Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 43
Filtrar
1.
BMJ Glob Health ; 6(5)2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-34059493

RESUMO

BACKGROUND: Most of the deaths among neonates in low-income and middle-income countries (LMICs) can be prevented through universal access to basic high-quality health services including essential facility-based inpatient care. However, poor routine data undermines data-informed efforts to monitor and promote improvements in the quality of newborn care across hospitals. METHODS: Continuously collected routine patients' data from structured paper record forms for all admissions to newborn units (NBUs) from 16 purposively selected Kenyan public hospitals that are part of a clinical information network were analysed together with data from all paediatric admissions ages 0-13 years from 14 of these hospitals. Data are used to show the proportion of all admissions and deaths in the neonatal age group and examine morbidity and mortality patterns, stratified by birth weight, and their variation across hospitals. FINDINGS: During the 354 hospital months study period, 90 222 patients were admitted to the 14 hospitals contributing NBU and general paediatric ward data. 46% of all the admissions were neonates (aged 0-28 days), but they accounted for 66% of the deaths in the age group 0-13 years. 41 657 inborn neonates were admitted in the NBUs across the 16 hospitals during the study period. 4266/41 657 died giving a crude mortality rate of 10.2% (95% CI 9.97% to 10.55%), with 60% of these deaths occurring on the first-day of admission. Intrapartum-related complications was the single most common diagnosis among the neonates with birth weight of 2000 g or more who died. A threefold variation in mortality across hospitals was observed for birth weight categories 1000-1499 g and 1500-1999 g. INTERPRETATION: The high proportion of neonatal deaths in hospitals may reflect changing patterns of childhood mortality. Majority of newborns died of preventable causes (>95%). Despite availability of high-impact low-cost interventions, hospitals have high and very variable mortality proportions after stratification by birth weight.


Assuntos
Hospitais , Mortalidade Infantil , Adolescente , Criança , Pré-Escolar , Estudos de Coortes , Humanos , Lactente , Recém-Nascido , Quênia/epidemiologia , Estudos Retrospectivos
2.
Arch Dis Child ; 106(4): 333-337, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33574028

RESUMO

In a companion paper, we showed how local hospital leaders could assess systems and identify key safety concerns and targets for system improvement. In the present paper, we consider how these leaders might implement practical, low-cost interventions to improve safety. Our focus is on making immediate safety improvements both to directly improve patient care and as a foundation for advancing care in the longer-term. We describe a 'portfolio' approach to safety improvement in four broad categories: prioritising critical processes, such as checking drug doses; strengthening the overall system of care, for example, by introducing multiprofessional handovers; control of known risks, such as only using continuous positive airway pressure when appropriate conditions are met; and enhancing detection and response to hazardous situations, such as introducing brief team meetings to identify and respond to immediate threats and challenges. Local clinical leaders and managers face numerous challenges in delivering safe care but, if given sufficient support, they are nevertheless in a position to bring about major improvements. Skills in improving safety and quality should be recognised as equivalent to any other form of (sub)specialty training and as an essential element of any senior clinical or management role. National professional organisations need to promote appropriate education and provide coaching, mentorship and support to local leaders.


Assuntos
Recursos em Saúde/economia , Neonatologia/organização & administração , Segurança do Paciente/normas , Qualidade da Assistência à Saúde/organização & administração , Países em Desenvolvimento/economia , Países em Desenvolvimento/estatística & dados numéricos , Pessoal de Saúde/educação , Recursos em Saúde/estatística & dados numéricos , Pesquisa sobre Serviços de Saúde/métodos , Humanos , Recém-Nascido , Quênia/epidemiologia , Liderança , Tutoria/métodos , Mães/educação , Mães/psicologia , Neonatologia/normas , Segurança do Paciente/estatística & dados numéricos , Melhoria de Qualidade
3.
Arch Dis Child ; 105(10): 927-931, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32554508

