Mortality among 5-17 year old children in Kenya

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Study Justification:
– Global mortality trends are changing, with a shift from communicable diseases to non-communicable diseases.
– Limited studies in Africa explore the causes of mortality in children aged 5-17 years.
– Increased survival of children beyond five years may change mortality patterns for these children.
Study Highlights:
– Retrospective review of medical records from six Kenyan hospitals in 2013.
– In-hospital mortality rate of 3.5% with variations between age groups and gender.
– 60% of deaths were due to communicable diseases, maternal and nutritional causes.
– 41.3% of deaths were due to non-communicable diseases.
– 11.9% of deaths were due to traumatic injuries.
– Predominant clinical diagnoses among patients who died were HIV/AIDS, respiratory tract infections, and malaria.
Study Recommendations:
– Improve prevention and treatment strategies for communicable diseases, maternal and nutritional causes.
– Strengthen healthcare systems to address non-communicable diseases in children.
– Enhance injury prevention measures to reduce traumatic deaths.
– Focus on improving HIV/AIDS, respiratory tract infection, and malaria management.
Key Role Players:
– Ministry of Health: Responsible for policy development and implementation.
– Hospitals: Provide healthcare services and implement recommendations.
– Healthcare professionals: Deliver medical care and support interventions.
– Research institutions: Conduct further studies to inform policy and practice.
Cost Items for Planning Recommendations:
– Healthcare infrastructure: Upgrading hospitals and clinics.
– Medical equipment and supplies: Procuring necessary tools for diagnosis and treatment.
– Training and capacity building: Educating healthcare professionals on best practices.
– Public health campaigns: Promoting awareness and prevention strategies.
– Research funding: Supporting further studies and data collection.

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is moderately strong. The study was carried out in multiple hospitals, including both government and private hospitals, which increases the generalizability of the findings. The study used a retrospective review of medical records to collect data, which may introduce bias and limitations in data accuracy. To improve the strength of the evidence, future studies could consider using a prospective design and include a larger sample size from a more diverse range of hospitals. Additionally, conducting a follow-up study to assess the long-term outcomes of children aged 5-17 years who died would provide valuable insights.

Introduction: Global mortality trends have changed over time and are expected to continue changing with a reduction in communicable diseases and an increase of non-communicable disease. Increased survival of children beyond five years may change mortality patterns for these children. There are few studies in Africa that explore the causes of mortality in children over five years. The objective of this study was to determine the mortality rate and clinical profiles of children aged 5-17 years who died in six Kenyan hospitals in 2013. Methods: Retrospective review of patients’ medical records to abstract data on diagnosis for those who died in year 2013. Data was analysed to provide descriptive statistics and explored differences in mortality rates between age groups and gender. Results: We retrieved 4,520 patient records. The in-hospital mortality rate was 3.5% (95%CI 3.0-4.1) with variations in deaths between the ages and gender. Among the deaths, 60% suffered from communicable diseases, maternal and nutritional causes; 41.3% suffered from non-communicable diseases. A further 11.9% succumbed to traumatic injuries. The predominant clinical diagnoses among patients who died were HIV/AIDS, respiratory tract infections and malaria. Conclusion: infectious causes had the highest proportion of diagnoses among children aged 5-17 years who died.

The study was carried out in five government hospitals spread across different regions of Kenya and one private hospital in Nairobi. The five government hospitals were purposively selected because they are the referral hospitals for the counties they serve and represent a wide geographical area within the country. The private hospital was included to provide a perspective of children from a higher socio-economic group. A retrospective hospital based study using admission registers as the sampling frame, for the 2013 calendar year was used to identify all children aged 5-17 years. The study included all children aged 5-17 as the study sample. Hospital records were retrieved, reviewed and data abstracted from patient’s discharge or death summaries for interest variables (age, gender and diagnosis at death). The researcher or trained research assistants reviewed the whole patient record to extract the required data where there were no summaries. Three patients’ records from the private hospital were not available for review due to medico-legal reasons and were excluded from this analysis. In this study, age was categorised into groups (5-9, 10-14 and 15-17 years) as a modification of the age categories used by Lozano [3], Patton [2], Wang [10], and the Kenya Demographic and Heath Survey [16] with the upper age cut-off of 17 years as the legal age cut-off for children. The mortality proportion was calculated as all the deaths in the age group divided by the age group total admissions, expressed as a percentage to describe the mortality pattern. Pearson’s chi-square test and odds ratios were calculated to explore differences in deaths between genders, age groups and HIV status at 95% confidence interval. The patients’ diagnoses were categorised in accordance with the Lozano [3] study classifications and to allow for comparison. The disease classification used was based on the study by Lozano, et al on global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010; a systematic analysis for the Global Burden of Disease (GBD) Study [3] as shown in Table 1. This classification was chosen to make comparison of findings with other international studies easier. However, many patients had multiple diagnoses with some appearing across disease classification categories and hence some patients fell in more than one disease category. Patients with injuries did not have full details on where it occurred, the cause, nature and type of injury and were therefore grouped together as injuries. We obtained approval from the Human Research Ethics Committee at the Faculty of Health Sciences, University of Cape Town (UCT) and the Kenyatta National Hospital/University of Nairobi Ethics and Research Committee (KNH-UoN ERC). Hospital review boards and administration permission were obtained from all the hospitals where the study was conducted. Patient confidentiality was maintained at all times. Names of the patients/study participants were not collected by the study. Once the hospital number was noted, it was de-identified by giving it a code that could not be traced back to the patients. Only coded data was transported to conceal identities. In addition, the data was stored in files kept under lock and key with restricted access in secured offices. Electronic databases were encrypted and stored in password-protected, secure computers. Classification of diseases as adopted from Lozano et al. (2010). Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010; a systematic analysis for the GBD Study [3]

