Public Hospitals In Kenya Research Articles

Quality Management Strategies and Customer Satisfaction among Public Hospitals in Embu County, Kenya

Product or service quality has become the driving force of global firms. Customers have becoming more enlightened with products and services that they consume due to access of information. However, it is observed from literature that the concept of quality has continued to evolve due to different attitudinal and perceptional nature of customers. Issues of quality among public organizations and more especially public hospitals in Kenya have continued to raise mixed reactions from different stakeholders such as the members of the public, public benefit organizations and management of County Governments in general. For public hospitals in Kenya to meet the changing needs and wants of their customers, they need to adopt effective quality management strategies in order to surpass customer expectations. The aim of this study was to investigate the influence of quality management strategies on customer satisfaction among public hospitals in Embu County, Kenya. The specific objectives of the study were; to establish the influence of employee training, research and development and employee motivation on customer satisfaction in public hospitals in Embu County, Kenya. The study was informed by the Total Quality Management Theory and supported by the SERVQUAL model and the Open System Theory. The study employed the descriptive research design to investigate the problem that was under study. Target population comprised of 239 respondents. The respondents of the study constituted employees of the six level four public hospitals in Embu County which included Siakago, Runyenjes, Kiritiri, Kianjokoma, Ishiara and Kairuri. Respondents were stratified into four strata and simple random sampling technique was used to select respondents from each strata. The units of analysis were level four public hospitals and unit of observation were employees of public hospitals in Embu County. Primary data was collected using structured questionnaires. Secondary data was obtained from internal management health reports, related articles and minutes of the organization. Validity of the instrument was tested using lecturers and quality management experts working in public hospitals in Kenya and reliability of the instrument was tested using Cronbach Alpha formula. Data was analyzed using descriptive and inferential statistics such as regression analysis. Regression analysis was carried out at 95% confidence level and 5% significance level to establish the statistical relationship between variables of the study. The analyzed data was tabulated and presented in the form of means, standard deviation and percentages. The study established that there was a positive statistical relationship between independent variables and the dependent variable because all the independent variables significance values were less than the critical value 0.05. The study concludes that employee training, research and development and employee motivation are key determinants of customer satisfaction in public hospitals in Kenya. The study recommends that unless public hospitals in Kenya recognize the aspect of employee motivation, research and development and employee training, achieving organizational goals will be a difficult task to achieve in the dynamic business environment.

Influence of Employee Assistance Programs on Commitment of Nurses in Public Hospitals in Kenya

The aim of this study was to investigate the influence of employee assistance programs on commitment of nurses in public hospitals in Kenya. Specifically, the study was guided by the hypothesis; Employee assistance program has no significant influence on commitment of nurses in public hospitals in Kenya. The researcher utilized proportionate simple random sampling to select 364 nurses. A cross sectional research design was used. Semi-structured questionnaires were used to collect data. Data were analysed using descriptive and inferential statistics. The findings suggest that there is a weak positive correlation between employee assistance programs and level of commitment of the nurses as indicated by a Pearson’s correlation coefficient of 0.394 significant at 5% level of significance. Secondly, the regression model on the influence of employee assistance programs on commitment of nurses; commitment=26.304+0.620(adequacy of Employee Assistance Programs), indicating that there is a positive linear relationship between employee assistance and commitment. Fourthly, t-test values and f- test values (t= 7.516, p < 0.05); f = 54.495, p < 0.05) indicated that employee assistance programs had a statistically significant effect on the level of commitment of the nurses. In addition, coefficient of determination R2 = 0.155, indicating that 15.5% of the variation in the level of commitment for the sample of 309 nurses in public hospitals can be explained by the variations in the adequacy of employee assistance programs. Based on these findings, the researcher concludes that adequacy of employee assistance programs significantly influences levels of commitment of nurses in public hospitals in Kenya. Given that employee assistance programs in public hospitals is inadequate the study recommends that public hospital management team should enhance employee assistance programs in terms of adequacy in order to improve on the levels of commitment of nurses. The researcher Suggests a further research on the influence of employee assistance programs on commitment of nurses’ in faith-based health and private hospitals in Kenya.

