{"id":38471,"date":"2019-09-10T10:08:33","date_gmt":"2019-09-10T14:08:33","guid":{"rendered":"https:\/\/www.healthynewbornnetwork.org\/?p=38471"},"modified":"2019-08-28T14:51:03","modified_gmt":"2019-08-28T18:51:03","slug":"missed-nursing-care-in-newborn-units-the-need-for-improvements-in-nursing-workforce-in-lmics","status":"publish","type":"post","link":"https:\/\/www.healthynewbornnetwork.org\/blog\/missed-nursing-care-in-newborn-units-the-need-for-improvements-in-nursing-workforce-in-lmics\/","title":{"rendered":"Missed nursing care in newborn units: The need for improvements in nursing workforce in LMICs"},"content":{"rendered":"

By Dr. David Gathara<\/strong><\/em><\/p>\n

Improved hospital care is needed to reduce newborn mortality in low- and mid-income countries (LMICs). Nurses are essential to the delivery of safe and effective care. In hospitals, they are responsible for initiating and delivering interventions as well as coordinating care provided by other professionals (e.g doctors, nutritionists); but nurse shortages and high patient workloads<\/a> may result in missed care. Sick newborns require continuous high-level care over multiple days, predominantly from nurses, and are especially likely to suffer detrimental consequences of missed care.<\/p>\n

Using direct-observational methods, we examined nursing care delivered to 216 sick newborns who were admitted in six health facilities across the public, mission and private sectors in Nairobi, Kenya<\/a>, in an effort to identify nursing tasks done (or left undone).<\/p>\n

We observed great variation in task completion with omission of nursing tasks that might directly influence the baby\u2019s outcome, such as feeding, monitoring of vital signs and appropriate use of interventions like fluids and oxygen. This highlights potentially critical safety and patient well-being issues. Aggregating nursing tasks done per baby, average task completion was 60% (95% CI 58 \u2013 62) with at least 80% of essential tasks completed for only 14% of babies. Private sector facilities had a median ratio of three babies to nurses, with a maximum of seven babies per nurse. In the public sector, the median ratio was 19 babies per nurse, with a maximum exceeding 25 babies per nurse. In exploratory analysis, ratios of \u2265 12 babies per nurse were associated with a 24% increase in missed care when compared with ratios of \u2264 three babies per nurse. Our results suggest that the high levels of missed care observed in the public sector are most likely related to the very high baby to nurse ratios found in public hospitals (figure 1).\"\"<\/p>\n

Figure 1: Nursing care index for each baby by number of babies per nurse across sectors<\/em><\/h3>\n

As part of a wider programme of work, we observed that nurses\u2019 time is often taken up by tasks that are not necessarily core to the nursing role. Examples include clerical tasks such as organising patient files, receiving telephone calls and billing, collecting supplies from stores and ward cleaning, including baby cots and equipment. These non-patient facing activities take up a significant amount of their time. There are opportunities to refocus nursing practice on skilled tasks for which they are specifically trained and re-assign some tasks to other workers.<\/p>\n

In higher income countries there is a growing body of literature that demonstrates that missed care is associated with low nurse staffing ratios and poorer patient safety, poorer care quality and worse patient outcomes. Similar data have been lacking from LMICs and our studies are some of the first to report and explain this link. We propose that the absence of studies quantifying the link between nursing shortages and the quality of hospital care in LMICs results in nurses\u2019 contribution being undervalued. As a result, shortages in nursing and throughout the wider workforce are not addressed and undermine the nurses\u2019 ability to deliver quality care.<\/p>\n

