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Nairobi Newborn Study: a protocol for an observational study to estimate the gaps in provision and quality of inpatient newborn care in Nairobi City County, Kenya
  1. Georgina A V Murphy1,2,
  2. David Gathara2,
  3. Jalemba Aluvaala2,3,
  4. Jacintah Mwachiro2,
  5. Nancy Abuya2,4,
  6. Paul Ouma2,
  7. Robert W Snow2,1,
  8. Mike English2,1
  1. 1Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
  2. 2Kenya Medical Research Institute/Wellcome Trust Research Programme, Nairobi, Kenya
  3. 3Department of Paediatrics and Child Health, College of Health Sciences, University of Nairobi, Nairobi, Kenya
  4. 4Nairobi City County Government, Nairobi, Kenya
  1. Correspondence to Dr Georgina AV Murphy; georgina.murphy{at}


Introduction Progress has been made in Kenya towards reducing child mortality as part of efforts aligned with the fourth Millennium Development Goal. However, little advancement has been made in reducing mortality among newborns, which now accounts for 45% of all child deaths. The frequently unanticipated nature of neonatal illness, its severity and the high dependency of sick newborns on skilled care make the provision of inpatient hospital services one key component of strategies to improve newborn survival.

Methods and analyses This project aims to assess the availability and quality of inpatient newborn care in hospitals in Nairobi City County across the public, private and not-for-profit sectors and align this to the estimated need for such services, providing a description of the quantity and quality gaps between capacity and demand. The population level burden of disease will be estimated using morbidity incidence estimates from a literature review applied to subcounty estimates of population-adjusted births, providing a spatially disaggregated estimate of need within the county. This will be followed by a survey of neonatal services across all health facilities providing 24/7 inpatient newborn care in the county. The survey will include: a retrospective audit of admission registers to estimate the usage of facilities and case-mix of patients; a structural assessment of facilities to gain insight into capacity; a questionnaire to nursing staff focusing on the process of delivering key obstetric and neonatal interventions; and a retrospective case audit to assess adherence to guidelines by clinicians.

Ethics and dissemination This study has been approved by the Kenya Medical Research Institute Scientific and Ethics Review Unit (SSC protocol No.2999). Results will be disseminated: to participating facilities through individualised reports and a joint workshop; to local and national stakeholders through meetings and a summary report; and to the international community through peer-review publication and international meetings.

  • Newborns
  • Africa

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  • Contributors ME and GAVM designed the study with contributions from JA and RWS. GAVM, DG, NA and JM were responsible for supervision of data collection. PO and RWS provided expertise on spatial metrics. GAVM wrote the study protocol with substantial critical input from all co-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. RWS is supported by the Wellcome Trust as a principal research fellow (# 103602).

  • Competing interests None declared.

  • Ethics approval Ethical approval has been granted by the Kenya Medical Research Institute (KEMRI) Scientific and Ethics Review Unit (SSC protocol No. 2999).

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

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