, Samuel, and English, Mike
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HYPOVOLEMIC anemia ,DISEASE prevalence ,DIARRHEA ,DEHYDRATION in children ,PEDIATRICS - Abstract
Background: Shock may complicate several acute childhood illnesses in hospitals within low-income countries and has a high case fatality. Hypovolemic shock secondary to diarrhoea/dehydration and septic shock are thought to be common, but there are few reliable data on prevalence or treatment that differ for the two major forms of shock. Examining prevalence and treatment practices has become important since reports suggest high risks from liberal use of fluid boluses in African children. The present study aims to estimate the prevalence, fluid management practices and outcomes of shock among hospitalised children. Methods: We analysed paediatric in-patient data collected using discharge case record review between October 2013 and February 2016 from 14 hospitals in Kenya which are part of a network (referred to as the Clinical Information Network) using similar tools for standardised clinical records with care directed by the local clinical team leaders. Data are from a period after dissemination of national guidance seeking to limit use of bolus fluids. Results: A total of 74,402 children were admitted between October 2013 and February 2016. Children aged < 30 days or > 5 years, with severe acute malnutrition, surgical/burns, or cases with pre-defined minimum data sets were excluded from analysis. This resulted in 42,937 patients meeting the inclusion criteria. Prevalence of clinically diagnosed shock was 1.5 % (n = 622) and overall bolus use was 0.9 % (n = 366); 41 % (256/622) of children with clinically diagnosed shock did not receive a fluid bolus (but had a fluid plan for management of dehydration). Identified cases appeared mostly to be hypovolaemic shock secondary to dehydration/diarrhoea (94 %, 582/622), with a high case fatality (34 %, 211/622). Overall mortality for all admitted children was 5 % (2115/42,937) and was 7.9 % (798/10,096) in children with dehydration/diarrhoea. The diagnosis of hypovolaemic shock was nearly always accompanied by additional clinical diagnosis (99 %), most often pneumonia or malaria. Where bolus fluids were used, they were prescribed in accordance with guidelines (isotonic fluid at correct volume) in 92 % of cases. Inappropriate use of bolus fluids to treat milder forms of impaired circulation appeared very rarely. Conclusion: A diagnosis of shock is uncommon at admission and use of fluid bolus is rare in admissions to Kenyan hospitals. A fluid bolus, when prescribed, is mostly used in children with hypovolemic shock secondary to dehydration and case fatality in these cases is high. We found little evidence of liberal use of fluid bolus that might cause harm in a period following dissemination of national guidelines suggesting very strict criteria for fluid bolus use. [ABSTRACT FROM AUTHOR]
- Published
- 2016
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23. The influence of power and actor relations on priority setting and resource allocation practices at the hospital level in Kenya: a case study.
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Barasa, Edwine W., Cleary, Susan, English, Mike, and Molyneux, Sassy
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RESOURCE allocation ,PUBLIC hospitals ,HEALTH care industry ,HOSPITAL personnel ,MEDICAL decision making ,HOSPITAL care - Abstract
Background: Priority setting and resource allocation in healthcare organizations often involves the balancing of competing interests and values in the context of hierarchical and politically complex settings with multiple interacting actor relationships. Despite this, few studies have examined the influence of actor and power dynamics on priority setting practices in healthcare organizations. This paper examines the influence of power relations among different actors on the implementation of priority setting and resource allocation processes in public hospitals in Kenya. Methods: We used a qualitative case study approach to examine priority setting and resource allocation practices in two public hospitals in coastal Kenya. We collected data by a combination of in-depth interviews of national level policy makers, hospital managers, and frontline practitioners in the case study hospitals (n = 72), review of documents such as hospital plans and budgets, minutes of meetings and accounting records, and non-participant observations in case study hospitals over a period of 7 months. We applied a combination of two frameworks, Norman Long's actor interface analysis and VeneKlasen and Miller's expressions of power framework to examine and interpret our findings Results: The interactions of actors in the case study hospitals resulted in socially constructed interfaces between: 1) senior managers and middle level managers 2) non-clinical managers and clinicians, and 3) hospital managers and the community. Power imbalances resulted in the exclusion of middle level managers (in one of the hospitals) and clinicians and the community (in both hospitals) from decision making processes. This resulted in, amongst others, perceptions of unfairness, and reduced motivation in hospital staff. It also puts to question the legitimacy of priority setting processes in these hospitals. Conclusions: Designing hospital decision making structures to strengthen participation and inclusion of relevant stakeholders could improve priority setting practices. This should however, be accompanied by measures to empower stakeholders to contribute to decision making. Strengthening soft leadership skills of hospital managers could also contribute to managing the power dynamics among actors in hospital priority setting processes. [ABSTRACT FROM AUTHOR]
- Published
- 2016
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24. Opportunities and challenges for implementing cost accounting systems in the Kenyan health system.