While our data illustrate how nursing shortages contribute to missed care of ill babies, there are probably important effects of such high workloads on the nurses themselves, including their own perception of failing to meet the standards of care they aspire to as professionals. The exhaustion and burnout that are also potential consequences are important detrimental effects on the emotional and psychological well-being of nurses and on the sustainability of this crucial workforce.<\/p>\n

Improving quality of care and its contribution to newborn survival clearly demands an expansion of the nursing workforce, potentially complemented by additional human resource investments that allow nurses to operate as skilled providers. Failure to address critical workforce issues will mean that missed care remains common and undermines efforts to deliver high-impact, low-cost interventions for small and sick babies. The highlighted gaps in care underscore the urgent need for system strengthening to support quality improvement initiatives and to increase neonatal survival, while also indicating the need for further research on service redesign that focus on nursing.<\/p>\n

Read the original journal article, Missed nursing care in newborn units: a cross-sectional direct observational study,\u00a0<\/em>here<\/a>.<\/p>\n","protected":false},"excerpt":{"rendered":"

By Dr. David Gathara Improved hospital care is needed to reduce newborn mortality in low- and mid-income countries (LMICs). Nurses are essential to the delivery of safe and effective care. In hospitals, they are responsible for initiating and delivering interventions as well as coordinating care provided by other professionals (e.g doctors, nutritionists); but nurse shortages … Continued<\/a><\/p>\n","protected":false},"author":7211,"featured_media":38475,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[1],"tags":[],"acf":[],"yoast_head":"\nHealthy Newborn Network<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.healthynewbornnetwork.org\/blog\/missed-nursing-care-in-newborn-units-the-need-for-improvements-in-nursing-workforce-in-lmics\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Missed nursing care in newborn units: The need for improvements in nursing workforce in LMICs - Healthy Newborn Network\" \/>\n<meta property=\"og:description\" content=\"By Dr. David Gathara Improved hospital care is needed to reduce newborn mortality in low- and mid-income countries (LMICs). 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However, the reality is that such research is rarely translated into practice, especially in low income settings. Thus, one of CNHG'S major aims is to understand and evaluate the quality of care and the development and implementation of clinical practice guidelines. The single largest area of work focuses on rural, Kenyan district hospitals and their ability to provide effective, evidence-based care to seriously ill children and newborns. Research includes quantitative and qualitative evaluation of health system performance and the roles of health workers, including, for example, evaluation of adherence to guidelines, explorations of health worker motivation and barriers to implementing best practice care.<\/p>\r\n<p>Further areas of work are also focused on helping to meet local research needs and build capacity and have a relatively broad scope including:<\/p>\r\n<ul>\r\n <li>  Examining the value of research from an ethical perspective<\/li>\r\n <li>  Economic evaluation of new childhood vaccines<\/li>\r\n <li>  Promoting bacterial disease surveillance in East Africa (www.netspear.org).<\/li>\r\n <li>  Evidence review and synthesis to inform development of national treatment guidelines (www.ichrc.org). This work is conducted in collaboration with the Ministry of Health in Kenya and, hopefully, with the proposed Kenyan Branch of the South African Cochrane Collaboration.<\/li>\r\n<\/ul>\r\n<p>In the future research in clinical epidemiology to tackle questions identified as of major importance by rural clinical, providers will be initiated to promote improved child and newborn survival.