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Health Services that Deliver for Newborns

This study examines the quality and coverage of essential in-patient newborn services in Nairobi County, highlighting the need for improved access to high-quality care for all newborns. The findings suggest the need to upgrade facilities and establish a referral strategy to ensure effective delivery of newborn health services.

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Health Services that Deliver for Newborns

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  1. Health Services that Deliver for Newborns Effective coverage of essential in-patient newborn services in Nairobi County David Gathara Post-Doctoral Researcher KEMRI Wellcome Trust

  2. Background • Despite the progress in reducing U-5 mortality, neonatal mortality still accounts for 45% of all child deaths deaths • “estimates suggest the greatest effect [on newborn survival] would come from a focus on the care of small and ill neonates, • Much of this effect is potentially achievable through newborn care services in subdistrict and district level hospitals.” • In Kenya we don’t have a good understanding of what care is currently being provided for sick newborns and what the quality of that care is • Nairobi County has NN mortality of 39 per 1000 live births (national average 22/1000).

  3. Nairobi Newborn Study • Estimating the need • Identify facilities • Estimate admissions • Structural assessment • Examine process of care • Assess knowledge of nurses

  4. METHODS Estimating need • Literature review Admission register review • All neonatal admissions for one year Structural assessment • Check list for infrastructure, staffing, equipment, drugs Medical record review • 1183 records sampled: proportional sampling/weighting • Correct’ defined a priori by national guidelines Nursing knowledge questionnaire • 125 maternity and newborn unit nurses sampled • Vignettes and direct questions Access gap Quality scores Structure Process Knowledge

  5. Newborns needing care <200 200 - 300 >300 - 700 >700 Need inpatient services: 18% of live birthsBMJ Global Health, Murphy et al, 2017

  6. Legend G FBO G Military G Private G Public Newborns needing care <200 200 - 300 >300 - 700 >700 34 facilities providing 24/7 inpatient service

  7. What is the need for neonatal inpatient care? • Using population projections to 2015 we estimate the need for INC services during study period (mid-2014 to mid-2015) = 21,966 • 18% of all live births will require inpatient newborn care • 12,202 admissions were registered across 31 facilities in the same period

  8. Where is inpatient neonatal care (INC) provided? 34 facilities 1 excluded & 2 declined  31 participated (30 with maternity) A: Facilities providing 24/7 inpatient newborn services (INC facilities) in Nairobi City County. B: Annual (1st July 2014 – 30th June 2015) admissions among 31 INC facilities. C: Cost of one overnight accommodation in a newborn unit (NBU) across 28 INC facilities. D: Percentage occupancy of NBUs across 29 INC facilities.

  9. Summary structure score per facility

  10. Summary process score per facility

  11. Knowledge scores

  12. What is the quality of care of provided?

  13. What quality of care is being accessed?

  14. Relationship between summary process score and structural capacity score Bubble size= patient volume Blue=public Orange=mission Yellow=private Note that the x- and y-axes do not begin at zero.

  15. EFFECTIVE COVERAGE Low quality: process ≤0.5 or structure <80 or knowledge ≤0.6 High quality: process >0.6 and structure ≥80 and knowledge >0.8 Quality of care received by all babies estimated requiring inpatient care

  16. Almost 1 in 5 live births requires inpatient neonatal care in NCC • There is poor effective coverage of essential inpatient neonatal services with barriers to care being: • Inadequate provision - about 45% on newborns have no access • Quality – only 25% of newborns access high quality care • Cost - only 4 public health facilities • Physical barriers – maldistribution of facilities with need • Improving neonatal care requires an expansion of appropriate human resources for health but also improvement on the availability of resources and quality provision • To Improve access to high quality for all and especially the poor, the county should consider • Upgrading some facilities to provide standard of care category neonatal care • Strengthening existing hospitals to reliably provide intermediate category of care • Establish a country wide referral strategy and system

  17. Health Services that Deliver for Newborns Stakeholder engagement and dissemination • Ministry of Health • Nairobi City County • Chief nursing officer • Nursing Council of Kenya • National Nurses Association of Kenya • Universities and training institutions • Hospital managers • Neonatal nurses

  18. Funders: Joint Health Systems Research Initiative • Wellcome Trust • MRC • UKAID • ESRC KEMRI-Wellcome Trust team Nurses Expert Group HSD-N Advisory Group Participating hospitals Mothers and Nurses that consented to the study

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