Atypical cervical cytomorphologic predictors: a descriptive study of pre-cervical cancer patients of low education in Kenya.

Introductionhigh risk HPV is the perpetrator of cervical cancer disease, however screening and vaccination is not included in cervical cancer prevention program within public hospitals in Kenya. This descriptive study assessed the association of specific microbial STI and socio-demographic characteristics and practices with cervical cytomorphologic presentations in regards to pre cervical cancer grades amongst health seeking patients attending the reproductive health clinic of Nakuru County referral hospital, a public hospital under newly devolved health services governance.Methodsa total of 142 patients (AGC/AIS, n=8; HSIL, n=59; LSIL, n=35; controls, n=40) whose median age ranged between 20-70 years were purposively sampled. A structured questionnaire with closed and open ended entries was administered and STI screening including Pap smear examination for cytomorphological profiling done according to revised 2014 Bethesda classification. Associations were established using chi-square and multivariate logistic regression model to determine prediction of cervical atypia manifestations.Resultsa majority of the study participants had only primary education or no education in AGC/AIS (63%) and HSIL (73%) relative to LSIL (49%) and controls (53%) (P=0.017). Koilocyte rates were higher in AGC/AIS (25%), HSIL (52%) and LSIL (77%) compared controls (12.5%) (P<0.0001). ASCUS predominated in HSIL (61%) and LSIL (86%), while almost all AGC/AIS had AGCUS (88%). HR HPV 16/18 infection rates were higher in AGC/AIS (100%), HSIL (80%) and LSIL (83%) relative to controls (10%) (P<0.0001), and was associated with higher risk of having AGC/AIS (OR, 2.0; 95% CI, 1.940-1.947; P<0.0001); HSIL, (OR, 36.3; 95% CI, 9.5-139.5; P<0.0001); and LSIL (OR, 50.1; 95% CI, 12.0-209.0; P<0.0001).Conclusionaltogether, pre-cervical cancer in Kenyan women is characterized by koilocytosis and ASCUS probably from the high rates of HPV 16/18 infections. Promoting cancer education and screening for high risk HPV infections and pre-cancerous lesions will improve women's reproductive health.

Intensive Care Outcomes and Mortality Prediction at a National Referral Hospital in Western Kenya.

The burden of critical care is greatest in resource-limited settings. Intensive care unit (ICU) outcomes at public hospitals in Kenya are unknown. The present study is timely, given the Kenyan Ministry of Health initiative to expand ICU capacity. To identify factors associated with mortality at Moi Teaching and Referral Hospital and validate the Mortality Probability Admission Model II (MPM0-II). A retrospective cohort of 450 patients from January 1, 2013, to April 5, 2015, was evaluated using demographics, presenting diagnoses, interventions, mortality, and cost data. ICU mortality was 53.6%, and 30-day mortality was 57.3%. Most patients were male (61%) and at least 18 years old (70%); the median age was 29 years. Factors associated with high adjusted odds of mortality were as follows: age younger than 10 years (adjusted odds ratio [aOR], 3.59; P ≤ 0.001), ages 35-49 years (aOR, 3.13; P = 0.002), and age above 50 years (aOR, 2.86; P = 0.004), with reference age range 10-24 years; sepsis (aOR, 3.39; P = 0.01); acute stroke (aOR, 8.14; P = 0.011); acute respiratory failure or mechanical ventilation (aOR, 6.37; P < 0.001); and vasopressor support (aOR, 7.98; P < 0.001). Drug/alcohol poisoning (aOR, 0.33; P = 0.005) was associated with lower adjusted odds of mortality. MPM0-II discrimination showed an area under the receiver operating characteristic curve of 0.78 (95% confidence interval, 0.72-0.82). The result of the Hosmer-Lemeshow test for calibration was significant (P < 0.001). In a Kenyan public ICU, high mortality was noted despite the use of advanced therapies. MPM0-II has acceptable discrimination but poor calibration. Modification of MPM0-II or development of a new model using a prospective multicenter global collaboration is needed. Standardized triage and treatment protocols for high-risk diagnoses are needed to improve ICU outcomes.

