No abstract

Globally, 2.4 million newborns die in the first month of life, with neonatal mortality rates (NMR) per 1,000 livebirths being highest in sub-Saharan Africa. Improving access to inpatient newborn care is necessary for reduction of neonatal deaths in the region. We explore the relationship between distance to inpatient hospital newborn care and neonatal mortality in Kenya. Data on service availability from numerous sources were used to map hospitals that care for newborns with very low birth weight (VLBW). Estimates of livebirths needing VLBW services were mapped from population census data at 100 m spatial resolution using a random forest algorithm and adjustments using a systematic review of livebirths needing these services. A cost distance algorithm that adjusted for proximity to roads, road speeds, land use and protected areas was used to define geographic access to hospitals offering VLBW services. County-level access metrics were then regressed against estimates of NMR to assess the contribution of geographic access to VLBW services on newborn deaths while controlling for wealth, maternal education and health workforce. 228 VLBW hospitals were mapped, with 29,729 births predicted as requiring VLBW services in 2019. Approximately 80.3% of these births were within 2 hours of the nearest VLBW hospital. Geographic access to these hospitals, ranged from less than 30% in Wajir and Turkana to as high as 80% in six counties. Regression analysis showed that a one percent increase in population within 2 hours of a VLBW hospital was associated with a reduction of NMR by 0.24. Despite access in the country being above the 80% threshold, 17/47 counties do not achieve this benchmark. To reduce inequities in NMR in Kenya, policies to improve care must reduce geographic barriers to access and progressively improve facilities’ capacity to provide quality care for VLBW newborns.

Purpose: This descriptive cross-sectional study sought to assess the implementation of the nursing process by nurses in two sub county hospitals in Machakos county, Namely: Kangundo and Kathiani sub county hospitals. The study examined the influence of the nurses’ characteristics and the nurses’ attitudes on the implementation of the nursing process in the  sub County. Methods: A self-administered questionnaire collected quantitative data, while key informant interviews were used to gather qualitative information. Descriptive statistics and inferential statistics (in particular, the chi-square and Fisher’s Exact) were derived from the data. Results: Sixty-three percent of the nurses (n=45) had drafted a NCP a week prior to the study while 35.7% (n=25) had not. Seventy-five percent of them (n=41) had implemented the NCP. The nurses who developed the nursing care plan frequently ended up implementing it (100%, n=43) compared to those who did not (23.1%, n=3; fisher’s Exact Test P=0.000). Similarly, among the nurses who did not implement the nursing process, 76.9% (N=10) of them felt that NCP is time consuming. This difference was significant at 5% confidence level (LR=8.717, df=2, p=0.013). Although statistical analysis revealed no significant association between nursing process implementation and socio-demographic factors (p>0.05), qualitative findings suggested that the newly qualified nurses are more familiar with the nursing process than their older colleagues. Unique contribution to theory, practice and policy: study recommends that nursing administration cultivate positive mentality among nurses towards the nursing process; particularly focusing on making nurses understand that the tool should be consistently used among all patients and that it significantly improves patient care.