By Gatonye Gathura
A newborn in Nairobi is more likely to die for lack of health care than in anywhere else in Kenya, shows an assessment report of city hospitals.
The assessment of all 33 city health facilities offering 24/7 inpatient newborn care shows almost all the sick children are crowded in just five poorly resourced facilities.
A team from the Nairobi County Government, the Ministry of Health, Kenya Medical Research Institute and Oxford University, UK, found half of sick newborns in the city are not getting adequate or any care at all.
Paradoxically the authors say Nairobi has the highest, 88.7 per cent, of mothers delivering within a health facility compared to 61.2 per cent nationally.
“Yet, the newborn death rate in Nairobi is considerably higher than elsewhere in Kenya,” says the report published on Friday (April 27, 2018) in the journal Plos One.
During the study period, July 2014 to June 2015, there were an estimated 21,966 births in Nairobi with 12,202 admissions for newborns, 84 per cent of these in only five facilities. Some 1,296 deaths were reported during the period.
The report says 44 per cent of the total newborns or 9,764 babies did not get health care while a further nine per cent or 2,026 attended substandard facilities.
“This suggests over 50 per cent of Nairobi’s sick newborns may not access a facility with adequate resources to provide essential care,” says the study.
The five most attended hospitals; four public and one low cost mission facility, the report says face major challenges including high patient deaths, few nurses and overcrowding.
Two of these facilities, a public and a low-cost mission sector facility, the report says had an occupancy of117 per cent and 149 per cent respectively. The mission hospital had 1,324 newborn admissions during the study period.
While for confidentiality the report does not name the assessed institutions, Kenyatta National Hospital, Mbagathi Sub-County Hospital, Mama Lucy Kibaki, Pumwani Maternity Hospital and St Mary’s Mission Hospital are some of the most visited 24/7 facilities in the city.
On the other hand 21 mainly private facilities were found to be of poor quality, with no capacity to adequately treat even common newborn illnesses. Some were found to employ various underhand practices to maximize profits.
Such facilities lacked equipment, space and commodities and had inadequate staffing levels.
In many cases a single nurse was in charge of up to 15 very sick newborns against the ideal staffing of one nurse to two such babies.
The report also captures the paradox of idle bed capacity mainly in private and faith based facilities compared to over admission in public hospitals offering free services.
Despite the low number of patients in private facilities there were high rates of referrals between facilities in the country. Most common referrals were from a private to a government facility mainly for patients who were not able to pay.
All private and mission facilities, levied charges ranging from Sh2, 000 to Sh30, 000 in mission hospitals and Sh3, 000 to Sh50, 000 in private hospitals per night stay.
The team also captured some underhand practices especially in the private hospitals including unnecessarily long hospital admissions.
They also found as many as, 2,605 babies with minor conditions being inappropriately admitted to the more expensive maternity and newborn units.
“There may also be perverse incentives for admission to the newborn unit in facilities levying charges for such admission,” suggest the authors.
The team suggest for Nairobi County to reduce newborn deaths it will require effective long-term, multi-sectoral planning and huge investment.
At a Glance
Study assessed all 33 facilities offering 24/7 newborn care in Nairobi
Estimated 21,966 annual newborns in Nairobi County
50 per cent receiving none or inadequate care
There were 12,202 admissions for newborns in the one year study period,
84 per cent admitted in only five hospitals
There were 1,296 deaths
These hospitals are ill resourced and overcrowded with inadequate staffing
21 of private facilities offering 24/7 newborn care are substandard