Evaluation of Patient Satisfaction with Nursing Care at Two Public Hospitals in Kenya: An Interventional Study

Evaluation of Patient Satisfaction with Nursing Care at Two Public Hospitals in Kenya: An Interventional Study

An exploration of mortality risk factors in non-severe pneumonia in children using clinical data from Kenya

BackgroundChildhood pneumonia is the leading infectious cause of mortality in children younger than 5 years old. Recent updates to World Health Organization pneumonia guidelines recommend outpatient care for a population of children previously classified as high risk. This revision has been challenged by policymakers in Africa, where mortality related to pneumonia is higher than in other regions and often complicated by comorbidities.This study aimed to identify factors that best discriminate inpatient mortality risk in non-severe pneumonia and explore whether these factors offer any added benefit over the current criteria used to identify children with pneumonia requiring inpatient care.MethodsWe undertook a retrospective cohort study of children aged 2–59 months admitted with a clinical diagnosis of pneumonia at 14 public hospitals in Kenya between February 2014 and February 2016. Using machine learning techniques, we analysed whether clinical characteristics and common comorbidities increased the risk of inpatient mortality for non-severe pneumonia. The topmost risk factors were subjected to decision curve analysis to explore if using them as admission criteria had any net benefit above the current criteria.ResultsOut of 16,162 children admitted with pneumonia during the study period, 10,687 were eligible for subsequent analysis. Inpatient mortality within this non-severe group was 252/10,687 (2.36%). Models demonstrated moderately good performance; the partial least squares discriminant analysis model had higher sensitivity for predicting mortality in comparison to logistic regression.Elevated respiratory rate (≥70 bpm), age 2–11 months and weight-for-age Z-score (WAZ) < –3SD were highly discriminative of mortality. These factors ranked consistently across the different models. For a risk threshold probability of 7–14%, there is a net benefit to admitting the patient sub-populations with these features as additional criteria alongside those currently used to classify severe pneumonia. Of the population studied, 70.54% met at least one of these criteria. Sensitivity analyses indicated that the overall results were not significantly affected by variations in pneumonia severity classification criteria.ConclusionsChildren with non-severe pneumonia aged 2–11 months or with respiratory rate ≥ 70 bpm or very low WAZ experience risks of inpatient mortality comparable to severe pneumonia. Inpatient care is warranted in these high-risk groups of children.

Factors influencing the job satisfaction of nurses working in obstetric units in public hospitals in Kenya

Introduction: The literature demonstrates that little research has been conducted to explore job satisfaction among nurses working in obstetric units in Kenya. The perception of job satisfaction by nurses is influenced by the environment in which they work.Methods: A cross-sectional survey design was used to carry out the study. The study tools included the work quality index (WQI) and the demographic data questionnaires. Convenience sampling method was. Data were analyzed using the SPSS version 20. The items in the WQI were organized into six subscales and Cronbach’s alpha was calculated to obtain the reliability coefficient of each subscale. An independent t-test was used to compare the subscales scores for the male and female participants. ANOVA was conducted to compare the level of satisfaction with the six subscales and the participants’ characteristics. Pearson’s product-moment correlation coefficient was calculated to assess if there was any relationships, the magnitude and the direction of the relationship between the six subscales.Results: Nurses are most satisfied with the perception that the work associated with their position provides them with the opportunity to be of service to others and least satisfied with receiving enough time to complete indirect patient care tasks. There are no significant differences in the overall level of satisfaction between males and females though males are more satisfied with autonomy of practice and professional role enactment. The six subscales strongly and positively correlate with one another.Conclusions: Nurses working in the obstetric units are relatively dissatisfied with most of the aspects of the work environment. The more educated nurses are less satisfied than less educated nurses. Since all aspects of job satisfaction are interrelated, emphasis should be put on each of them so as to create a satisfying work environment for nurses working in obstetric units.