RESUMO

OBJECTIVE: To examine the availability of paediatricians in Kenya and plans for their development. DESIGN: Review of policies and data from multiple sources combined with local expert insight. SETTING: Kenya with a focus on the public, non-tertiary care sector as an example of a low-income and middle-income country aiming to improve the survival and long-term health of newborns, children and adolescents. RESULTS: There are 305 practising paediatricians, 1.33 per 100 000 individuals of the population aged <19 years which in total numbers approximately 25 million. Only 94 are in public sector, non-tertiary county hospitals. There is either no paediatrician at all or only one paediatrician in 21/47 Kenyan counties that are home to over a quarter of a million under 19 years of age. Government policy is to achieve employment of 1416 paediatricians in the public sector by 2030, however this remains aspirational as there is no comprehensive training or financing plan to reach this target and health workforce recruitment, financing and management is now devolved to 47 counties. The vast majority of paediatric care is therefore provided by non-specialist healthcare workers. DISCUSSION: The scale of the paediatric workforce challenge seriously undermines the ability of the Kenyan health system to deliver on the emerging survive, thrive and transform agenda that encompasses more complex health needs. Addressing this challenge may require innovative workforce solutions such as task-sharing, these may in turn require the role of paediatricians to be redefined. Professional paediatric communities in countries like Kenya could play a leadership role in developing such solutions.


Assuntos
Necessidades e Demandas de Serviços de Saúde , Mão de Obra em Saúde , Pediatras/provisão & distribuição , Previsões , Planejamento em Saúde , Humanos , Quênia , Pediatras/estatística & dados numéricos , Papel do Médico , Setor Público , Estudantes de Medicina/estatística & dados numéricos
4.
BMJ Glob Health ; 5(1): e001937, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32133169

RESUMO

There are global calls for research to support health system strengthening in low-income and middle-income countries (LMICs). To examine the nature and magnitude of gaps in access and quality of inpatient neonatal care provided to a largely poor urban population, we combined multiple epidemiological and health services methodologies. Conducting this work and generating findings was made possible through extensive formal and informal stakeholder engagement linked to flexibility in the research approach while keeping overall goals in mind. We learnt that 45% of sick newborns requiring hospital care in Nairobi probably do not access a suitable facility and that public hospitals provide 70% of care accessed with private sector care either poor quality or very expensive. Direct observations of care and ethnographic work show that critical nursing workforce shortages prevent delivery of high-quality care in high volume, low-cost facilities and likely threaten patient safety and nurses' well-being. In these challenging settings, routines and norms have evolved as collective coping strategies so health professionals maintain some sense of achievement in the face of impossible demands. Thus, the health system sustains a functional veneer that belies the stresses undermining quality, compassionate care. No one intervention will dramatically reduce neonatal mortality in this urban setting. In the short term, a substantial increase in the number of health workers, especially nurses, is required. This must be combined with longer term investment to address coverage gaps through redesign of services around functional tiers with improved information systems that support effective governance of public, private and not-for-profit sectors.


Assuntos
Política de Saúde , Acesso aos Serviços de Saúde , Cuidado do Lactente , Qualidade da Assistência à Saúde , Hospitalização , Humanos , Lactente , Cuidado do Lactente/economia , Cuidado do Lactente/legislação & jurisprudência , Cuidado do Lactente/normas , Mortalidade Infantil , Recém-Nascido , Doenças do Recém-Nascido/economia , Doenças do Recém-Nascido/terapia , Quênia
5.
Vaccine ; 38(11): 2435-2448, 2020 03 04.
Artigo em Inglês | MEDLINE | ID: mdl-31974017

