Objective An audit of neonatal care services provided
by clinical training centres was undertaken to identify
areas requiring improvement as part of wider efforts to
improve newborn survival in Kenya.
Design Cross-sectional study using indicators based on
prior work in Kenya. Statistical analyses were descriptive
with adjustment for clustering of data.
Setting Neonatal units of 22 public hospitals.
Patients Neonates aged <7 days.
Main outcome measures Quality of care was
assessed in terms of availability of basic resources
(principally equipment and drugs) and audit of case
records for documentation of patient assessment and
treatment at admission.
Results All hospitals had oxygen, 19/22 had
resuscitation and phototherapy equipment, but some key
resources were missing—for example kangaroo care was
available in 14/22. Out of 1249 records, 56.9% (95%
CI 36.2% to 77.6%) had a standard neonatal admission
form. A median score of 0 out of 3 for symptoms of
severe illness (IQR 0–3) and a median score of 6 out of
8 for signs of severe illness (IQR 4–7) were documented.
Maternal HIV status was documented in 674/1249
(54%, 95% CI 41.9% to 66.1%) cases. Drug doses
exceeded recommendations by >20% in prescriptions for
penicillin (11.6%, 95% CI 3.4% to 32.8%) and
gentamicin (18.5%, 95% CI 13.4% to 25%),
respectively.
Conclusions Basic resources are generally available,
but there are deficiencies in key areas. Poor
documentation limits the use of routine data for quality
improvement. Significant opportunities exist for
improvement in service delivery and adherence to
guidelines in hospitals providing professional training.