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Estimating the need for inpatient neonatal services: an iterative approach employing evidence and expert consensus to guide local policy in Kenya
  1. Georgina A V Murphy1,2,
  2. Donald Waters3,
  3. Paul O Ouma2,
  4. David Gathara2,
  5. Sasha Shepperd4,
  6. Robert W Snow1,2,
  7. Mike English1,2
  8. Health Services that Deliver for Newborns Expert Group
  1. 1 Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
  2. 2 KEMRI - Wellcome Trust Research Programme, Nairobi, Kenya
  3. 3 Oxford University Clinical Academic Graduate School, Medical Sciences Division, University of Oxford, Oxford, UK
  4. 4 Nuffield Department of Population Health, University of Oxford, Oxford, UK
  1. Correspondence to Dr Georgina A V Murphy; georgina.murphy{at}ndm.ox.ac.uk

Abstract

Universal access to quality newborn health services will be essential to meeting specific Sustainable Development Goals to reduce neonatal and overall child mortality. Data for decision making are crucial for planning services and monitoring progress in these endeavours. However, gaps in local population-level and facility-based data hinder estimation of health service requirements for effective planning in many low-income and middle-income settings.

We worked with local policy makers and experts in Nairobi City County, an area with a population of four million and the highest neonatal mortality rate amongst counties in Kenya, to address this gap, and developed a systematic approach to use available data to support policy and planning. We developed a framework to identify major neonatal conditions likely to require inpatient neonatal care and identified estimates of incidence through literature review and expert consultation, to give an overall estimate for the year 2017 of the need for inpatient neonatal care, taking account of potential comorbidities.

Our estimates suggest that almost 1 in 5 newborns (183/1000 live births) in Nairobi City County may need inpatient care, resulting in an estimated 24 161 newborns expected to require care in 2017. Our approach has been well received by local experts, who showed a willingness to work together and engage in the use of evidence in healthcare planning. The process highlighted the need for co-ordinated thinking on admission policy and referral care especially in a pluralistic provider environment helping build further appetite for data-informed decision making.

  • child health
  • health services research
  • health policy
  • public health

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/

https://doi.org/10.1136/bmjgh-2017-000472

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    Footnotes

    • GAVM and DW contributed equally.

    • Handling editor Seye Abimbola

    • Contributors ME and GAVM designed the approach discussed in the manuscript with contributions from DW, RWS, DG and SS. DW conducted the literature review and analysis. POO and RWS provided expertise on geospatial mapping. GAVM and DW wrote the manuscript with substantial critical input from all authors. All authors read and approved the final version of the manuscript.

    • Funding This work was supported by a Health Systems Research Initiative joint grant provided by the Department for International Development, UK (DFID), Economic and Social Research Council (ESRC), Medical Research Council (MRC) and Wellcome Trust, grant number MR/M015386/1. DW was supported by Oxford University Clinical Academic Graduate School (OUCAGS). RWS is supported by the Wellcome Trust as Principal Research Fellow (#103602) and ME by a Wellcome Trust Senior Fellowship (#097170).

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement Comprehensive supplemental material has been provided with this manuscript. If the reader requires any further information about the methods or literature review findings, they are welcome to contact the corresponding author.

    • Collaborators Health Services that Deliver for Newborns Expert Group: Prof Aggrey Wasunna (University of Nairobi), Prof Fred Were (University of Nairobi/ Aga Khan University), Dr Catherine Mutinda and Dr Beth Maina (Pumwani Maternity Hospital), Dr Cecilia Mutiso (Mama Lucy Kibaki Hospital), Dr David Githanga (Kenya Paediatric Association), Dr David Kimutai (Mbagathi District Hospital), Dr Nancy Abuya (Nairobi City County/KWTRP), Prof Rachel Musoke (University of Nairobi), Dr Roseline Ochieng (Aga Khan University), Prof William Macharia (Aga Khan University), and Dr Rachel Nyamai (Ministry of Health).

    • Correction notice This article has been corrected since it first published. The equal contributor statement has been included