RESUMO

Respiratory syncytial virus (RSV) is a leading cause of lower respiratory tract infection (LRTI) and hospitalization in infants and children globally. Many observational studies have found an association between RSV LRTI in early life and subsequent respiratory morbidity, including recurrent wheeze of early childhood (RWEC) and asthma. Conversely, two randomized placebo-controlled trials of efficacious anti-RSV monoclonal antibodies (mAbs) in heterogenous infant populations found no difference in physician-diagnosed RWEC or asthma by treatment group. If a causal association exists and RSV vaccines and mAbs can prevent a substantial fraction of RWEC/asthma, the full public health value of these interventions would markedly increase. The primary alternative interpretation of the observational data is that RSV LRTI in early life is a marker of an underlying predisposition for the development of RWEC and asthma. If this is the case, RSV vaccines and mAbs would not necessarily be expected to impact these outcomes. To evaluate whether the available evidence supports a causal association between RSV LRTI and RWEC/asthma and to provide guidance for future studies, the World Health Organization convened a meeting of subject matter experts on February 12-13, 2019 in Geneva, Switzerland. After discussing relevant background information and reviewing the current epidemiologic evidence, the group determined that: (i) the evidence is inconclusive in establishing a causal association between RSV LRTI and RWEC/asthma, (ii) the evidence does not establish that RSV mAbs (and, by extension, future vaccines) will have a substantial effect on these outcomes and (iii) regardless of the association with long-term childhood respiratory morbidity, severe acute RSV disease in young children poses a substantial public health burden and should continue to be the primary consideration for policy-setting bodies deliberating on RSV vaccine and mAb recommendations. Nonetheless, the group recognized the public health importance of resolving this question and suggested good practice guidelines for future studies.


Assuntos
Asma/etiologia , Sons Respiratórios , Infecções por Vírus Respiratório Sincicial/complicações , Doenças Respiratórias/complicações , Causalidade , Criança , Pré-Escolar , Humanos , Lactente , Estudos Observacionais como Assunto , Ensaios Clínicos Controlados Aleatórios como Assunto , Doenças Respiratórias/virologia , Suíça , Organização Mundial da Saúde
6.
Implement Sci ; 14(1): 20, 2019 03 04.
Artigo em Inglês | MEDLINE | ID: mdl-30832678

RESUMO

BACKGROUND: The World Health Organization (WHO) revised its clinical guidelines for management of childhood pneumonia in 2013. Significant delays have occurred during previous introductions of new guidelines into routine clinical practice in low- and middle-income countries (LMIC). We therefore examined whether providing enhanced audit and feedback as opposed to routine standard feedback might accelerate adoption of the new pneumonia guidelines by clinical teams within hospitals in a low-income setting. METHODS: In this parallel group cluster randomized controlled trial, 12 hospitals were assigned to either enhanced feedback (n = 6 hospitals) or standard feedback (n = 6 hospitals) using restricted randomization. The standard (network) intervention delivered in both trial arms included support to improve collection and quality of patient data, provision of mentorship and team management training for pediatricians, peer-to-peer networking (meetings and social media), and multimodal (print, electronic) bimonthly hospital specific feedback reports on multiple indicators of evidence guideline adherence. In addition to this network intervention, the enhanced feedback group received a monthly hospital-specific feedback sheet targeting pneumonia indicators presented in multiple formats (graphical and text) linked to explicit performance goals and action plans and specific email follow up from a network coordinator. At the start of the trial, all hospitals received a standardized training on the new guidelines and printed booklets containing pneumonia treatment protocols. The primary outcome was the proportion of children admitted with indrawing and/or fast-breathing pneumonia who were correctly classified using new guidelines and received correct antibiotic treatment (oral amoxicillin) in the first 24 h. The secondary outcome was the proportion of correctly classified and treated children for whom clinicians changed treatment from oral amoxicillin to injectable antibiotics. RESULTS: The trial included 2299 childhood pneumonia admissions, 1087 within the hospitals randomized to enhanced feedback intervention, and 1212 to standard feedback. The proportion of children who were correctly classified and treated in the first 24 h during the entire 9-month period was 38.2% (393 out of 1030) and 38.4% (410 out of 1068) in the enhanced feedback and standard feedback groups, respectively (odds ratio 1.11; 95% confidence interval [CI] 0.37-3.34; P = 0.855). However, in exploratory analyses, there was evidence of an interaction between type of feedback and duration (in months) since commencement of intervention, suggesting a difference in adoption of pneumonia policy over time in the enhanced compared to standard feedback arm (OR = 1.25, 95% CI 1.14 to 1.36, P < 0.001). CONCLUSIONS: Enhanced feedback comprising increased frequency, clear messaging aligned with goal setting, and outreach from a coordinator did not lead to a significant overall effect on correct pneumonia classification and treatment during the 9-month trial. There appeared to be a significant effect of time (representing cumulative effect of feedback cycles) on adoption of the new policy in the enhanced feedback compared to standard feedback group. Future studies should plan for longer follow-up periods to confirm these findings. TRIAL REGISTRATION: US National Institutes of Health-ClinicalTrials.gov identifier (NCT number) NCT02817971 . Registered September 28, 2016-retrospectively registered.