Molecular epidemiology of Klebsiella pneumoniae invasive infections over a decade at Kilifi County Hospital in Kenya

Multidrug resistant (MDR) Klebsiella pneumoniae is a common cause of nosocomial infections worldwide. Recent years have seen an explosion of resistance to extended-spectrum β-lactamases (ESBLs) and emergence of carbapenem resistance. Here, we examine 198 invasive K. pneumoniae isolates collected from over a decade in Kilifi County Hospital (KCH) in Kenya. We observe a significant increase in MDR K. pneumoniae isolates, particularly to third generation cephalosporins conferred by ESBLs. Using whole-genome sequences, we describe the population structure and the distribution of antimicrobial resistance genes within it. More than half of the isolates examined in this study were ESBL-positive, encoding CTX-M-15, SHV-2, SHV-12 and SHV-27, and 79% were MDR conferring resistance to at least three antimicrobial classes. Although no isolates in our dataset were found to be resistant to carbapenems we did find a plasmid with the genetic architecture of a known New Delhi metallo-β-lactamase-1 (NDM)-carrying plasmid in 25 isolates. In the absence of carbapenem use in KCH and because of the instability of the NDM-1 gene in the plasmid, the NDM-1 gene has been lost in these isolates. Our data suggests that isolates that encode NDM-1 could be present in the population; should carbapenems be introduced as treatment in public hospitals in Kenya, resistance is likely to ensue rapidly.

Exploring injury severity measures and in-hospital mortality: A multi-hospital study in Kenya

IntroductionLow- and middle-income countries (LMICs) have a disproportionately high burden of injuries. Most injury severity measures were developed in high-income settings and there have been limited studies on their application and validity in low-resource settings. In this study, we compared the performance of seven injury severity measures: estimated Injury Severity Score (eISS), Glasgow Coma Score (GCS), Mechanism, GCS, Age, Pressure score (MGAP), GCS, Age, Pressure score (GAP), Revised Trauma Score (RTS), Trauma and Injury Severity Score (TRISS) and Kampala Trauma Score (KTS), in predicting in-hospital mortality in a multi-hospital cohort of adult patients in Kenya. MethodsThis study was performed using data from trauma registries implemented in four public hospitals in Kenya. Estimated ISS, MGAP, GAP, RTS, TRISS and KTS were computed according to algorithms described in the literature. All seven measures were compared for discrimination by computing area under curve (AUC) for the receiver operating characteristics (ROC), model fit information using Akaike information criterion (AIC), and model calibration curves. Sensitivity analysis was conducted to include all trauma patients during the study period who had missing information on any of the injury severity measure(s) through multiple imputations. ResultsA total of 16,548 patients were included in the study. Complete data analysis included 14,762 (90.2%) patients for the seven injury severity measures. TRISS (complete case AUC: 0.889, 95% CI: 0.866–0.907) and KTS (complete case AUC: 0.873, 95% CI: 0.852–0.892) demonstrated similarly better discrimination measured by AUC on in-hospital deaths overall in both complete case analysis and multiple imputations. Estimated ISS had lower AUC (0.764, 95% CI: 0.736–0.787) than some injury severity measures. Calibration plots showed eISS and RTS had lower calibration than models from other injury severity measures. ConclusionsThis multi-hospital study in Kenya found statistical significant higher performance of KTS and TRISS than other injury severity measures. The KTS, is however, an easier score to compute as compared to the TRISS and has stable good performance across several hospital settings and robust to missing values. It is therefore a practical and robust option for use in low-resource settings, and is applicable to settings similar to Kenya.