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Kihuba, Elesban, Gheorghe, Adrian, Bozzani, Fiammetta, English, Mike, and Griffiths, Ulla K.
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MEDICAL care ,ACCOUNTING ,INFORMATION storage & retrieval systems ,MEDICAL databases ,INTERVIEWING ,MANAGEMENT information systems ,RESEARCH methodology ,MEDICAL care costs ,PUBLIC health laws ,RELIABILITY (Personality trait) ,RESEARCH evaluation ,SYSTEMS design ,QUALITATIVE research ,COST analysis ,ELECTRONIC health records ,FIELD notes (Science) - Abstract
Background: Low- and middle-income countries need to sustain efficiency and equity in health financing on their way to universal health care coverage. However, systems meant to generate quality economic information are often deficient in such settings. We assessed the feasibility of streamlining cost accounting systems within the Kenyan health sector to illustrate the pragmatic challenges and opportunities. Design: We reviewed policy documents, and conducted field observations and semi-structured interviews with key informants in the health sector. We used an adapted Human, Organization and Technology fit (HOT-fit) framework to analyze the components and standards of a cost accounting system. Results: Among the opportunities for a viable cost accounting system, we identified a supportive broad policy environment, political will, presence of a national data reporting architecture, good implementation experience with electronic medical records systems, and the availability of patient clinical and resource use data. However, several practical issues need to be considered in the design of the system, including the lack of a framework to guide the costing process, the lack of long-term investment, the lack of appropriate incentives for ground-level staff, and a risk of overburdening the current health management information system. Conclusion: To facilitate the implementation of cost accounting into the health sector, the design of any proposed system needs to remain simple and attuned to the local context. [ABSTRACT FROM AUTHOR]
- Published
- 2016
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25. The public sector nursing workforce in Kenya: a county-level analysis.
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Wakaba, Mabel, Mbindyo, Patrick, Ochieng, Jacob, Kiriinya, Rose, Todd, Jim, Waudo, Agnes, Noor, Abdisalan, Rakuom, Chris, Rogers, Martha, and English, Mike
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NURSING ,PUBLIC sector ,NURSES ,MEDICAL care ,STAKEHOLDERS - Abstract
Background Kenya's human resources for health shortage is well documented, yet in line with the new constitution, responsibility for health service delivery will be devolved to 47 new county administrations. This work describes the public sector nursing workforce likely to be inherited by the counties, and examines the relationships between nursing workforce density and key indicators. Methods National nursing deployment data linked to nursing supply data were used and analyzed using statistical and geographical analysis software. Data on nurses deployed in national referral hospitals and on nurses deployed in non-public sector facilities were excluded from main analyses. The densities and characteristics of the public sector nurses across the counties were obtained and examined against an index of county remoteness, and the nursing densities were correlated with five key indicators. Results Of the 16,371 nurses in the public non-tertiary sector, 76% are women and 53% are registered nurses, with 35% of the nurses aged 40 to 49 years. The nursing densities across counties range from 1.2 to 0.08 per 1,000 population. There are statistically significant associations of the nursing densities with a measure of health spending per capita (P value = 0.0028) and immunization rates (P value = 0.0018). A higher county remoteness index is associated with explaining lower female to male ratio of public sector nurses across counties (P value <0.0001). Conclusions An overall shortage of nurses (range of 1.2 to 0.08 per 1,000) in the public sector countrywide is complicated by mal-distribution and varying workforce characteristics (for example, age profile) across counties. All stakeholders should support improvements in human resources information systems and help address personnel shortages and maldistribution if equitable, quality health-care delivery in the counties is to be achieved. [ABSTRACT FROM AUTHOR]
- Published
- 2014
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26. Are hospitals prepared to support newborn survival? – an evaluation of eight first-referral level hospitals in Kenya.