Assuntos
Amoxicilina/administração & dosagem , Antibacterianos/administração & dosagem , Pneumonia Bacteriana/tratamento farmacológico , Administração Oral , Pré-Escolar , Análise por Conglomerados , Substituição de Medicamentos , Retroalimentação , Feminino , Política de Saúde , Hospitalização , Hospitais de Condado/estatística & dados numéricos , Humanos , Lactente , Injeções , Quênia , Masculino , Auditoria Médica , Política Organizacional , Pneumonia Bacteriana/diagnóstico , Padrões de Prática Médica/estatística & dados numéricos , Rede Social
7.
Vaccine ; 37(3): 464-472, 2019 01 14.
Artigo em Inglês | MEDLINE | ID: mdl-30502070

RESUMO

BACKGROUND: In 2014 the Kenya National Immunization Technical Advisory Group (KENITAG) was asked by the Ministry of Health to provide an evidence-based recommendation on whether the seasonal influenza vaccine should be introduced into the national immunization program (NIP). METHODS: We reviewed KENITAG manuals, reports and meeting minutes generated between June 2014 and June 2016 in order to describe the process KENITAG used in arriving at that recommendation and the challenges encountered. RESULTS: KENITAG developed a recommendation framework to identify critical, important and non-critical data elements that would guide deliberations on the subject. Literature searches were conducted in several databases and the quality of scientific articles obtained was assessed using the Critical Appraisal Skills Programme tool. There were significant gaps in knowledge on the national burden of influenza disease among key risk groups, i.e., pregnant women, individuals with co-morbidities, the elderly and health care workers. Insufficient funding and limited work force hindered KENITAG activities. In 2016 KENITAG recommended introduction of the annual seasonal influenza vaccine among children 6 to 23 months of age. However, the recommendation was contingent on implementation of a pilot study to address gaps in local data on the socio-economic impact of influenza vaccination programs, strategies for vaccine delivery, and the impact of the vaccination program on the healthcare workforce and existing immunization program. KENITAG did not recommend the influenza vaccine for any other risk group due to lack of local burden of disease data. CONCLUSION: Local data are a critical element in NITAG deliberations, however, where local data and in particular burden of disease data are lacking, there is need to adopt scientifically acceptable methods of utilizing findings from other countries to inform local decisions in a manner that is valid and acceptable to decision makers.


Assuntos
Comitês Consultivos , Tomada de Decisões , Programas de Imunização , Vacinas contra Influenza/uso terapêutico , Influenza Humana/prevenção & controle , Pré-Escolar , Feminino , Política de Saúde/economia , Política de Saúde/legislação & jurisprudência , Humanos , Programas de Imunização/legislação & jurisprudência , Programas de Imunização/organização & administração , Lactente , Quênia , Projetos Piloto , Gravidez , Gestantes , Estudos Retrospectivos , Fatores de Risco , Vacinação/economia , Vacinação/legislação & jurisprudência
8.
BMC Psychiatry ; 18(1): 381, 2018 12 05.
Artigo em Inglês | MEDLINE | ID: mdl-30518351