Nurses knowledge, Perspectives and Practice of the nursing Process in Two Public Hospitals in Kenya: an Interventional Study

The nursing process is the foundation and organizational framework that guides professional nursing practice. Professionally, the nursing process is recognized as a model on which nursing standards are based and remains the universally accepted method of scientific nursing practice. This was a quasi-experimental study (with pre-test and post-test that was carried out from March 2013 to July 2015 in two public hospitals in Kenya. It aimed at establishing whether training of nurses on the nursing process would improve their knowledge, perspectives and practice of the nursing process in patient care. Analysis was performed by use of computer software statistical package for social scientists (SPSS version 22). Descriptive statistics was used to summarize the quantitative data while Chi square test was used to determine the whether there was significant difference between pre-test and posttest.The findings revealed significant difference (p&lt;0.05) in knowledge of the nursing process and on the number of nurses who stated that they utilize the nursing process. However there was no significant difference (p&gt;0.05) on the nurses perspectives towards the nursing process and the number of patients drawn for a care plan. The study concludedthat training was effective inimproving nursing process knowledge and utilizationbut not on the perspectives towards the nursing process. This therefore calls for healthcare organizations who intend to use the nursing process as model of providing quality nursing care to plan for continuous training programmes and also develop nursing audit mechanism to ensure its continued utilization and change of perspective.

Patient’s Participation in Nursing Care: an Integration of Orems Theory to the Nursing Process at Two Public Hospitals in Kenya

Patient’s Participation in Nursing Care: an Integration of Orems Theory to the Nursing Process at Two Public Hospitals in Kenya

Setting healthcare priorities: a description and evaluation of the budgeting and planning process in county hospitals in Kenya.

This paper describes and evaluates the budgeting and planning processes in public hospitals in Kenya. We used a qualitative case study approach to examine these processes in two hospitals in Kenya. We collected data by in-depth interviews of national level policy makers, hospital managers, and frontline practitioners in the case study hospitals (n = 72), a review of documents, and non-participant observations within the hospitals over a 7 month period. We applied an evaluative framework that considers both consequentialist and proceduralist conditions as important to the quality of priority-setting processes. The budgeting and planning process in the case study hospitals was characterized by lack of alignment, inadequate role clarity and the use of informal priority-setting criteria. With regard to consequentialist conditions, the hospitals incorporated economic criteria by considering the affordability of alternatives, but rarely considered the equity of allocative decisions. In the first hospital, stakeholders were aware of - and somewhat satisfied with - the budgeting and planning process, while in the second hospital they were not. Decision making in both hospitals did not result in reallocation of resources. With regard to proceduralist conditions, the budgeting and planning process in the first hospital was more inclusive and transparent, with the stakeholders more empowered compared to the second hospital. In both hospitals, decisions were not based on evidence, implementation of decisions was poor and the community was not included. There were no mechanisms for appeals or to ensure that the proceduralist conditions were met in both hospitals. Public hospitals in Kenya could improve their budgeting and planning processes by harmonizing these processes, improving role clarity, using explicit priority-setting criteria, and by incorporating both consequentialist (efficiency, equity, stakeholder satisfaction and understanding, shifted priorities, implementation of decisions), and proceduralist (stakeholder engagement and empowerment, transparency, use of evidence, revisions, enforcement, and incorporating community values) conditions.

Relationship between Flexible Work-Arrangement and Commitment of Nurses in Public Hospitals in Kenya

The study was set to determine the relationship between flexible work arrangement and commitment of nurses in public hospitals in Kenya. The study adopted cross sectional survey design and the target population consisted of 1217 nurses in 27 level 4 and 5 public hospitals. The researcher utilized simple random sampling to select counties that formed the sample of study. Five (5) counties out of forty seven (47) counties in Kenya were selected for the study. Proportionate random sampling was used to select 8 hospitals from the five counties selected. From the 7 hospitals sampled 364 nurses were selected through proportionate simple random sampling. Primary data were collected through the use of questionnaires which had both structured and unstructured questions. For data analysis linear regression analysis was used to regress relationship between flexible work arrangement and commitment of nurses in public hospitals in Kenya .It was found out that there is a significant positive relationship between flexible work arrangements and nurses’ commitment in public hospitals in Kenya (? = 0.725, p< 0.01). The study concludes that flexible work arrangement (flexitime, compressed work schedule, shift schedule and job sharing) has a positive significant linear relationship with nurses’ commitment. It recommends that matrons and administrators in public hospitals to develop flexible work arrangements practices that suit individual needs of the nurses and implement them in order to greatly enhance their commitment.

