Delivery of paediatric care at the first-referral level in Kenya.

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Bibliographic Details
Title:	Delivery of paediatric care at the first-referral level in Kenya.
Authors:	English, Mike, Esamai, Fabian, Wasunna, Aggrey, Were, Fred, Ogutu, Bernhards, Wamae, Annah, Snow, Robert W., Peshu, Norbert
Source:	Lancet. 10/30/2004, Vol. 364 Issue 9445, p1622-1629. 8p. 1 Color Photograph, 4 Charts, 2 Graphs.
Subjects:	Evaluation of medical care, Public health administration, Health services administration, Hospitals, Child care, Health policy, Social medicine, National health services, Medical audit, Medical personnel
Abstract:	We aimed to investigate provision of paediatric care in government district hospitals in Kenya. We surveyed 14 first-referral level hospitals from seven of Kenya's eight provinces and obtained data for workload, outcome of admission, infrastructure, and resources and the views of hospital staff and caretakers of admitted children. Paediatric admission rates varied almost ten-fold. Basic anti-infective drugs, clinical supplies, and laboratory tests were available in at least 12 hospitals, although these might be charged for on discharge. In at least 11 hospitals, antistaphylococcal drugs, appropriate treatment for malnutrition, newborn feeds, and measurement of bilirubin were rarely or never available. Staff highlighted infrastructure and human and consumable resources as problems. However, a strong sense of commitment, support for the work of the hospital, and a desire for improvement were expressed. Caretakers' views were generally positive, although dissatisfaction with the physical environment in which care took place was common. The capacity of the district hospital in Kenya needs strengthening by comprehensive policies that address real needs if current or new interventions and services at this level of care are to enhance child survival. INSETS: Panel 1: Responses selected from hospital staff questionnaires;Panel 2: Responses selected from caretakers' interviews. [ABSTRACT FROM AUTHOR]
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Database:	Psychology and Behavioral Sciences Collection

Description
Abstract:	We aimed to investigate provision of paediatric care in government district hospitals in Kenya. We surveyed 14 first-referral level hospitals from seven of Kenya's eight provinces and obtained data for workload, outcome of admission, infrastructure, and resources and the views of hospital staff and caretakers of admitted children. Paediatric admission rates varied almost ten-fold. Basic anti-infective drugs, clinical supplies, and laboratory tests were available in at least 12 hospitals, although these might be charged for on discharge. In at least 11 hospitals, antistaphylococcal drugs, appropriate treatment for malnutrition, newborn feeds, and measurement of bilirubin were rarely or never available. Staff highlighted infrastructure and human and consumable resources as problems. However, a strong sense of commitment, support for the work of the hospital, and a desire for improvement were expressed. Caretakers' views were generally positive, although dissatisfaction with the physical environment in which care took place was common. The capacity of the district hospital in Kenya needs strengthening by comprehensive policies that address real needs if current or new interventions and services at this level of care are to enhance child survival. INSETS: Panel 1: Responses selected from hospital staff questionnaires;Panel 2: Responses selected from caretakers' interviews. [ABSTRACT FROM AUTHOR]
ISSN:	01406736
DOI:	10.1016/S0140-6736(04)17318-2