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Developing recommendations for neonatal inpatient care service categories: reflections from the research, policy and practice interface in Kenya

Neonatal deaths contribute a growing proportion to childhood mortality, and increasing access to inpatient newborn care has been identified as a potential driver of improvements in child health. However, previous work by this research team identified substantial gaps in the coverage and standardisat...

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Autores principales: Keene, Claire Marriott, Aluvaala, Jalemba, Murphy, Georgina A V, Abuya, Nancy, Gathara, David, English, Mike
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6441269/
https://www.ncbi.nlm.nih.gov/pubmed/30997163
http://dx.doi.org/10.1136/bmjgh-2018-001195
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author Keene, Claire Marriott
Aluvaala, Jalemba
Murphy, Georgina A V
Abuya, Nancy
Gathara, David
English, Mike
author_facet Keene, Claire Marriott
Aluvaala, Jalemba
Murphy, Georgina A V
Abuya, Nancy
Gathara, David
English, Mike
author_sort Keene, Claire Marriott
collection PubMed
description Neonatal deaths contribute a growing proportion to childhood mortality, and increasing access to inpatient newborn care has been identified as a potential driver of improvements in child health. However, previous work by this research team identified substantial gaps in the coverage and standardisation of inpatient newborn care in Nairobi City County, Kenya. To address the issue in this particular setting, we sought to draft recommendations on the categorisation of neonatal inpatient services through a process of policy review, evidence collation and examination of guidance in other countries. This work supported discussions by a panel of local experts representing a diverse set of stakeholders, who focused on formulating pragmatic, context-relevant guidance. Experts in the discussions rapidly agreed on overarching priorities guiding their decision-making, and that three categories of inpatient neonatal care (standard, intermediate and intensive care) were appropriate. Through a modified nominal group technique, they achieved consensus on allocating 36 of the 38 proposed services to these categories and made linked recommendations on minimum healthcare worker requirements (skill mix and staff numbers). This process was embedded in the local context where the need had been identified, and required only modest resources to produce recommendations on the categorisation of newborn inpatient care that the experts agreed could be relevant in other Kenyan settings. Recommendations prioritised the strengthening of existing facilities linked to a need to develop effective referral systems. In particular, expansion of access to the standard category of inpatient neonatal care was recommended. The process and the agreed categorisations could inform discussion in other low-resource settings seeking to address unmet needs for inpatient neonatal care.
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spelling pubmed-64412692019-04-17 Developing recommendations for neonatal inpatient care service categories: reflections from the research, policy and practice interface in Kenya Keene, Claire Marriott Aluvaala, Jalemba Murphy, Georgina A V Abuya, Nancy Gathara, David English, Mike BMJ Glob Health Practice Neonatal deaths contribute a growing proportion to childhood mortality, and increasing access to inpatient newborn care has been identified as a potential driver of improvements in child health. However, previous work by this research team identified substantial gaps in the coverage and standardisation of inpatient newborn care in Nairobi City County, Kenya. To address the issue in this particular setting, we sought to draft recommendations on the categorisation of neonatal inpatient services through a process of policy review, evidence collation and examination of guidance in other countries. This work supported discussions by a panel of local experts representing a diverse set of stakeholders, who focused on formulating pragmatic, context-relevant guidance. Experts in the discussions rapidly agreed on overarching priorities guiding their decision-making, and that three categories of inpatient neonatal care (standard, intermediate and intensive care) were appropriate. Through a modified nominal group technique, they achieved consensus on allocating 36 of the 38 proposed services to these categories and made linked recommendations on minimum healthcare worker requirements (skill mix and staff numbers). This process was embedded in the local context where the need had been identified, and required only modest resources to produce recommendations on the categorisation of newborn inpatient care that the experts agreed could be relevant in other Kenyan settings. Recommendations prioritised the strengthening of existing facilities linked to a need to develop effective referral systems. In particular, expansion of access to the standard category of inpatient neonatal care was recommended. The process and the agreed categorisations could inform discussion in other low-resource settings seeking to address unmet needs for inpatient neonatal care. BMJ Publishing Group 2019-03-07 /pmc/articles/PMC6441269/ /pubmed/30997163 http://dx.doi.org/10.1136/bmjgh-2018-001195 Text en © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY. Published by BMJ. This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.
spellingShingle Practice
Keene, Claire Marriott
Aluvaala, Jalemba
Murphy, Georgina A V
Abuya, Nancy
Gathara, David
English, Mike
Developing recommendations for neonatal inpatient care service categories: reflections from the research, policy and practice interface in Kenya
title Developing recommendations for neonatal inpatient care service categories: reflections from the research, policy and practice interface in Kenya
title_full Developing recommendations for neonatal inpatient care service categories: reflections from the research, policy and practice interface in Kenya
title_fullStr Developing recommendations for neonatal inpatient care service categories: reflections from the research, policy and practice interface in Kenya
title_full_unstemmed Developing recommendations for neonatal inpatient care service categories: reflections from the research, policy and practice interface in Kenya
title_short Developing recommendations for neonatal inpatient care service categories: reflections from the research, policy and practice interface in Kenya
title_sort developing recommendations for neonatal inpatient care service categories: reflections from the research, policy and practice interface in kenya
topic Practice
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6441269/
https://www.ncbi.nlm.nih.gov/pubmed/30997163
http://dx.doi.org/10.1136/bmjgh-2018-001195
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