RESUMO

BACKGROUND: Adverse childhood experiences (ACEs) is a significant public health and social welfare problem in low-and middle income countries (LMICs). However, most ACEs research is based on developed countries, and little is known about mechanisms of early ACEs on adulthood health and offspring's wellbeing for populations in LMICs. This area is needed to guide social welfare policy and intervention service planning. This study addresses these research gaps by examining patterns of ACEs and understanding the role of ACEs on adulthood health (i.e., physical, mental health, experience of underage pregnancy) and offspring's mental health in Kenya. The study was guided by an Integrated Family Stress and Adverse Childhood Experiences Mediation Framework. METHODS: Three hundred ninety four mothers from two informal communities in Kariobangi and Kangemi in Nairobi were included in this study. The Adverse Childhood Experiences International Questionnaire (ACE-IQ), the Kessler Psychological Distress Scale (K10), Overall Health and Quality of Life items, and Child Behavior Checklist were used to study research questions. Data was gathered through a one-time interview with mothers. Structural Equational Modeling (SEM) was applied for mediational mechanism testing. RESULTS: Among 13 ACE areas, most mothers experienced multiple adversity during their childhood (Mean (SD) = 4.93 (2.52)), with household member treated violently (75%) as the most common ACE. SEM results showedthat all domains of ACEs were associated with some aspects of maternal health, and all three domains of maternal health (maternal mental health, physical health, and adolescent pregnancy) were significantly associated with development of offspring's mental health problems. CONCLUSION: ACEs are highly prevalent in Kenyan informal settlements. Consistent with cross cultural literature on family stress model, maternal ACEs are robust predictors for poor child mental health. Preventive interventions for child mental health need to address maternal adverse childhood traumatic experiences as well as their current health in order to effectively promote child mental health.


Assuntos
Crianças Adultas , Experiências Adversas da Infância , Mães , Qualidade de Vida , Adulto , Crianças Adultas/psicologia , Crianças Adultas/estatística & dados numéricos , Experiências Adversas da Infância/organização & administração , Experiências Adversas da Infância/estatística & dados numéricos , Criança , Saúde da Família , Feminino , Planejamento em Saúde/métodos , Humanos , Quênia/epidemiologia , Masculino , Saúde Mental , Serviços de Saúde Mental/normas , Mães/psicologia , Mães/estatística & dados numéricos , Determinação de Necessidades de Cuidados de Saúde , Prevalência
9.
Ann Nutr Metab ; 73 Suppl 1: 20-25, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30196293

RESUMO

In this article, we will summarize the key non-nutritional aspects of the introduction of complementary feeding. Intestinal maturation related to starch digestion is relatively complete by the time complementary feeding is recommended to be initiated. A much more complex maturation is needed, however, from the neurodevelopmental standpoint as the infants need to be able to hold their head and trunk and be able to coordinate tongue movement followed by swallowing. Issues can arise in infants with a history of medical problems as well as when caretakers cannot handle the initial difficulties or want to impose certain rigidity to the learning process. The introduction of complementary feedings is also part of the early steps in introduction to human socialization. In that regard, it sets up the infant to internalize and accept the diversity of food textures and food choices. Early refusal of some food items is common and should not be interpreted as being disliked. Multiple attempts should be made to incorporate new food items. To accomplish these dynamics, caregivers need comprehensive education and relevant information.


Assuntos
Desenvolvimento Infantil/fisiologia , Comportamento Alimentar/fisiologia , Comportamento Alimentar/psicologia , Fenômenos Fisiológicos da Nutrição do Lactente/fisiologia , Cuidadores/educação , Feminino , Humanos , Lactente , Intestinos/crescimento & desenvolvimento , Masculino , Socialização
11.
Artigo em Inglês | PAHO-IRIS | ID: phr-34394

RESUMO

The Pan American Journal of Public Health recognizes with appreciation the contributions of the members of the Editorial Committee, and authors of the Overview article. Their contributions and dedication to this issue on immunization in the Region of the Americas were extraordinary and helped make the manuscripts more interesting, more accurate, and more useful to our readers and all others who work to improve the health of the peoples of the Americas. The Journal would like to give special thanks to the General Coordination of the National Immunization Program, Department of Transmissible Disease Surveillance, Health Surveillance Secretariat, Ministry of Health, Brazil, whose financial and programmatic contributions were essential to the publication of this special issue.