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Opondo, Charles, Ntoburi, Stephen, Wagai, John, Wafula, Jackline, Wasunna, Aggrey, Were, Fred, Wamae, Annah, Migiro, Santau, Irimu, Grace, and English, Mike
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HOSPITAL care of newborn infants ,NEONATAL intensive care ,HOSPITAL maternity services ,MATERNAL health services ,MEDICAL care research - Abstract
Copyright of Tropical Medicine & International Health is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
- Published
- 2009
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27. Access, sources and value of new medical information: views of final year medical students at the University of Nairobi.
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Gituma, Adrian, Masika, Moses, Muchangi, Eric, Nyagah, Lily, Otieno, Vincent, Irimu, Grace, Wasunna, Aggrey, Ndiritu, Moses, and English, Mike
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MEDICAL education ,MEDICAL students ,EVIDENCE-based medicine ,QUESTIONNAIRES ,UNIVERSITY of Nairobi (Nairobi, Kenya) ,EDUCATION - Abstract
Copyright of Tropical Medicine & International Health is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
- Published
- 2009
- Full Text
- View/download PDF
28. Assessment of Severe Malnutrition Among Hospitalized Children in Rural Kenya: Comparison of Weight for Height and Mid Upper Arm Circumference.
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Berkley, James, Mwangi, Isaiah, Griffiths, Karen, Ahmed, Ismail, Mithwani, Sadik, English, Mike, Newton, Charles, and Maitland, Kathryn
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MALNUTRITION in children ,CHILD death ,MALNUTRITION ,CHILD nutrition ,NUTRITION disorders ,MORTALITY ,HOSPITAL care of children - Abstract
Context Severe malnutrition has a high mortality rate among hospitalized children in sub-Saharan Africa. However, reports suggest that malnutrition is often poorly assessed. The World Health Organization recommends using weight for height, but this method is problematic and often not undertaken in practice. Mid upper arm circumference (MUAC) and the clinical sign “visible severe wasting” are simple and inexpensive methods but have not been evaluated in this setting. Objectives To evaluate MUAC and visible severe wasting as predictors of inpatient mortality at a district hospital in sub-Saharan Africa and to compare these with weight-for-height z score (WHZ). Design, Setting, and Participants Cohort study with data collected at admission and at discharge or death. Predictive values for inpatient death were determined using the area under receiver operating characteristic curves. Participants were children aged 12 to 59 months admitted to a district hospital in rural Kenya between April 1, 1999, and July 31, 2002. Main Outcome Measure MUAC, WHZ, and visible severe wasting as predictors of inpatient death. Results Overall, 4.4% (359) of children included in the study died while in the hospital. Sixteen percent (1282/8190) of admitted children had severe wasting (WHZ ≤-3) (n = 756), kwashiorkor (n = 778), or both. The areas under the receiver operating characteristic curves for predicting inpatient death did not significantly differ (MUAC: 0.75 [95% confidence interval, 0.72-0.78]; WHZ: 0.74 [95% confidence interval, 0.71-0.77]) (P = .39). Although sensitivity and specificity for subsequent inpatient death were 46% and 91%, respectively, for MUAC less than or equal to 11.5 cm, 42% and 92% for WHZ less than or equal to -3, and 47% and 93% for visible severe wasting, the 3 indices identified different sets of children and were independently associated with mortality. Clinical features of malnutrition were significantly more common among children with MUAC less than or equal to 11.5 cm than among those with WHZ less than or equal to -3. Conclusions MUAC is a practical screening tool that performs at least as well as WHZ in predicting subsequent inpatient mortality among severely malnourished children hospitalized in rural Kenya. Visible severe wasting is also a potentially useful sign at this level, providing appropriate training has been given. [ABSTRACT FROM AUTHOR]
- Published
- 2005
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29. Implementing an Open Source Electronic Health Record System in Kenyan Health Care Facilities: Case Study.