Kenya Hospices and Palliative Care Association: integrating palliative care in public hospitals in Kenya.

BackgroundIn Kenya, cancers as a disease group rank third as a cause of death after infectious and cardiovascular diseases. It is estimated that the annual incidence of cancer is about 37,000 new cases with an annual mortality of 28,000 cases (Kenya National Cancer Control Strategy 2010). The incidence of non-communicable diseases accounts for more than 50% of total hospital admissions and over 55% of hospital deaths (Kenya National Strategy for the Prevention and Control of Non Communicable Diseases 2015–2020). The prevalence of HIV is 6.8 (KIAS 2014). Most of these patients will benefit from palliative care services, hence the need to integrate palliative care services in the public healthcare system.MethodThe process of integrating palliative care in public hospitals involved advocacy both at the national level and at the institutional level, training of healthcare professionals, and setting up services within the hospitals that we worked with. Technical support was provided to each individual institution as needed.ResultsEleven provincial hospitals across the country have now integrated palliative care services (Palliative Care Units) and are now centres of excellence. Over 220 healthcare providers have been trained, and approximately, over 30,000 patients have benefited from these services. Oral morphine is now available in the hospital palliative care units.ConclusionAs a success of the pilot project, Kenya Hospices and Palliative Care Association (KEHPCA) is now working with the Ministry of Health Kenya to integrate palliative care services in 30 other county hospitals across the country, thus ensuring more availability and access to more patients. Other developing countries can learn from Kenya’s successful experience.

Laparoscopic Surgery in Low-income and Limited-resource Settings: Does It safely add Value? A Review of 2,901 Laparoscopic Gynecologic Procedures

Objectives: Of the 234 million surgeries conducted yearly worldwide, only 3.5% are carried out in low-income countries. Known advantages exist to laparoscopic surgery, and it is widely utilized in high-income countries; however, many barriers exist to uptake in low-income countries. Since 1992, laparoscopic surgery has been successfully undertaken in various rural public hospitals in Kenya. We sought to review outcomes of laparoscopic surgeries performed by our group in these facilities. Materials and methods: Between 1992 and 2015, 3,119 laparoscopic procedures were performed at 17 rural hospitals in Kenya as a part of the Round Table’s “Week of Healing Project.” The medical and operative records of all patients who underwent gynecological laparoscopic surgery were retrospectively reviewed for outcomes. Results: During the reporting period, 2,901 cases performed were gynecologic procedures; the mean age of patients was 34.2. Forty-one complications were encountered (1.41%), and one death (0.03%) occurred secondary to hemorrhage WJOLS

English

The aim of this study was to confirm the level of availability of essential medicines in public hospitals in Kenya and the factors leading to this. A cross-section approach was adopted for the research which was conducted across several public hospitals in Nakuru County. Data was collected using questionnaires as the main tool. The findings revealed that majority of the essential medicines that include common antibiotics, common analgesics, antihypertensives, emergency drugs and pediatric formulations were found to be stocked out. Stock outs were caused by poor distribution (91.2%), issues of funding (58%), inappropriate selection (58%), and irrational use (56%) of essential medicines. Key words: Health system, essential medicines, public health.

P2.170 Outcomes of Isoniazid Prophylaxis Among HIV-Infected Children in Routine Clinical Settings in Kenya

BackgroundIn 2011, the TB and HIV control programmes commenced a phased isoniazid prophylaxis therapy (IPT) implementation in selected public hospitals in Kenya. We report outcomes from the first three public...

