Abstract:
We intend to conduct a unique public health efficacy study of an intervention to improve care
for children in district hospitals in Kenya. The intervention has been developed, based on the
referral care component of the IMCI strategy, with the Ministry of Health. It comprises,
training, guidelines, job aides, supervision and quality improvement activities and will be
delivered over 1.5 years to four intervention hospitals. Four control hospitals will receive
guidelines and information from regular surveys. Random selection will be used to decide
allocation to the hospital groupings. The impact of the interventions in hospitals from both
groups will be monitored over 2.5-3.0 years (extending before and after intervention) with
performance assessed against the guidelines provided and pre-defined standard criteria.
Assessments will include:
1) Process measures of the quality of care, representing proximate impacts of the
intervention,
2) Paediatric inpatient mortality and the adequacy of resources and the environment
(outcomes with a complex causal pathway)
3) Exploration of factors at hospital and health worker levels (including institutional and
person-specific factors such as motivation) that may affect the delivery of care
4) The costs and cost-effectiveness of the intervention
Qualitative studies will be used to describe: each hospital’s context and the broader
institutional response to intervention.
Results will critically inform the debates on scaling-up and improving the delivery of
evidence based hospital care for children in Kenya and elsewhere.