<\/p>\r\n<p>Collaborators:<\/p>\r\n<ul>\r\n <li>  University of Nairobi,<\/li>\r\n <li>  Ministry of Medical Services \/ Ministry of Public Health and Sanitation,<\/li>\r\n <li>  University of Witswatersrand,<\/li>\r\n <li>  London School of Hygiene and Tropical Medicine,<\/li>\r\n <li>  University of Oxford,<\/li>\r\n <li>  WHO-Geneva and WHO-Kenya<\/li>\r\n<\/ul>\r\n","post_title":"Child & Newborn Health Group, Kemri-Wellcome Trust Research Programme","post_excerpt":"","post_status":"publish","comment_status":"closed","ping_status":"closed","post_password":"","post_name":"child-newborn-health-group-kemri-wellcome-trust-research-programme","to_ping":"","pinged":"","post_modified":"2016-01-20 22:16:48","post_modified_gmt":"2016-01-20 22:16:48","post_content_filtered":"","post_parent":0,"guid":"http:\/\/www.healthynewbornnetwork.org\/?post_type=partner&p=492","menu_order":0,"post_type":"partner","post_mime_type":"","comment_count":"0","filter":"raw"}],"issues":[{"ID":124,"post_author":"7211","post_date":"2015-10-21 15:18:57","post_date_gmt":"2015-10-21 15:18:57","post_content":"<p>[vc_row full_width=\"stretch_row\" css=\".vc_custom_1453403441710{margin-top: -60px !important;padding-top: 30px !important;padding-bottom: 30px !important;background-color: #ffffff !important;}\"][vc_column width=\"1\/2\"][vc_column_text]<\/p>\n<h2>In order to meet our maternal and newborn health objectives, we need health professionals and community health workers that:<\/h2>\n<ul>\n<li>Are readily available where and when needed<\/li>\n<li>Have the necessary knowledge and skills for the services they are providing<\/li>\n<li>Are appropriately motivated to provide the needed service<\/li>\n<li>Are adequately supported and enabled with supervision, support systems (supply chain and\u00a0information systems), necessary infrastructure (space, water, electricity, and communications), and more<\/li>\n<\/ul>\n<p>Ensuring that this set of conditions is met depends on adequate human resources policy and management.[\/vc_column_text][\/vc_column][vc_column width=\"1\/2\" el_class=\"issue-stats\"][vc_row_inner content_placement=\"middle\"][vc_column_inner el_class=\"text-red\" width=\"1\/3\"][vc_column_text]<\/p>\n<h1 style=\"text-align: center;\"><strong><span class=\"ticker\">82<\/span><\/strong><\/h1>\n<p>[\/vc_column_text][\/vc_column_inner][vc_column_inner width=\"2\/3\"][vc_column_text css=\".vc_custom_1691004009799{padding-top: 10px !important;padding-bottom: 10px !important;}\"]<\/p>\n<h3 style=\"text-align: center;\"><span style=\"font-weight: 400;\">percentage of global births that were assisted by suitably qualified health workers between 2016 and 2021<\/span><\/h3>\n<p>[\/vc_column_text][\/vc_column_inner][\/vc_row_inner][vc_separator][vc_row_inner content_placement=\"middle\"][vc_column_inner el_class=\"text-yellow\" width=\"1\/3\"][vc_column_text]<\/p>\n<h1 style=\"text-align: center;\"><strong><span class=\"ticker\">66<\/span><\/strong><\/h1>\n<p>[\/vc_column_text][\/vc_column_inner][vc_column_inner width=\"2\/3\"][vc_column_text css=\".vc_custom_1691004076215{padding-top: 10px !important;padding-bottom: 10px !important;}\"]<\/p>\n<h3 style=\"text-align: center;\"><span style=\"font-weight: 400;\">percentage of women in least developed countries that were assisted by suitably qualified health workers during birth between 2016 and 2021<\/span><\/h3>\n<p>[\/vc_column_text][\/vc_column_inner][\/vc_row_inner][vc_separator][vc_column_text]<\/p>\n<h6 style=\"text-align: center;\"><em>All data on this page represents the most recent data available, unless otherwise noted. Please visit our <a href=\"https:\/\/www.healthynewbornnetwork.org\/numbers\/\">Newborn Numbers<\/a> page and download the Excel spreadsheet to explore the data further.