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Muinga, Naomi, Magare, Steve, Monda, Jonathan, Kamau, Onesmus, Houston, Stuart, Fraser, Hamish, Powell, John, English, Mike, and Paton, Chris
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OPEN source software ,ELECTRONIC health records ,MEDICAL informatics ,MEDICAL care ,MEDICAL centers - Abstract
Background: The Kenyan government, working with international partners and local organizations, has developed an eHealth strategy, specified standards, and guidelines for electronic health record adoption in public hospitals and implemented two major health information technology projects: District Health Information Software Version 2, for collating national health care indicators and a rollout of the KenyaEMR and International Quality Care Health Management Information Systems, for managing 600 HIV clinics across the country. Following these projects, a modified version of the Open Medical Record System electronic health record was specified and developed to fulfill the clinical and administrative requirements of health care facilities operated by devolved counties in Kenya and to automate the process of collating health care indicators and entering them into the District Health Information Software Version 2 system. Objective: We aimed to present a descriptive case study of the implementation of an open source electronic health record system in public health care facilities in Kenya. Methods: We conducted a landscape review of existing literature concerning eHealth policies and electronic health record development in Kenya. Following initial discussions with the Ministry of Health, the World Health Organization, and implementing partners, we conducted a series of visits to implementing sites to conduct semistructured individual interviews and group discussions with stakeholders to produce a historical case study of the implementation. Results: This case study describes how consultants based in Kenya, working with developers in India and project stakeholders, implemented the new system into several public hospitals in a county in rural Kenya. The implementation process included upgrading the hospital information technology infrastructure, training users, and attempting to garner administrative and clinical buy-in for adoption of the system. The initial deployment was ultimately scaled back due to a complex mix of sociotechnical and administrative issues. Learning from these early challenges, the system is now being redesigned and prepared for deployment in 6 new counties across Kenya. Conclusions: Implementing electronic health record systems is a challenging process in high-income settings. In low-income settings, such as Kenya, open source software may offer some respite from the high costs of software licensing, but the familiar challenges of clinical and administration buy-in, the need to adequately train users, and the need for the provision of ongoing technical support are common across the North-South divide. Strategies such as creating local support teams, using local development resources, ensuring end user buy-in, and rolling out in smaller facilities before larger hospitals are being incorporated into the project. These are positive developments to help maintain momentum as the project continues. Further integration with existing open source communities could help ongoing development and implementations of the project. We hope this case study will provide some lessons and guidance for other challenging implementations of electronic health record systems as they continue across Africa. [ABSTRACT FROM AUTHOR]
- Published
- 2018
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30. ‘Pastoral practices’ for quality improvement in a Kenyan clinical network.
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McGivern, Gerry, Nzinga, Jacinta, and English, Mike
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- *
MEDICAL personnel , *QUALITY assurance , *PROFESSIONALISM , *SPIRITUAL care (Medical care) - Abstract
We explain social and organisational processes influencing health professionals in a Kenyan clinical network to implement a form of quality improvement (QI) into clinical practice, using the concept of ‘pastoral practices’. Our qualitative empirical case study, conducted in 2015–16, shows the way practices constructing and linking local evidence-based guidelines and data collection processes provided a foundation for QI. Participation in these constructive practices gave network leaders pastoral status to then inscribe use of evidence and data into routine care, through championing, demonstrating, supporting and mentoring, with the support of a constellation of local champions. By arranging network meetings, in which the professional community discussed evidence, data, QI and professionalism, network leaders also facilitated the reconstruction of network members' collective professional identity. This consequently strengthened top-down and lateral accountability and inspection practices, disciplining evidence and audit-based QI in local hospitals. By explaining pastoral practices in this way and setting, we contribute to theory about governmentality in health care and extend Foucauldian analysis of QI, clinical networks and governance into low and middle income health care contexts. [ABSTRACT FROM AUTHOR]
- Published
- 2017
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31. Hospitals as complex adaptive systems: A case study of factors influencing priority setting practices at the hospital level in Kenya.