Assuntos
Imunização , América Latina , Vacinação , Imunização , América Latina , Vacinas , Imunização , Vacinas
12.
Papillomavirus Res ; 4: 66-71, 2017 12.
Artigo em Inglês | MEDLINE | ID: mdl-29179872

RESUMO

Several African countries have recently introduced or are currently introducing the HPV vaccine, either nationwide or through demonstration projects, while some countries are planning for introduction. A collaborative project was developed to strengthen country adolescent immunisation programmes and health systems in the African Region, addressing unique public health considerations of HPV vaccination: adolescents as the primary target group, delivery platforms (e.g. school-based and facility based), socio-behavioural issues, and the opportunity to deliver other health interventions alongside HPV vaccination. Following a successful "taking-stock" meeting, a training programme was drafted to assist countries to strengthen the integration of adolescent health interventions using HPV vaccination as an entry point. Two workshops were conducted in the Eastern and Southern African Regions. All countries reported on progress made during a final joint symposium. Of the 20 countries invited to participate in either of the workshops and/or final symposium, 17 countries participated: Angola, Botswana, Ethiopia, Kenya, Malawi, Mauritius, Mozambique, Namibia, Rwanda, Seychelles, South Africa, South Sudan, Swaziland, Tanzania, Uganda, Zambia and Zimbabwe. Countries that are currently implementing HPV vaccination programmes, either nationally or through demonstration projects, reported varying degrees of integration with other adolescent health interventions. The most commonly reported adolescent health interventions alongside HPV vaccination include health education (including sexually transmitted infections), deworming and delivering of other vaccines like tetanus toxoid (TT) or tetanus diphtheria (Td). The project has successfully (a) established an African-based network that will advocate for incorporating the HPV vaccine into national immunisation programmes; (b) created a platform for experience exchange and thereby contributed to novel ideas of revitalising and strengthening school-based health programmes as delivery platform of adolescent immunisation services and other adolescent health interventions, as well as identifying ways of reaching out-of-school girls through facility and community based programmes; and (c) laid a foundation for incorporating future adolescent vaccination programmes.


Assuntos
Saúde do Adolescente , Programas de Imunização , Infecções por Papillomavirus/prevenção & controle , Vacinas contra Papillomavirus/administração & dosagem , Neoplasias do Colo do Útero/prevenção & controle , Vacinação/métodos , Adolescente , África/epidemiologia , Atenção à Saúde/métodos , Atenção à Saúde/estatística & dados numéricos , Feminino , Programas Governamentais/estatística & dados numéricos , Educação em Saúde , Instalações de Saúde , Humanos , Infecções por Papillomavirus/epidemiologia , Vacinas contra Papillomavirus/efeitos adversos , Saúde Pública , Serviços de Saúde Escolar , Instituições Acadêmicas , Vacinação/psicologia
13.
BMC Infect Dis ; 17(1): 623, 2017 09 16.
Artigo em Inglês | MEDLINE | ID: mdl-28915796

RESUMO

BACKGROUND: Sub-Saharan Africa continues to document high pediatric tuberculosis (TB) burden, especially among the urban poor. One recommended preventive strategy involves tracking and isoniazid preventive therapy (IPT) for children under 5 years in close contact with infectious TB. However, sub-optimal effectiveness has been documented in diverse settings. We conducted a study to elucidate correlates to IPT strategy failure in children below 5 years in high burden settings. METHODS: A prospective longitudinal cohort study was done in informal settlings in Nairobi, where children under 5 years in household contact with recently diagnosed smear positive TB adults were enrolled. Consent was sought. Structured questionnaires administered sought information on index case treatment, socio-demographics and TB knowledge. Contacts underwent baseline clinical screening exclude TB and/or pre-existing chronic conditions. Contacts were then put on daily isoniazid for 6 months and monitored for new TB disease, compliance and side effects. Follow-up continued for another 6 months. RESULTS: At baseline, 428 contacts were screened, and 14(3.2%) had evidence of TB disease, hence excluded. Of 414 contacts put on IPT, 368 (88.8%) completed the 1 year follow-up. Operational challenges were reported by 258(70%) households, while 82(22%) reported side effects. Good compliance was documented in 89% (CI:80.2-96.2). By endpoint, 6(1.6%) contacts developed evidence of new TB disease and required definitive anti-tuberculosis therapy. The main factor associated with IPT failure was under-nutrition of contacts (p = 0.023). CONCLUSION: Under-nutrition was associated with IPT failure for child contacts below 5 years in high burden, resource limited settings. IPT effectiveness could be optimized through nutrition support of contacts.