Based on the provided information, here are some potential innovations that could improve access to maternal health:

1. Telemedicine: Implementing telemedicine services can provide remote access to healthcare professionals for pregnant women in rural areas, allowing them to receive prenatal care and consultations without having to travel long distances to a healthcare facility.

2. Mobile health (mHealth) applications: Developing mobile applications that provide educational resources, appointment reminders, and personalized health information can empower pregnant women to take control of their own health and access important maternal health services.

3. Community health workers: Training and deploying community health workers who can provide basic prenatal care, health education, and referrals to pregnant women in underserved areas can improve access to maternal health services and reduce maternal mortality rates.

4. Maternal health clinics: Establishing dedicated maternal health clinics in areas with high maternal mortality rates can ensure that pregnant women have access to comprehensive prenatal care, skilled birth attendants, and emergency obstetric care.

5. Transportation services: Providing reliable and affordable transportation services, such as ambulances or community transport systems, can help pregnant women in remote areas reach healthcare facilities in a timely manner for prenatal care, delivery, and emergency obstetric care.

6. Maternal health financing schemes: Implementing innovative financing schemes, such as community-based health insurance or conditional cash transfer programs, can help reduce financial barriers to accessing maternal health services and ensure that pregnant women receive the care they need.

7. Maternal health information systems: Developing robust information systems that track maternal health indicators and outcomes can help identify gaps in access to care, monitor progress, and inform evidence-based decision-making to improve maternal health services.

8. Public-private partnerships: Collaborating with private sector organizations, such as pharmaceutical companies or technology companies, can leverage their resources and expertise to improve access to maternal health services through innovative solutions and initiatives.

It is important to note that these recommendations are general and may need to be adapted to the specific context and needs of the population in Kenya.
AI Innovations Description
Based on the information provided, the study focused on mortality rates and clinical profiles of children aged 5-17 years in Kenya. The study found that communicable diseases, maternal and nutritional causes, non-communicable diseases, and traumatic injuries were the main causes of death among this age group.

To develop an innovation to improve access to maternal health based on this study, the following recommendation can be considered:

1. Strengthen healthcare infrastructure: Improve the availability and quality of healthcare facilities, particularly in rural areas, to ensure that pregnant women have access to skilled healthcare providers and necessary medical equipment.

2. Enhance community-based healthcare services: Implement community-based programs that provide education and support to pregnant women, including prenatal care, nutrition counseling, and postnatal care. This can be done through the establishment of mobile clinics or community health workers who can reach remote areas.

3. Increase awareness and education: Conduct awareness campaigns to educate women and their families about the importance of maternal health, including the need for regular check-ups, proper nutrition, and early detection and management of complications.

4. Improve transportation and logistics: Address transportation barriers by providing reliable and affordable transportation options for pregnant women to access healthcare facilities. This can include initiatives such as ambulance services or transportation vouchers.

5. Strengthen data collection and monitoring: Establish a robust system for collecting and analyzing data on maternal health outcomes to identify areas of improvement and track progress over time. This can help in identifying high-risk areas and implementing targeted interventions.

It is important to note that these recommendations are based on the information provided and may need to be tailored to the specific context and needs of the community. Additionally, collaboration with local stakeholders, including healthcare providers, policymakers, and community leaders, is crucial for the successful implementation of any innovation to improve access to maternal health.
AI Innovations Methodology
Based on the provided information, it seems that you are looking for innovations to improve access to maternal health. However, the information you provided is about mortality among 5-17 year old children in Kenya. If you could provide more specific details or clarify your request, I would be happy to assist you with recommendations for innovations to improve access to maternal health.

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