<\/em><\/h6>\n<p>[\/vc_column_text][vc_row_inner content_placement=\"middle\"][vc_column_inner][\/vc_column_inner][\/vc_row_inner][\/vc_column][\/vc_row][vc_row][vc_column][vc_text_separator title=\"More information\"][\/vc_column][\/vc_row][vc_row][vc_column width=\"1\/2\"][vc_column_text]Over the past decade and a half, considerable emphasis within global maternal-newborn health programs has been placed on \u201cskilled birth attendance,\u201d i.e., births assisted by suitably qualified health workers. This reflects the observation that for women delivering at home without ready access to emergency obstetrical care, support from traditional birth attendants proved inadequate to substantially reduce risk of death for the mother or newborn. Considerable effort has been expended in many settings to help ensure that women give birth with the assistance of qualified human resources, specifically a health worker, and generally in a health facility.<\/p>\n<p>However, in many instances there has not\u00a0been equal attention given to the actual substance of the care provided or the necessary supports to enable health workers to provide adequate care. In recent years, there has been increasing attention in program work to the quality and content of maternal-newborn services, particularly around the time of birth. This is reflected in current work at the World Health Organization on improving quality of maternal-newborn health care.[\/vc_column_text][\/vc_column][vc_column width=\"1\/2\"][vc_column_text]Part of what is implied in the \u201cskilled birth attendance\u201d strategy is that assisting in childbirth does not necessarily require a physician. Many interventions related to maternal-newborn health can be competently delivered by categories of health workers with comparatively modest training.<\/p>\n<p>Accordingly, certain maternal-newborn services can be provided by categories of health workers labelled as \u201ccommunity health workers\u201d (CHWs). This is a broad designation that includes:<\/p>\n<ul>\n<li>Health auxiliaries with training sometimes approaching that of registered nurses<\/li>\n<li>Paid full-time workers with several months of basic training<\/li>\n<li>Non-salaried but financially \u201cincentivized\u201d workers, typically working less than full-time<\/li>\n<li>Volunteers providing services on a periodic or intermittent basis with little or no financial incentives<\/li>\n<\/ul>\n<p>[\/vc_column_text][\/vc_column][\/vc_row][vc_row][vc_column][vc_single_image image=\"13796\" add_caption=\"yes\" alignment=\"center\" css_animation=\"appear\"][vc_column_text]In some settings, there is more than one tier of CHWs.\u00a0When robustly supported (as they can be under project conditions), non-salaried and volunteer CHWs have been demonstrated as effective for various maternal- and newborn-related services. There are fewer examples of such work being effectively delivered at national scale, under non-project conditions. A very important but frequently neglected factor is the supports needed for effective programs.<\/p>\n<p>The issue is not so much,<\/p>\n<ul>\n<li><em><strong>can <\/strong>CHWs be effective for a particular service?<\/em><\/li>\n<\/ul>\n<p>But rather,<\/p>\n<ul>\n<li><em><strong>what supports are necessary<\/strong> for effectiveness?<\/em><\/li>\n<\/ul>\n<p>And,<\/p>\n<ul>\n<li><em><strong>are such supports feasible at scale<\/strong> under normal, non-project conditions?<\/em><\/li>\n<\/ul>\n<p>Program efforts commonly address health worker knowledge and skills. This is typically done primarily by training. Motivation is less often given focused attention. Certainly, some aspects of performance can be positively affected by financial incentives, although such incentives can also have unintended negative consequences. However, motivation is more than just a matter of incentives.<\/p>\n<p>In many settings, legitimate and illegitimate absences from work significantly undermine reliable access to services. This can be a consequence, for example, of frequent off-site trainings. There are also many settings where health workers are either frequently away from their posts without authorization or where they offer services only for very limited periods of time each day.