Assuntos
Antituberculosos/uso terapêutico , Isoniazida/uso terapêutico , Tuberculose/prevenção & controle , Adolescente , Adulto , Pré-Escolar , Características da Família , Feminino , Humanos , Quênia , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Estado Nutricional , Estudos Prospectivos , Falha de Tratamento , Tuberculose/transmissão
14.
Pan Afr Med J ; 27: 121, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28819541

RESUMO

INTRODUCTION: Global mortality trends have changed over time and are expected to continue changing with a reduction in communicable diseases and an increase of non-communicable disease. Increased survival of children beyond five years may change mortality patterns for these children. There are few studies in Africa that explore the causes of mortality in children over five years. The objective of this study was to determine the mortality rate and clinical profiles of children aged 5-17 years who died in six Kenyan hospitals in 2013. METHODS: Retrospective review of patients' medical records to abstract data on diagnosis for those who died in year 2013. Data was analysed to provide descriptive statistics and explored differences in mortality rates between age groups and gender. RESULTS: We retrieved 4,520 patient records. The in-hospital mortality rate was 3.5% (95%CI 3.0-4.1) with variations in deaths between the ages and gender. Among the deaths, 60% suffered from communicable diseases, maternal and nutritional causes; 41.3% suffered from non-communicable diseases. A further 11.9% succumbed to traumatic injuries. The predominant clinical diagnoses among patients who died were HIV/AIDS, respiratory tract infections and malaria. CONCLUSION: Infectious causes had the highest proportion of diagnoses among children aged 5-17 years who died.


Assuntos
Causas de Morte/tendências , Mortalidade Hospitalar/tendências , Mortalidade/tendências , Adolescente , Distribuição por Idade , Criança , Pré-Escolar , Feminino , Humanos , Quênia/epidemiologia , Masculino , Estudos Retrospectivos , Distribuição por Sexo
15.
Arch Dis Child ; 102(9): 846-851, 2017 09.
Artigo em Inglês | MEDLINE | ID: mdl-28584069

RESUMO

There are few examples of sustained nationally organised, evidence-informed clinical guidelines development processes in Sub-Saharan Africa. We describe the evolution of efforts from 2005 to 2015 to support evidence-informed decision making to guide admission hospital care practices in Kenya. The approach to conduct reviews, present evidence, and structure and promote transparency of consensus-based procedures for making recommendations improved over four distinct rounds of policy making. Efforts to engage important voices extended from government and academia initially to include multiple professional associations, regulators and practitioners. More than 100 people have been engaged in the decision-making process; an increasing number outside the research team has contributed to the conduct of systematic reviews, and 31 clinical policy recommendations has been developed. Recommendations were incorporated into clinical guideline booklets that have been widely disseminated with a popular knowledge and skills training course. Both helped translate evidence into practice. We contend that these efforts have helped improve the use of evidence to inform policy. The systematic reviews, Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approaches and evidence to decision-making process are well understood by clinicians, and the process has helped create a broad community engaged in evidence translation together with a social or professional norm to use evidence in paediatric care in Kenya. Specific sustained efforts should be made to support capacity and evidence-based decision making in other African settings and clinical disciplines.