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Barasa, Edwine W., Molyneux, Sassy, English, Mike, and Cleary, Susan
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- *
AUTONOMY (Psychology) , *EXECUTIVES , *FEDERAL government , *HEALTH care rationing , *INTERVIEWING , *LEADERSHIP , *POLICY sciences , *PUBLIC hospitals - Abstract
There is a dearth of literature on priority setting and resource allocation (PSRA) practices in hospitals, particularly in low and middle income countries (LMICs). Using a case study approach, we examined PSRA practices in 2 public hospitals in coastal Kenya. We collected data through a combination of in-depth interviews of national level policy makers, hospital managers, and frontline practitioners in the case study hospitals (n = 72), review of documents such as hospital plans and budgets, minutes of meetings and accounting records, and non-participant observations of PSRA practices in case study hospitals over a period of 7 months. In this paper, we apply complex adaptive system (CAS) theory to examine the factors that influence PSRA practices. We found that PSRA practices in the case hospitals were influenced by, 1) inadequate financing level and poorly designed financing arrangements, 2) limited hospital autonomy and decision space, and 3) inadequate management and leadership capacity in the hospital. The case study hospitals exhibited properties of complex adaptive systems (CASs) that exist in a dynamic state with multiple interacting agents. Weaknesses in system ‘hardware’ (resource scarcity) and ‘software’ (including PSRA guidelines that reduced hospitals decision space, and poor leadership skills) led to the emergence of undesired properties. The capacity of hospitals to set priorities should be improved across these interacting aspects of the hospital organizational system. Interventions should however recognize that hospitals are CAS. Rather than rectifying isolated aspects of the system, they should endeavor to create conditions for productive emergence. [ABSTRACT FROM AUTHOR]
- Published
- 2017
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32. Pulse oximetry in low-income settings : a case study of Kenyan hospitals
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Enoch, Abigail J., English, Mike, and Shepperd, Sasha
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362.1083 ,Child health ,Kenya ,Public Health ,Low-income settings ,Pulse oximeters ,Child mortality ,Global Health ,Pneumonia ,Mixed-methods ,Hypoxemia ,Oxygen ,Low-cost interventions ,Diffusion of innovation ,Implementation science - Abstract
Pulse oximeters are low-cost, easy to use, and effective at detecting hypoxemia (low blood oxygen levels), a common complication of bronchiolitis, asthma, and pneumonia, the leading infectious cause of death in children worldwide. However, pulse oximeters are often unavailable in lowincome settings, and if available, often underused, yet little research investigates why. In this thesis, I examine pulse oximeter implementation in low-income settings, focusing on Kenyan hospitals as a case study, and using a mixed-methods approach. I conducted a systematic literature review, examining how pulse oximeter use with children at admission to hospital impacts health outcomes; I then conducted quantitative analyses of 28,000 children admitted to seven Kenyan hospitals to determine with which children pulse oximeters are used, and pulse oximetry's impact on treatment provision; these analyses informed the qualitative research component, for which I conducted interviews with 30 healthcare workers (HCWs) and staff in 14 Kenyan hospitals and employed theoretical frameworks to determine how HCWs decide whether to use pulse oximeters, and the barriers to pulse oximetry. I found that pulse oximeter use varies substantially between and within Kenyan hospitals over time. After adjusting for case-mix and signs of illness severity, HCWs were most likely to use pulse oximeters with children with a very high respiratory rate, indrawing and/or who were not alert; children who obtained a pulse oximeter reading were more likely to be prescribed oxygen than if a pulse oximeter was not used; and children with a reading below 90% were more likely to be prescribed oxygen than those with higher readings, suggesting that HCW decision-making is influenced by international and national guidelines. However, HCWs sometimes cannot use pulse oximeters when they intend to, because of insufficient pulse oximeter availability, largely due to inefficient and confusing procurement processes and repair delays. Furthermore, HCWs sometimes use pulse oximeters incorrectly or misinterpret their results, because of insufficient training. Pulse oximeter promotion programme planners can use the recommendations I provide to effectively target barriers to pulse oximeter uptake in low-income settings. Increased pulse oximetry implementation could enable early detection of hypoxemia, improving accurate diagnosis, and supporting prompt, effective treatment, which could help reduce mortality in children needing oxygen, in line with Sustainable Development Goal 3.
- Published
- 2018
33. Protocol for the Pathways Study: a realist evaluation of staff social ties and communication in the delivery of neonatal care in Kenya
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C Wanyama, C Blacklock, J Jepkosgei, M English, L Hinton, J McKnight, S Molyneux, M Boga, P Musitia, G Wong, Wanyama, Conrad [0000-0002-3553-6679], English, Mike [0000-0002-7427-0826], Hinton, Lisa [0000-0002-6082-3151], Musitia, Peris Muoga [0000-0003-4715-902X], and Apollo - University of Cambridge Repository
- Subjects
NEONATOLOGY ,Child, Preschool ,Communication ,Quality in health care ,Infant, Newborn ,Humans ,General Medicine ,Focus Groups ,Kenya ,Delivery of Health Care ,Quality Improvement ,Health policy - Abstract
Peer reviewed: True, Funder: Nuffield Department of Medicine, University of Oxford, UK, INTRODUCTION: The informal social ties that health workers form with their colleagues influence knowledge, skills and individual and group behaviours and norms in the workplace. However, improved understanding of these 'software' aspects of the workforce (eg, relationships, norms, power) have been neglected in health systems research. In Kenya, neonatal mortality has lagged despite reductions in other age groups under 5 years. A rich understanding of workforce social ties is likely to be valuable to inform behavioural change initiatives seeking to improve quality of neonatal healthcare.This study aims to better understand the relational components among health workers in Kenyan neonatal care areas, and how such understanding might inform the design and implementation of quality improvement interventions targeting health workers' behaviours. METHODS AND ANALYSIS: We will collect data in two phases. In phase 1, we will conduct non-participant observation of hospital staff during patient care and hospital meetings, a social network questionnaire with staff, in-depth interviews, key informant interviews and focus group discussions at two large public hospitals in Kenya. Data will be collected purposively and analysed using realist evaluation, interim analyses including thematic analysis of qualitative data and quantitative analysis of social network metrics. In phase 2, a stakeholder workshop will be held to discuss and refine phase one findings.Study findings will help refine an evolving programme theory with recommendations used to develop theory-informed interventions targeted at enhancing quality improvement efforts in Kenyan hospitals. ETHICS AND DISSEMINATION: The study has been approved by Kenya Medical Research Institute (KEMRI/SERU/CGMR-C/241/4374) and Oxford Tropical Research Ethics Committee (OxTREC 519-22). Research findings will be shared with the sites, and disseminated in seminars, conferences and published in open-access scientific journals.