<\/p>\n<p>Even when health workers are at their posts, their practices are affected not only by material they may have been exposed to in training but also by other influences on what they consider appropriate care. For example, health workers may be well aware of what treatments are recommended or authorized in national treatment guidelines but may -- for any number of reasons -- prefer to offer treatments not reflected in official protocols. For human resources program efforts to be effective in ensuring availability of appropriate care, they need to respond to the actual factors influencing health worker practices.<\/p>\n<p>Supervision is often mentioned as an important performance factor in health worker practices. Certainly under project conditions, there are numerous examples of \u201csupportive technical supervision\u201d or \u201cmentoring\u201d that appear to have made a positive contribution to quality of care. There are, however, far fewer examples of this function being effectively delivered under non-project conditions. Health-facility-level quality improvement efforts can serve a somewhat similar function, whereby groups of health staff work collectively to improve performance, holding each other accountable.[\/vc_column_text][vc_column_text]<strong>Key resources<\/strong><\/p>\n<ul>\n<li><a href=\"https:\/\/apps.who.int\/iris\/handle\/10665\/77764\">WHO Recommendations: Optimizing health worker roles for maternal and newborn health<\/a><\/li>\n<\/ul>\n<p>[\/vc_column_text][\/vc_column][\/vc_row]<\/p>\n","post_title":"Human resources for health","post_excerpt":"","post_status":"publish","comment_status":"closed","ping_status":"closed","post_password":"","post_name":"human-resources","to_ping":"","pinged":"","post_modified":"2023-08-02 15:22:01","post_modified_gmt":"2023-08-02 19:22:01","post_content_filtered":"","post_parent":0,"guid":"http:\/\/www.healthynewbornnetwork.org\/?post_type=issue&p=124","menu_order":0,"post_type":"issue","post_mime_type":"","comment_count":"0","filter":"raw"},{"ID":135,"post_author":"7211","post_date":"2015-10-21 15:20:52","post_date_gmt":"2015-10-21 15:20:52","post_content":"[vc_row full_width=\"stretch_row\" css=\".vc_custom_1453403441710{margin-top: -60px !important;padding-top: 30px !important;padding-bottom: 30px !important;background-color: #ffffff !important;}\"][vc_column width=\"1\/2\"][vc_column_text]\r\n<h2>Many countries, even those that have achieved improvements in the last 15 years, still experience high rates of maternal and newborn deaths due to poor quality services.<\/h2>\r\nPoor quality can affect the demand for care from communities. Accelerating reduction of preventable deaths and poor outcomes depends on service quality improvements, including addressing health system challenges such as infrastructure, supplies, skilled and appropriately deployed health providers, and management. Quality improvement systems that address both the content and standards as well as the process and experience of care should be an important area of investment during the period of the new <a href=\"http:\/\/www.un.org\/sustainabledevelopment\/sustainable-development-goals\/\" target=\"_blank\">Sustainable Development Goals<\/a>.[\/vc_column_text][\/vc_column][vc_column width=\"1\/2\" el_class=\"issue-stats\"][vc_single_image image=\"13784\"][vc_separator][vc_row_inner content_placement=\"middle\"][vc_column_inner][vc_empty_space height=\"16px\"][\/vc_column_inner][\/vc_row_inner][\/vc_column][\/vc_row]","post_title":"Quality improvement","post_excerpt":"","post_status":"publish","comment_status":"closed","ping_status":"closed","post_password":"","post_name":"quality-improvement","to_ping":"","pinged":"","post_modified":"2016-02-25 15:58:05","post_modified_gmt":"2016-02-25 20:58:05","post_content_filtered":"","post_parent":0,"guid":"http:\/\/www.healthynewbornnetwork.org\/?post_type=issue&p=135","menu_order":0,"post_type":"issue","post_mime_type":"","comment_count":"0","filter":"raw"}],"regions":[{"ID":247,"post_author":"7211","post_date":"2015-11-22 