Comprehensive approach can improve clinical care of Kenyan children

Comprehensive approach can improve clinical care of Kenyan children.

A novel study recently published in PLoS Medicine Journal shows that severely ill children in developing countries often succumb to common childhood illnesses due to inadequate paediatric care at primary health care facilities. The study carried out by KEMRI-Wellcome Trust researchers suggests that specific efforts are needed to improve pediatric care in rural areas of low income countries such as Kenya- where 74 in every 1000 children die before their fifth birthday.

This is despite the availability of World Health Organisation (WHO) certified, disease specific, clinical guidelines that form part of the Intergrated Management of Childhood Illnesses (IMCI) approach adopted by over 100 countries. The study therefore set out to evaluate the paediatric care practices and address deficiencies in clinical knowledge, skills, motivation, resources, and the organisation of care in rural district hospitals.

The study was conducted in eight rural Kenyan district hospitals where four hospitals were randomly chosen to receive full intervention comprising evidence-based guidelines, training, job aides, local facilitation, supervision, and face-to-face feedback while the remaining four hospitals acted as a control group that received partial intervention in terms of guidelines, didactic training, job aides, and written feedback.

After eighteen months, the study concluded that a full, multifaceted intervention at rural Kenyan hospitals, was associated with greater changes in pediatric practice than a partial intervention. These changes in practice spanned multiple, high mortality conditions including malaria, pneumonia and diarrhoea.

Philip Ayieko of the Child and Newborn Health Group (CNHG) at the KEMRI-Wellcome Trust Research Programme and one of the lead researchers in the study, comments: '' The results of this study which is among the first of its type in developing countries are remarkable. We have shown that it is possible to improve hospital care for children in settings with limited resources by changing clinical behaviour and that such change is sustained.''

Dr Mike English, also of the Child and Newborn Health Group (CNHG) at the KEMRI-Wellcome Trust Research Programme and co-author of the study observed that ''...considerable research effort over many years has helped define the best forms of care for severely ill children; unfortunately many children still do not receive these best forms of care.''

''This study is unusual because it does not aim to identify what the best form of care is; instead it examines how we might support hospitals to improve the care they give. The results indicate that with support the number of children receiving care in line with best practice in hospitals can be considerably increased, '' he adds.

''To our knowledge our data represents the first major report examining national adaptation and implementation of a broad set of rural hospital care recommendations. They are relevant to many of the 100 countries with Intergrated Management of Childhood Illnesses programmes where rural hospitals have important roles supporting primary health care systems and in helping to reduce child mortality, '' the authors conclude.

The study, entitled A Multifaceted Intervention to Implement Guidelines and Improve Admission Pediatric Care in Kenyan District Hospitals: A Cluster Randomized Trial, is published in PLoS Medicine and is freely available for anyone to read, download and distribute. http//www.plosmedicine.org/article/info%3.

Photo: AP/Obed Zilwa