Hospitals 'skip basic care step for children'

Almost half of sick children in public hospitals do not have their vital signs recorded at admission, as is required, a study has said.

The largest ever study on nursing care of children, which was conducted over two years, also shows one in 10 children die mainly due to lack of basic care.

The survey, conducted in 13 referral county facilities and covering 54,000 admissions, was carried out by the Clinical Information Network (CIN), a collaboration of the Ministry of Health, Kenya Medical Research Institute, University of Nairobi and Kenya Paediatric Association.

The data was collected up to 2016, analysed last year and published in June in the Journal of Global Health.

The survey found that the vital signs in 43 per cent of children were not been taken at admission.

Body temperature, pulse and respiration rates are supposed to be recorded and monitored throughout the hospital stay.

However, this was only done consistently in three of the 13 hospitals.

Vital signs

In some of the facilities, less than two per cent of children had their vital signs recorded.

More than eight per cent of children did not have any of their vital signs recorded while only 0.2 per cent had their pulse rates taken.

Once admitted, the researchers said it was a requirement that patients’ vital signs be monitored and recorded at least three times in every 24 hours.

Again, this was only consistently done in three of the 13 hospitals.

Even where monitoring was done, the quality of the recording was poor, with evidence showing most of the nurses had recorded estimates. For example, most of the recorded data were round-up figures or most ended in even numbers. This, the authors said, was an indication that they were estimates.

“Our data raise concerns that in practice, inaccurate respiratory rate measures are likely to result in misclassification of pneumonia, poor targeting of treatments and inability to detect deterioration or improvement,” says the study.

The CIN group said it was disturbing that pneumonia and respiratory illnesses remained major problems in almost all hospitals despite availability of protective vaccines.

“The high proportion of children admitted with pneumonia is worthy of note despite more than 10?years use of flu (HiB) vaccine and use of the PCV10 pneumonia vaccine.”

Two recent studies at Gertrude’s Children’s Hospital and Kenyatta National Hospital have questioned the effectiveness of the pneumonia and rotavirus vaccines. The researchers further investigated the cause of children's neglect in top-tier public hospitals, which they identified as acute shortage of nursing staff.

“In these hospitals each qualified nurse is typically responsible for between 10 and 41 beds. There can be two or more children admitted to a bed,” says the report.

In five of the 13 hospitals, typically only one qualified nurse was present on a shift whereas in the other eight, there were only two nurses.

Data from the Health ministry indicate there are 20,981 nurses in public hospitals against a requirement of about 52,000. www.rocketscience.co.ke