21:37:22","post_date_gmt":"2015-11-22 21:37:22","post_content":"","post_title":"Africa","post_excerpt":"","post_status":"publish","comment_status":"closed","ping_status":"closed","post_password":"","post_name":"africa","to_ping":"","pinged":"","post_modified":"2016-02-11 21:42:43","post_modified_gmt":"2016-02-11 21:42:43","post_content_filtered":"","post_parent":0,"guid":"http:\/\/www.healthynewbornnetwork.org\/?post_type=region&p=247","menu_order":0,"post_type":"region","post_mime_type":"","comment_count":"0","filter":"raw"}],"countries":[{"ID":190,"post_author":"7211","post_date":"2015-10-21 21:59:16","post_date_gmt":"2015-10-21 21:59:16","post_content":"[vc_row][vc_column css=\".vc_custom_1453305596740{padding-top: 30px !important;padding-bottom: 30px !important;}\"][vc_text_separator title=\"Leading causes of neonatal deaths in Kenya (2020)\" el_class=\"transform:upperclass\"][vc_row_inner][vc_column_inner][vc_round_chart type=\"doughnut\" stroke_width=\"1\" stroke_color=\"custom\" values=\"%5B%7B%22title%22%3A%221%25%20Diarrhoea%22%2C%22value%22%3A%221%25%22%2C%22color%22%3A%22vista-blue%22%7D%2C%7B%22title%22%3A%220%25%20Tetanus%22%2C%22value%22%3A%220%25%22%2C%22color%22%3A%22mulled-wine%22%2C%22custom_color%22%3A%22%23555555%22%7D%2C%7B%22title%22%3A%229%25%20Pneumonia%22%2C%22value%22%3A%229%25%22%2C%22color%22%3A%22peacoc%22%7D%2C%7B%22title%22%3A%2239%25%20Preterm%20birth%20complications%22%2C%22value%22%3A%2239%25%22%2C%22color%22%3A%22blue%22%7D%2C%7B%22title%22%3A%2226%25%20Intrapartum%20related%20events%22%2C%22value%22%3A%2226%25%22%2C%22color%22%3A%22turquoise%22%7D%2C%7B%22title%22%3A%226%25%20Sepsis%20and%20other%20infectious%20conditions%20of%20the%20newborn%22%2C%22value%22%3A%226%25%22%2C%22color%22%3A%22pink%22%7D%2C%7B%22title%22%3A%227%25%20Congenital%20abnormalities%5Ct%22%2C%22value%22%3A%227%25%22%2C%22color%22%3A%22violet%22%7D%2C%7B%22title%22%3A%2212%25%20Other%20conditions%22%2C%22value%22%3A%2212%25%22%2C%22color%22%3A%22chino%22%7D%5D\" custom_stroke_color=\"#f6f6f4\" css=\".vc_custom_1686158928999{padding-right: 30px !important;padding-left: 30px !important;background-position: center !important;background-repeat: no-repeat !important;background-size: contain !important;}\"][\/vc_column_inner][\/vc_row_inner][vc_column_text]\r\n<h6 style=\"text-align: left;\">Source: Estimates for causes of death 2000-2020 generated by the WHO and Maternal and Child Epidemiology Estimation Group (MCEE) 2023 and downloaded from <a href=\"http:\/\/data.unicef.org\/\" target=\"_blank\" rel=\"noopener noreferrer\" data-saferedirecturl=\"https:\/\/www.google.com\/url?q=http:\/\/data.unicef.org&source=gmail&ust=1551964625737000&usg=AFQjCNFsFTtu9FzS8H64YC88NPOzQVbPwQ\">http:\/\/data.unicef.org<\/a><\/h6>\r\n[\/vc_column_text][\/vc_column][\/vc_row][vc_row full_width=\"stretch_row\" gap=\"5\" css=\".vc_custom_1453306441839{background-image: url(\/\/www.healthynewbornnetwork.org\/hnn-content\/uploads\/country-stat-bkgr.jpg?id=389) !important;background-position: center !important;background-repeat: no-repeat !important;background-size: cover !important;}\"][vc_column css=\".vc_custom_1453306493120{margin-top: 30px !important;margin-bottom: 30px !important;}\"][vc_text_separator title=\"key indicators\" el_class=\"transform:uppercase text-white\"][vc_row_inner][vc_column_inner width=\"1\/4\"][vc_column_text css=\".vc_custom_1686159003707{margin-bottom: -5px !important;}\"]\r\n<h1 style=\"text-align: center;\"><span style=\"color: #e05533;\"><strong><span class=\"ticker\">18.4<\/span><\/strong><\/span><\/h1>\r\n[\/vc_column_text][vc_column_text el_class=\"text-white\"]\r\n<h5 style=\"text-align: center;\">Newborn mortality rate (deaths per 1,000 live births)<\/h5>\r\n[\/vc_column_text][\/vc_column_inner][vc_column_inner width=\"1\/4\"][vc_column_text css=\".vc_custom_1686159017138{margin-bottom: -5px !important;}\"]\r\n<h1 style=\"text-align: center;\"><span style=\"color: #d9a23b;\"><strong><span class=\"ticker\">1.9<\/span><\/strong><\/span><\/h1>\r\n[\/vc_column_text][vc_column_text