Job conditions, job satisfaction, somatic complaints and burnout among East African nurses

To describe job conditions, job satisfaction, somatic complaints and burnout of female East African nurses working in public and private hospitals and to determine how these well-being outcomes are associated with job conditions. Insight into job conditions, health and well-being status and their interrelation is virtually lacking for East African nurses. Cross-sectional survey of 309 female nurses in private and public hospitals in Kenya, Tanzania and Uganda. Nurses completed a survey assessing job conditions and job satisfaction (the Leiden Quality of Work Life Questionnaire-nurses version), somatic complaints (subscale of the Symptom CheckList) and burnout (Maslach Burnout Inventory). The East African nurses show high levels of somatic complaints, and nearly one-third of the sample would be labelled as burned out. In comparison with a Western European nurses reference group, the nurses score unfavourably on job conditions that require financial investment (e.g. workload, staffing, equipment and materials). On aspects related to the social climate (e.g. decision latitude, cooperation), however, they score more favourably. In comparison with private hospital nurses, public hospital nurses score similarly on aspects related to the social climate, but worse on the other job conditions. Public hospital nurses have a lower job satisfaction than private hospital nurses, but show comparable levels of somatic complaints and burnout. Strongest correlates of low job satisfaction are low supervisor support and low financial reward. Burnout is mainly associated with high workload and inadequate information provision, whereas somatic complaints are associated with demanding physical working conditions. Improvement in job conditions may reduce the high levels of burnout and somatic complaints and enhance job satisfaction in East African nurses. Efforts and investments should be made to improve the job conditions in East African nurses as they are key persons in the delivery of health care.

Diagnostic performance of visible severe wasting for identifying severe acute malnutrition in children admitted to hospital in Kenya.

To determine the diagnostic value of visible severe wasting in identifying severe acute malnutrition at two public hospitals in Kenya. This was a cross-sectional study of children aged 6 to 59.9 months admitted to one rural and one urban hospital. On admission, mid-upper arm circumference (MUAC), weight and height were measured and the presence of visible severe wasting was assessed. The diagnostic performance of visible severe wasting was evaluated against anthropometric criteria. Of 11,166 children admitted, 563 (5%) had kwashiorkor and 1406 (12.5%) were severely wasted (MUAC < 11.5 cm). The combined sensitivity and specificity of visible severe wasting at the two hospitals, as assessed against a MUAC < 11.5 cm, were 54% (95% confidence interval, CI: 51-56) and 96% (95% CI: 96-97), respectively; at one hospital, its sensitivity and specificity against a weight-for-height z-score below -3 were 44.7% (95% CI: 42-48) and 96.5% (95% CI: 96-97), respectively. Severely wasted children who were correctly identified by visible severe wasting were consistently older, more severely wasted, more often having kwashiorkor, more often positive to the human immunodeficiency virus, ill for a longer period and at greater risk of death. Visible severe wasting had lower sensitivity for determining the risk of death than the anthropometric measures. There was no evidence to support measuring both MUAC and weight-for-height z-score. Visible severe wasting failed to detect approximately half of the children admitted to hospital with severe acute malnutrition diagnosed anthropometrically. Routine screening by MUAC is quick, simple and inexpensive and should be part of the standard assessment of all paediatric hospital admissions in the study setting.

The magnitude of abortion complications in Kenya

To estimate and describe the magnitude of abortion complications presenting at public hospitals in Kenya. Cross-sectional descriptive study. Hospital-based. Population Records of all women presenting prior to 22 weeks of gestation with abortion-related complications at selected hospitals during a three-week study period. All public tertiary and provincial hospitals were included; stratified random sampling was employed to select a subset of 54 district hospitals nationwide. Data collectors identified 809 patients with abortion complications on all hospital wards and completed a standardised questionnaire for each by extracting information from the patient's hospital record. Incidence, aetiology, morbidity and mortality of abortion complications. Most women (80%) presented with incomplete abortion. Approximately 34% of the women had reached the second trimester of pregnancy. Adolescents (14-19 years old) accounted for approximately 16% of the study sample. Manual vacuum aspiration was used to manage 80% of first trimester cases. The projected annual number of women with abortion complications admitted to public hospitals in Kenya is 20,893. The case fatality rate was estimated to be 0.87% (95% CI 0.71-1.02%), so an estimated 182 (95% CI 148-213) of these women die annually. The annual incidence of incomplete abortion and other abortion-related complications per 1000 women aged 15 to 49 years is projected to be 3.03. The high rate of abortion-related morbidity and mortality documented in the study highlights the critical need to address the issue of unsafe abortion in Kenya.