- Published
- 2023
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34. Pairwise joint modeling of clustered and high‐dimensional outcomes with covariate missingness in pediatric pneumonia care
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Susan Gachau, Edmund Njeru Njagi, Geert Molenberghs, Nelson Owuor, Rachel Sarguta, Mike English, Philip Ayieko, Gachau, Susan, NJAGI, Edmund, MOLENBERGHS, Geert, Owuor, Nelson, Sarguta, Rachel, English, Mike, and Ayieko, Philip
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Pharmacology ,Statistics and Probability ,Science & Technology ,multiple imputation ,Statistics & Probability ,MORTALITY ,MIXED MODELS ,Pneumonia ,Kenya ,MULTIVARIATE ,pairwise joint modeling ,pediatric care ,pseudo-likelihood ,Research Design ,Data Interpretation, Statistical ,Physical Sciences ,Linear Models ,pneumonia ,Humans ,Computer Simulation ,Pharmacology (medical) ,Pharmacology & Pharmacy ,Child ,Life Sciences & Biomedicine ,Mathematics - Abstract
Multiple outcomes reflecting different aspects of routine care are a common phenomenon in health care research. A common approach of handling such outcomes is multiple univariate analyses, an approach which does not allow for answering research questions pertaining to joint inference. In this study, we sought to study associations among nine pediatric pneumonia care outcomes spanning assessment, diagnosis and treatment domains of care, while circumventing the computational challenge posed by their clustered and high-dimensional nature and incompletely recorded covariates. We analyzed data from a cluster randomized trial conducted in 12 Kenyan hospitals. There were varying degrees of missingness in the covariates of interest, and these were multiply imputed using latent normal joint modeling. We used the pairwise joint modeling strategy to fit a correlated random effects joint model for the nine outcomes. This entailed fitting 36 bivariate generalized linear mixed models and deriving inference for the joint model using pseudo-likelihood theory. We also analyzed the nine outcomes separately before and after multiple imputation. We observed joint effects of patient-, clinician- and hospital-level factors on pneumonia care indicators before and after multiple imputation of missing covariates. In both pairwise joint modeling and separate univariate analysis methods, enhanced audit and feedback improved documentation and adherence to recommended clinical guidelines over time in six and five pneumonia care indicators, respectively. Additionally, multiple imputation improved precision of parameter estimates compared to complete case analysis. The strength and direction of association among pneumonia outcomes varied within and across the three domains of pneumonia care This work was supported through the DELTAS Africa Initiative Grant No. 107754/Z/15/Z-DELTAS Africa SSACAB. The DELTAS Africa Initiative is an independent funding scheme of the African Academy of Sciences (AAS)’s Alliance for Accelerating Excellence in Science in Africa (AESA) and supported by the New Partnership for Africa's Development Planning and Coordinating Agency (NEPAD Agency) with funding from the Wellcome Trust (Grant No. 107754/Z/15/Z) and the UK government. The views expressed in this publication are those of the author(s) and not necessarily those of AAS, NEPAD Agency, Wellcome Trust or the UK government. Funds from the Wellcome Trust (Grant No. 207522) awarded to Prof. Mike English as a senior Fellow together with additional funds from a Wellcome Trust core grant awarded to the KEMRIWellcome Trust Research Programme (Grant No. 092654) supported CIN data collection.
