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Note: This report has undergone an external review process. Simpson, whose patience and expertise has ensured that our work integrates with the broader goals of the Commission. we thank you for championing the recognition of the importance of the social determinants of health and for committing to moving this work from knowledge to action. We would like to(More)
BACKGROUND In developing countries referral of severely ill children from primary care to district hospitals is common, but hospital care is often of poor quality. However, strategies to change multiple paediatric care practices in rural hospitals have rarely been evaluated. METHODS AND FINDINGS This cluster randomized trial was conducted in eight rural(More)
BACKGROUND The district hospital is considered essential for delivering basic, cost-effective health care to children in resource poor countries. We aimed to investigate the performance of these facilities in Kenya. METHODS Government hospitals providing first referral level care were prospectively sampled from 13 Kenyan districts. Workload statistics and(More)
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(More)
BACKGROUND It is increasingly appreciated that the interpretation of health systems research studies is greatly facilitated by detailed descriptions of study context and the process of intervention. We have undertaken an 18-month hospital-based intervention study in Kenya aiming to improve care for admitted children and newborn infants. Here we describe the(More)
BACKGROUND Given the high mortality associated with neonatal illnesses and severe malnutrition and the development of packages of interventions that provide similar challenges for service delivery mechanisms we set out to explore how well such services are provided in Kenya. METHODS As a sub-component of a larger study we evaluated care during surveys(More)
OBJECTIVE To assess the availability of resources that support the provision of basic neonatal care in eight first-referral level (district) hospitals in Kenya. METHODS We selected two hospitals each from four of Kenya's eight provinces with the aim of representing the diversity of this part of the health system in Kenya. We created a checklist of 53(More)
BACKGROUND We have conducted an intervention study aiming to improve hospital care for children and newborns in Kenya. In judging whether an intervention achieves its aims, an understanding of how it is delivered is essential. Here, we describe how the implementation team delivered the intervention over 18 months and provide some insight into how health(More)
acknowledgements 1 This report represents the efforts and commitment of many people that contributed to the team-ecd document that we would like to gratefully acknowledge: the Members of the Knowledge Network for Early Child Simpson, whose patience and expertise has ensured that our work integrates with the broader goals of the Commission. we thank you for(More)
BACKGROUND The structured admission form is an apparently simple measure to improve data quality. Poor motivation, lack of supervision, lack of resources and other factors are conceivably major barriers to their successful use in a Kenyan public hospital setting. Here we have examined the feasibility and acceptability of a structured paediatric admission(More)