Kenya: High child deaths as public nurses fail to record vital signs, MoH

Almost half of sick children in Kenya’s public hospitals do not have their vital signs including temperature, breathing and pulse rates recorded at admission as is required.

Consequently the number of children dying in public hospitals due to lack of basic care is staggering, shows a report by the Ministry of Health.

In a rare admission, the report says more children are dying in Kenya’s general wards than in intensive care units of developed countries.

54,000 admissions studied

The largest ever study on nursing care of children in Kenya shows one in 10 admitted children die mainly due to lack of basic care.

The two-year study shows that sick children are not receiving the most basic but crucial care in referral public health facilities.

Almost half of the children do not have their vital signs including temperature, breathing and pulse rates recorded at admission as is required.

Since the reported deaths of 11 infants at Pumwani hospital last month, congestion at Kiambu and Oginga Odinga facilities and drug shortages across the country more evidence shows a sector in total crisis.

This is laid bare in a study which assessed the quality of nursing care admitted children are getting in  top-tier county hospitals across Kenya.

The survey in 13 referral county facilities, previously district hospitals, covered 54,000 admissions.

The results show the care being given to sick children is extremely poor and highly sickening.

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

Clinical Information Network (CIN)

The survey was carried out by the Clinical Information Network (CIN) a collaboration of the Ministry of Health, Kenya Medical Research Institute (Kemri), University of Nairobi and Kenya Paediatric Association.

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

Vital signs: Body temperature, beating of the heart or pulse rate and breathing or respiration rate are supposed to be recorded on admission and monitored throughout the hospital stay.

However, only in three out of the 13 facilities this was being done consistently.

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 the vital signs recorded while only 0.2 per cent had their purse rates taken.

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

This, the report shows to have been very low and only consistent in three out of the 13 hospitals.

Estimates

Even where done, the quality of the recording was very poor with evidence showing most of the nurses had recorded estimates but not actual measurements.

For example most of the recorded data were rounded figures or most ended in even numbers, an indication, the authors say 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,” say the study.

The study found pneumonia and respiratory conditions as the major problem in almost all the hospitals.

The CIN group says it is disturbing that pneumonia and respiratory illnesses still remain major problems 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,” queries the study.

Two other recent studies at Gertrude’s Children’s Hospital and Kenyatta National Hospital have questioned the effectiveness of pneumonia and rotavirus vaccines.

The researchers further investigated the cause of this huge neglect of children in top tier public hospitals.

The main problem, the team says is the acute shortage of nursing staff in public hospitals.

“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.

One nurse for 40 beds

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

“It is then not surprising that vital signs may be left unmeasured or unrecorded and nurses are unable to prioritize sicker patients for monitoring.”

Data from the Ministry of Health indicates there are 20,981 nurses in public hospitals against a requirement of about 52,000 nurses.

But with reduced, irregular and delayed budgetary allocations from the central government, counties are not employing.

Last year a report by Elkana Onguti, the chief economist at the ministry warned that the current county health wage bill is not sustainable.

Onguti said 37 counties had allocated more than the recommended 72 per cent to recurrent expenditure with almost all the money going into staff salaries.

He had recommended that counties bring down the health wage bill to between 50 and 60 per cent of their health budgetary allocations.

www.rocketscience.co.ke

Some data

Study involved 54,000 admissions

43 per cent of children’s vital signs not recorded

1 out of 10 children die for lack of basic care

1 nurse in charge of 41 beds with some beds having more than 2 children

20,981 nurses in public hospitals against a requirement of about 52,000 nurses

Currently no budget to employ new nurses

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