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- 2022
35. Promoting the social value of research in Kenya: Examining the practical aspects of collaborative partnerships using an ethical framework
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Lairumbi, Geoffrey Mbaabu, Molyneux, Sassy, Snow, Robert W., Marsh, Kevin, Peshu, Norbert, and English, Mike
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SOCIAL values , *MEDICAL research , *MEDICAL geography , *PARTNERSHIPS in education , *RESEARCH ethics - Abstract
Abstract: The ethics of research continue to attract considerable debate, particularly when that research is sponsored by partners from the North and carried out in the South. Ethical research should contribute to social value in the country where research is being carried out, but there is significant debate around how this might be achieved and who is responsible. The literature suggests that researchers might employ two inter-related strategies to maximise social value: collaborative partnerships with policy makers and communities from the outset of research, and dissemination of research results to participants, policy makers and implementers once the research is over. These areas have received relatively little empirical attention. In this study, we carried out 40 in-depth interviews to explore the role of collaborative partnerships in health research priority setting, and the way in which research findings are disseminated to aid policy making and implementation in Kenya. Interviewees included policy makers, researchers, policy implementers and representatives of organisations funding health reforms in Kenya. Two policy issues were drawn upon as tracers wherever possible: (1) the introduction of Artemesinin- based Combination Therapies (ACTs), an anti-malarial treatment policy; and (2) Haemophilus influenzae (Hib) vaccine for the prevention of pneumococcal diseases among children. The findings point to significant gaps in the ‘research to policy to practice’ pathway, particularly for national research institutions with a focus on clinical/biomedical research. These gaps reflect poorly effective partnerships among stakeholders and limit the potential social value of much research. While more investment is needed to establish strong structures for promoting and directing collaboration and partnership, how to target this investment is not entirely clear, especially in the context of the considerable power of the global health agenda and the research financing tied to it. [Copyright &y& Elsevier]
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- 2008
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36. Collective strategies to cope with work related stress among nurses in resource constrained settings: An ethnography of neonatal nursing in Kenya.
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McKnight, Jacob, Nzinga, Jacinta, Jepkosgei, Joyline, and English, Mike
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JOB stress prevention , *PSYCHOLOGICAL adaptation , *ANXIETY , *PSYCHOLOGICAL burnout , *ETHNOLOGY , *INTERVIEWING , *RESEARCH methodology , *NEONATAL intensive care , *NURSES , *NURSING , *NURSING education , *NURSING models , *SCIENTIFIC observation , *PSYCHOLOGICAL resilience , *STRESS management , *OCCUPATIONAL roles , *SOCIOECONOMIC factors , *UNOBTRUSIVE measures , *NEONATAL intensive care units , *NEONATAL nursing , *MIDDLE-income countries , *LOW-income countries - Abstract
Kenyan neonatal nurses are asked to do the impossible: to bridge the gap between international standards of nursing and the circumstances they face each day. They work long hours with little supervision in ill-designed wards, staffed by far too few nurses given the pressing need. Despite these conditions, a single neonatal nurse can be tasked with looking after forty sick babies for whom very close care is a necessity. Our 18-month ethnography explores this uniquely stressful environment in order to understand how nurses operate under such pressures and what techniques they use to organise work and cope. Beginning in January 2015, we conducted 250 h of non-participant observation and 32 semi-structured interviews in three newborn units in Nairobi to describe how nurses categorise babies, balance work across shifts, use routinised care, and demonstrate pragmatism and flexibility in their dealings with each other in order to reduce stress. In so doing, we present an empirically based model of the ways in which nurses cope in a lower-middle income setting and develop early work in nursing studies that highlighted collective strategies for reducing anxiety. This allows us to address the gap left by prevalent theories of nursing stress that have focused on the personal characteristics of individual nurses. Finally, we extend outwards from our ethnographic findings to consider how a deeper understanding of these collective strategies to reduce stress might inform policy, and why, even when the forces that create stress are alleviated, the underlying model of nursing work may prevail. • Describes the understudied environment of LMIC inpatient newborn wards. • Details how stress is managed through the design and enactment of nursing work. • Develops and extends early theories of nurses' collective coping methods. • Offers an alternative to questionnaire-based understandings of nursing stress. • Links low-resource environments to nurse coping mechanisms. [ABSTRACT FROM AUTHOR]
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- 2020
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