Audit of quality of neonatal sepsis care at Kenyatta National Hospital general paediatric wards

Abstract

Background:Neonatal sepsis is a major contributor to neonatal deaths, accounting for about 26% of all neonatal deaths in Africa. Studies have shown that clinical outcome for specific conditions, including the risk of death, are correlated with quality of hospital care. Clinical practice guidelines for childhood illnesses, including neonatal sepsis in Kenya are contained in the Ministry of Health Basic Paediatric Protocols. These have been disseminated through Emergency Triage, Assessment and Treatment plus Admission (ETAT+) course since 2007. Objectives:The study set to assess the process of clinical care given to neonates admitted at Kenyatta National Hospital general paediatric wards with a diagnosis of sepsis and to determine the factors associated with mortality. Methodology:This was a hospital based descriptive study involving review of medical records of neonates admitted with the diagnosis of neonatal sepsis at the Kenyatta National Hospital general paediatric wards between January 2011 and December 2011. A total of 385 medical records were evaluated. Data were collected by use of an assessment tool and entered into preformed access spreadsheets and analyzed using statistical package for social sciences (SPSS). Results: Assessment was done based on three domains of care. Total documentation score was 16 (IQR 14-17), recommended first line antibiotic treatment for neonatal sepsis was given in 64.4% and supportive care given at admission was good. Mortality rate was 5.5% with 52.4% deaths occurring within the first 48 hours of admission. Neonates with no change in level of activity, no difficulty breastfeeding and who had no grunting were at a lower risk of dying. Conclusion: Documentation of some aspects of neonatal history was good, antibiotic choice was good though there were dosing errors and initial supportive care was good though monitoring of vital signs was poor. Mortality was significantly associated with short duration of hospital stay, change in level of activity, difficulty breastfeeding and grunting.