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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)
Small hospitals sit at the apex of the pyramid of primary care in the health systems of many low-income countries. If the Millennium Development Goal for child survival is to be achieved, hospital care for referred severely ill children will need to be improved considerably in parallel with primary care in many countries. Yet little is known about how to(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)
Declines in case management of diarrhoea among children less than five years old In the January 2007 Bulletin, Forsberg et al. present an elegant analysis of the trends in diarrhoea case management using data from national Demographic and Health Surveys (DHS) from 1986 to 2003. 1 They conclude that despite global efforts to promote appropriate diarrhoea(More)