Assuntos
Serviços de Saúde da Criança/normas , Medicina Baseada em Evidências/métodos , Guias de Prática Clínica como Assunto , Criança , Tomada de Decisões , Difusão de Inovações , Fidelidade a Diretrizes , Hospitalização , Humanos , Quênia , Admissão do Paciente/normas , Formulação de Políticas , Pobreza , Guias de Prática Clínica como Assunto/normas
16.
Health Res Policy Syst ; 15(1): 4, 2017 Feb 02.
Artigo em Inglês | MEDLINE | ID: mdl-28153020

RESUMO

BACKGROUND: The creation of a clinical network was proposed as a means to promote implementation of a set of recommended clinical practices targeting inpatient paediatric care in Kenya. The rationale for selecting a network as a strategy has been previously described. Here, we aim to describe network activities actually conducted over its first 2.5 years, deconstruct its implementation into specific components and provide our 'insider' interpretation of how the network is functioning as an intervention. METHODS: We articulate key activities that together have constituted network processes over 2.5 years and then utilise a recently published typology of implementation components to give greater granularity to this description from the perspective of those delivering the intervention. Using the Behaviour Change Wheel we then suggest how the network may operate to achieve change and offer examples of change before making an effort to synthesise our understanding in the form of a realist context-mechanism-outcome configuration. RESULTS: We suggest our network is likely to comprise 22 from a total of 73 identifiable intervention components, of which 12 and 10 we consider major and minor components, respectively. At the policy level, we employed clinical guidelines, marketing and communication strategies with intervention characteristics operating through incentivisation, persuasion, education, enablement, modelling and environmental restructuring. These might influence behaviours by enhancing psychological capability, creating social opportunity and increasing motivation largely through a reflective pathway. CONCLUSIONS: We previously proposed a clinical network as a solution to challenges implementing recommended practices in Kenyan hospitals based on our understanding of theory and context. Here, we report how we have enacted what was proposed and use a recent typology to deconstruct the intervention into its elements and articulate how we think the network may produce change. We offer a more generalised statement of our theory of change in a context-mechanism-outcome configuration. We hope this will complement a planned independent evaluation of 'how things work', will help others interpret results of change reported more formally in the future and encourage others to consider further examination of networks as means to scale up improvement practices in health in lower income countries.


Assuntos
Cuidado da Criança/normas , Hospitais/normas , Serviços de Informação , Informática Médica , Criança , Difusão de Inovações , Promoção da Saúde/normas , Hospitalização , Humanos , Quênia , Prática Profissional/normas
17.
BMJ Open Gastroenterol ; 4(1): e000124, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28123772

RESUMO

BACKGROUND: Diarrhoea is the second most common cause of death in children under 5 years of age in Kenya. It is usually treated with oral rehydration, zinc and continued feeding. Racecadotril has been in use for over 2 decades; however, there is a paucity of data regarding its efficacy from Africa. OBJECTIVES: The objectives of this study were: to compare the number of stools in the first 48 hours in children with severe gastroenteritis requiring admission and treated with either racecadotril or placebo, to study the impact of racecadotril on duration of inpatient stay as well as duration of diarrhoea and to describe the side effect profile of racecadotril. METHODS: This was a randomised, double-blinded, placebo-controlled trial. It enrolled children between the age of 3 and 60 months who were admitted with severe acute gastroenteritis. They received either racecadotril or placebo in addition to oral rehydration solution (ORS) and zinc and were followed up daily. RESULTS: 120 children were enrolled into the study. There were no differences in the demographics or outcomes between the 2 groups. Stools at 48 hours: median (IQR) of 5 (3-7) and 5 (2.5-7.5), respectively; p=0.63. The duration of inpatient stay: median (IQR): 4 days (1.5-6.5) and 4.5 (1.8-6.3); p=0.71. The duration of illness: 3 days (2-4) and 2 days (1-3); p=0.77. The relative risk of a severe adverse event was 3-fold higher in the drug group but was not statistically significant (95% CI 0.63 to 14.7); p=0.16. CONCLUSIONS: Racecadotril has no impact on the number of stools at 48 hours, the duration of hospital stay or the duration of diarrhoea in children admitted with severe gastroenteritis and managed with ORS and zinc. TRIAL REGISTRATION NUMBER: PACTR201403000694398; Pre-results.

SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...