el_class=\"text-white\"]\r\n<h5 style=\"text-align: center;\">Annual reduction in newborn mortality rate 2000-2021 (%)<\/h5>\r\n[\/vc_column_text][\/vc_column_inner][vc_column_inner width=\"1\/4\"][vc_column_text css=\".vc_custom_1650893091343{margin-bottom: -5px !important;}\"]\r\n<h1 style=\"text-align: center;\"><span style=\"color: #41aaab;\"><strong><span class=\"ticker\">50<\/span><\/strong><\/span><\/h1>\r\n[\/vc_column_text][vc_column_text el_class=\"text-white\"]\r\n<h5 style=\"text-align: center;\">Proportion of under-5 child deaths that are newborn (%)<\/h5>\r\n[\/vc_column_text][\/vc_column_inner][vc_column_inner width=\"1\/4\"][vc_column_text css=\".vc_custom_1686159032200{margin-bottom: -5px !important;}\"]\r\n<h1 style=\"text-align: center;\"><span style=\"color: #e05533;\"><strong><span class=\"ticker\">18.5<\/span><\/strong><\/span><\/h1>\r\n[\/vc_column_text][vc_column_text el_class=\"text-white\"]\r\n<h5 style=\"text-align: center;\">Stillbirth rate (deaths per 1,000 births)<\/h5>\r\n[\/vc_column_text][\/vc_column_inner][\/vc_row_inner][vc_row_inner][vc_column_inner width=\"1\/4\"][vc_column_text css=\".vc_custom_1686158945191{margin-bottom: -5px !important;}\"]\r\n<h1 style=\"text-align: center;\"><span style=\"color: #d9a23b;\"><strong><span class=\"ticker\">70.2<\/span><\/strong><\/span><\/h1>\r\n[\/vc_column_text][vc_column_text el_class=\"text-white\"]\r\n<h5 style=\"text-align: center;\">Skilled birth attendance (%)<\/h5>\r\n[\/vc_column_text][\/vc_column_inner][vc_column_inner width=\"1\/4\"][vc_column_text css=\".vc_custom_1484418978635{margin-bottom: -5px !important;}\"]\r\n<h1 style=\"text-align: center;\"><span style=\"color: #41aaab;\"><strong><span class=\"ticker\">62\r\n<\/span><\/strong><\/span><\/h1>\r\n[\/vc_column_text][vc_column_text el_class=\"text-white\"]\r\n<h5 style=\"text-align: center;\">Early initiation of breastfeeding (%)<\/h5>\r\n[\/vc_column_text][\/vc_column_inner][vc_column_inner width=\"1\/4\"][vc_column_text css=\".vc_custom_1698696361666{margin-bottom: -5px !important;}\"]\r\n<h1 style=\"text-align: center;\"><span style=\"color: #e05533;\"><strong><span class=\"ticker\">8.8<\/span><\/strong><\/span><\/h1>\r\n[\/vc_column_text][vc_column_text el_class=\"text-white\"]\r\n<h5 style=\"text-align: center;\">Preterm birth rate (births <37 weeks per 100 live births)<\/h5>\r\n[\/vc_column_text][\/vc_column_inner][vc_column_inner width=\"1\/4\"][vc_column_text css=\".vc_custom_1686158969454{margin-bottom: -5px !important;}\"]\r\n<h1 style=\"text-align: center;\"><span style=\"color: #d9a23b;\"><strong><span class=\"ticker\">530<\/span><\/strong><\/span><\/h1>\r\n[\/vc_column_text][vc_column_text el_class=\"text-white\"]\r\n<h5 style=\"text-align: center;\">Maternal mortality ratio (deaths per 100,000 live births)<\/h5>\r\n[\/vc_column_text][\/vc_column_inner][\/vc_row_inner][vc_column_text css=\".vc_custom_1453307990481{margin-top: 20px !important;}\"]\r\n<h5 style=\"text-align: center;\"><span style=\"color: #ffffff;\">Visit our<\/span> <a href=\"https:\/\/www.healthynewbornnetwork.org\/numbers\/\">Newborn Numbers<\/a> <span style=\"color: #ffffff;\">page to explore the most recent data further<\/span><\/h5>\r\n[\/vc_column_text][\/vc_column][\/vc_row]","post_title":"Kenya","post_excerpt":"","post_status":"publish","comment_status":"closed","ping_status":"closed","post_password":"","post_name":"kenya","to_ping":"","pinged":"","post_modified":"2023-10-30 16:04:37","post_modified_gmt":"2023-10-30 20:04:37","post_content_filtered":"","post_parent":0,"guid":"http:\/\/www.healthynewbornnetwork.org\/?post_type=country&p=190","menu_order":0,"post_type":"country","post_mime_type":"","comment_count":"0","filter":"raw"}],"about_the_author":"<p><strong>David Gathara<\/strong> is a health systems researcher currently leading work on nursing services research aimed at developing indicators, tools and approches for evaluating the quality of nursing care delivered in hospitals. He also co-leads the Health Services that Deliver for Newborns programme