Related Experiment Video
Updated: Apr 15, 2026
Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Moving towards routine evaluation of quality of inpatient pediatric care in Kenya
David Gathara1, Rachael Nyamai2, Fred Were3
1KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya.
Insights
Routine quality of care assessments in Kenyan hospitals show improvements in pediatric care, particularly in documentation and some treatment protocols. Further enhancements are needed, especially in fluid management and specific drug use.
Area of Science:
- Pediatric healthcare quality assessment
- Health systems strengthening in low-income countries
- Cross-sectional survey methodology
Background:
- Regular quality of care assessments are crucial for monitoring health system progress and identifying areas for improvement.
- Initiating routine assessments in a low-income country, in partnership with the government, is a key strategy for enhancing healthcare outcomes.
- This study reports on the initial efforts to establish such routine assessments.
Purpose of the Study:
- To assess the quality of pediatric care in Kenyan hospitals.
- To evaluate the availability of essential resources and the process of care for common childhood illnesses.
- To identify gaps and areas for improvement in pediatric healthcare delivery.
Main Methods:
- A cross-sectional survey was conducted in 22 internship training hospitals in Kenya.
- The survey examined essential resource availability and reviewed 60 case records per site for common childhood illnesses (pneumonia, malaria, diarrhea, malnutrition, meningitis).
- Data collection included assessing documentation practices and treatment correctness.
Main Results:
- 8 out of 22 hospitals had 75% or more essential resources available.
- HIV testing rates were suboptimal (12%). A structured pediatric admission form improved symptom/sign documentation.
- Correct dosing for penicillin and gentamicin was >85%, but fluid/oral feed volumes for severe dehydration/malnutrition were low (54% and 25%). Zinc use for diarrhea was 66%, but artesunate for malaria was rare. Significant hospital-level variability in care quality was observed.
Conclusions:
- Pediatric care quality in Kenya has shown improvement but has potential for further enhancement.
- The described survey approach is feasible for routine assessments across numerous hospitals, supporting national improvement efforts.
- Understanding inter-hospital variability is key to targeting improvement initiatives effectively.
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.
Related Concept Videos
01:26Pharmacokinetics in Pediatric Patients: Drug Excretion
01:15Nursing Evaluation
01:20Acute Kidney Injury V: Interprofessional Care
00:59Hospitals-II
Nurses that work in...
01:28Chronic Kidney Disease III: Interprofessional Care
01:22Healthcare Associated Infections II: Preventive Measures
The best practices for preventing healthcare-associated infections include hand hygiene, patient risk...