Improving clinical care for newborns in Kenyan hospitals
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AbstractClinical practice guidelines are widely seen as important quality improvement tools that can contribute to evidence-based clinical practices. This thesis explores key processes aimed at improving neonatal care practices in rural hospitals in Kenya through the development and implementation of evidence-informed clinical practice guidelines.
The studies presented in this thesis span key areas of evidence synthesis to support clinical guideline development, the translation process linking evidence synthesis to guideline recommendations, and the effects of specific health worker training linked to implementation of emergency care guidelines.
The findings presented in this thesis highlight a number of challenges that hinder effective development of, and delivery of evidence-based practices needed to improve the quality of care for newborns and children in Kenya, and similar low-resource settings. The identified challenges in the translation of evidence into guideline recommendations underscore the need to improve skills in evidence-based medicine to support guideline development in low-income countries and create health system contexts that support recommended practices.
List of papers. Paper V is removed from the thesis due to publisher restrictions.
Paper I: Opiyo N, English M.: What clinical signs best identify severe illness in young infants aged 0-59 days in developing countries? A systematic review. Arch Dis Child. 2011 Nov;96(11):1052-9. doi:10.1136/adc.2010.186049 Distributed under the terms of the Creative Commons Attribution Non Commercial licence.
Paper II: Opiyo N, Were F, Govedi F, Fegan G, Wasunna A, English M.: Effect of newborn resuscitation training on health worker practices in Pumwani Hospital, Kenya. PLoS One. 2008 Feb 13;3(2):e1599. doi:10.1371/journal.pone.0001599 Distributed under the terms of the Creative Commons Attribution License.
Paper III: Opiyo N, English M.: In-service training for health professionals to improve care of the seriously ill newborn or child in low and middle-income countries (Review). This review is published as a Cochrane Review in the Cochrane Database Syst Rev. 2010 Apr 14;(4):CD007071. Cochrane Reviews are regularly updated as new evidence emerges and in response to comments and criticisms, and the Cochrane Database of Systematic Reviews should be consulted for the most recent version of the Review. doi:10.1002/14651858.CD007071.pub2
Paper IV: Opiyo N, Shepperd S, Musila N, Allen E, Nyamai R, Fretheim A, English M.: Comparison of alternative evidence summary and presentation formats in clinical guideline development: a mixed-method study. PLoS One. 2013;8(1):e55067. Distributed under the terms of the Creative Commons Attribution License. doi:10.1371/journal.pone.0055067
Paper V: Opiyo N, Shepperd S, Musila N, English M, Fretheim A.: The "Child Health Evidence Week" and GRADE grid may aid transparency in the deliberative process of guideline development. J Clin Epidemiol. 2012 Sep;65(9):962-9. doi:10.1016/j.jclinepi.2012.03.004