of work whose focus is understanding the burden, need and access of newborn care services as well as evaluating the quality of newborn care services. He holds a Master of Science in Epidemiology from the London School of Hygiene and Tropical Medicine and a PhD from the University of Amsterdam. Since joining KWTRP in August 2008, his research work has spanned a range of disciplines including, clinical trials, evaluation of quality of care within hospitals and exploration of the application of various statistical methods (propensity score analysis, multi-level models and statistical process control) to routine data. David played a key role in development, database design and setting up the Clinical Information Network – a pragmatic research database collecting patient level data from all paediatric admissions from 14 county referral hospitals and aims at improving use of information in policy and practice. He has broad interests\u2019 in the use of epidemiology to monitor disease trends, interventions effects, identify quality of care gaps and the use of this data for effective decision making although with a bias on how human resources for health more specifically the nursing workforce influences the quality of care provided. His future work aims at developing human resource interventions as well as optimising approaches for nursing care provision.<\/p>\n","author_image":{"ID":38479,"id":38479,"title":"David Gathara","filename":"David-Gathara.gif","filesize":136152,"url":"https:\/\/www.healthynewbornnetwork.org\/hnn-content\/uploads\/David-Gathara.gif","link":"https:\/\/www.healthynewbornnetwork.org\/blog\/missed-nursing-care-in-newborn-units-the-need-for-improvements-in-nursing-workforce-in-lmics\/david-gathara\/","alt":"","author":"7211","description":"","caption":"","name":"david-gathara","status":"inherit","uploaded_to":38471,"date":"2019-08-28 15:21:52","modified":"2019-08-28 15:21:52","menu_order":0,"mime_type":"image\/gif","type":"image","subtype":"gif","icon":"https:\/\/www.healthynewbornnetwork.org\/wp-includes\/images\/media\/default.png","width":480,"height":468,"sizes":{"thumbnail":"https:\/\/www.healthynewbornnetwork.org\/hnn-content\/uploads\/David-Gathara-150x150.gif","thumbnail-width":150,"thumbnail-height":150,"medium":"https:\/\/www.healthynewbornnetwork.org\/hnn-content\/uploads\/David-Gathara-300x293.gif","medium-width":300,"medium-height":293,"medium_large":"https:\/\/www.healthynewbornnetwork.org\/hnn-content\/uploads\/David-Gathara.gif","medium_large-width":480,"medium_large-height":468,"large":"https:\/\/www.healthynewbornnetwork.org\/hnn-content\/uploads\/David-Gathara.gif","large-width":480,"large-height":468,"1536x1536":"https:\/\/www.healthynewbornnetwork.org\/hnn-content\/uploads\/David-Gathara.gif","1536x1536-width":480,"1536x1536-height":468,"2048x2048":"https:\/\/www.healthynewbornnetwork.org\/hnn-content\/uploads\/David-Gathara.gif","2048x2048-width":480,"2048x2048-height":468}}},"_links":{"self":[{"href":"https:\/\/www.healthynewbornnetwork.org\/wp-json\/wp\/v2\/posts\/38471"}],"collection":[{"href":"https:\/\/www.healthynewbornnetwork.org\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.healthynewbornnetwork.org\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.healthynewbornnetwork.org\/wp-json\/wp\/v2\/users\/7211"}],"replies":[{"embeddable":true,"href":"https:\/\/www.healthynewbornnetwork.org\/wp-json\/wp\/v2\/comments?post=38471"}],"version-history":[{"count":0,"href":"https:\/\/www.healthynewbornnetwork.org\/wp-json\/wp\/v2\/posts\/38471\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.healthynewbornnetwork.org\/wp-json\/wp\/v2\/media\/38475"}],"wp:attachment":[{"href":"https:\/\/www.healthynewbornnetwork.org\/wp-json\/wp\/v2\/media?parent=38471"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.healthynewbornnetwork.org\/wp-json\/wp\/v2\/categories?post=38471"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.healthynewbornnetwork.org\/wp-json\/wp\/v2\/tags?post=38471"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}