RT Journal Article SR Electronic T1 Employing learning health system principles to advance research on severe neonatal and paediatric illness in Kenya JF BMJ Global Health JO BMJ Global Health FD BMJ Publishing Group Ltd SP e005300 DO 10.1136/bmjgh-2021-005300 VO 6 IS 3 A1 Mike English A1 Grace Irimu A1 Samuel Akech A1 Jalemba Aluvaala A1 Morris Ogero A1 Lynda Isaaka A1 Lucas Malla A1 Timothy Tuti A1 David Gathara A1 Jacquie Oliwa A1 Ambrose Agweyu YR 2021 UL http://gh.bmj.com/content/6/3/e005300.abstract AB We have worked to develop a Clinical Information Network (CIN) in Kenya as an early form of learning health systems (LHS) focused on paediatric and neonatal care that now spans 22 hospitals. CIN’s aim was to examine important outcomes of hospitalisation at scale, identify and ultimately solve practical problems of service delivery, drive improvements in quality and test interventions. By including multiple routine settings in research, we aimed to promote generalisability of findings and demonstrate potential efficiencies derived from LHS. We illustrate the nature and range of research CIN has supported over the past 7 years as a form of LHS. Clinically, this has largely focused on common, serious paediatric illnesses such as pneumonia, malaria and diarrhoea with dehydration with recent extensions to neonatal illnesses. CIN also enables examination of the quality of care, for example that provided to children with severe malnutrition and the challenges encountered in routine settings in adopting simple technologies (pulse oximetry) and more advanced diagnostics (eg, Xpert MTB/RIF). Although regular feedback to hospitals has been associated with some improvements in quality data continue to highlight system challenges that undermine provision of basic, quality care (eg, poor access to blood glucose testing and routine microbiology). These challenges include those associated with increased mortality risk (eg, delays in blood transfusion). Using the same data the CIN platform has enabled conduct of randomised trials and supports malaria vaccine and most recently COVID-19 surveillance. Employing LHS principles has meant engaging front-line workers, clinical managers and national stakeholders throughout. Our experience suggests LHS can be developed in low and middle-income countries that efficiently enable contextually appropriate research and contribute to strengthening of health services and research systems.