Low skilled health workers, wrong drug dosages and substandard medicines are cause for persistent child deaths from pneumonia in Kenya.
Children with pneumonia are the most likely to be readmitted in public hospitals with a big number likely to die.
A recent investigation at Thika Level 5 Hospital in Central Kenya, reports a worryingly high number of child readmissions; a sigh all is not well with the provided care.
The study published in the August 2021 issue of the East African Medical Journal, says 10 per cent of children treated at the facility during the study period were readmitted within 30 days.
The study had revisited the records of 803 children aged 13 years and below admitted at the facility in a four month period,
“About a tenth of discharged children were readmitted within 30 days of discharge. Pneumonia was the commonest condition at admission and re-admission,” says the study.
Of the readmitted children, about 20 per cent were either referred or died. Readmitted children, the report says were likely to have received incorrect drug dosage, discharged by a low level trained health worker and or had stayed in the hospital for a long time.
This study is published almost simultaneously with recent reports of junior health providers at Moi Teaching and Referral Hospital (MTRH) blaming absenteeism of senior doctors for poor survival of children with blood cancer.
Nurses especially, an in house evaluation of child leukemia outcomes at the hospital said they are left to handle complex procedures on the children, some they were not competent to handle.
It also comes at a time the Kenya Medical Research Institute (Kemri) has alerted over substandard antibiotics in the country. Some of these are used in the treatment of pneumonia.
Last month Kemri, reported about a third of the key antibiotic cotrimoxazole suspension selling in Nairobi pharmacies are of poor quality. Many public hospitals are known to send patients to purchase medicines from retail pharmacies.
Forty percent of the antibiotic, Kemri said were in the market illegally as they had not been retained with the Pharmacy and Poisons Board as required.
“Our study provides evidence of poor quality cotrimoxazole medicines in Nairobi that could compromise treatment of infectious diseases in children,” said the Kemri study.
Last year Kemri and Kenyatta University researchers, reported about 40 per cent of analyzed amoxicillin drugs had failed quality tests.
“Our results highlight the presence of poor-quality amoxicillin formulations in Nairobi County, confirming the need for regular post market surveillance,” said the study.
Amoxicillin, the researchers said is one of the commonly prescribed, aﬀordable, and easily accessible antibiotic in Kenya and also a most counterfeited.
The quality of Kenya’s health workers has also recently come into question over their competency.
A study published in May 2021 found many final year medical students at Uganda’s Makerere University, Kenya’s Mount Kenya University, and Tanzania’s Catholic University of Health and Allied Sciences had no clue on the use of antibiotics in hospital settings.
Only about a third of sampled students had a good general knowledge about antibiotics. This was blamed on lack of practical training of medical students.
Another study published in June 2021 by among others the Ministry of Health, Oxford University, UK, and the University of Nairobi had sampled 61 out of all 74 internship hospitals in Kenya.
None met all the required parameters for training medical officers to the required competency in the country. Only 60 per cent had a modest capacity to offer the required training.
Meanwhile pneumonia remains the top killer of children year in year out. The Kenya Economic Survey 2021 shows pneumonia had for decades continued to be the main cause of child illnesses, hospitalizations and death.
Leading cause of child deaths
Pneumonia, the survey shows, was the leading cause of admissions for children under-five years in health facilities for the period 2018 to 2020.
This is at about 20,000 admissions per year at an increasing rate. This is despite industry supported studies in Kenya claiming pneumonia had declined by about 70 per cent since the introduction of a vaccine a decade ago.
A study at Gertrude’s Children Hospital, Nairobi which had reported high rates of vaccinated children being admitted with pneumonia remains a preprint since 2019 despite being stripped off its criticism of the vaccine.
By Gatonye Gathura