Browsing by Author "English, Mike"

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    Evaluating hospital performance in antibiotic stewardship to guide action at national and local levels in a lower-middle income setting
    (Global Health Action, 2019) McKnight, Jacob; Maina, Michuki; Zosi, Mathias; Kimemia, Grace; Onyango, Truphena; Schultsz, Constance; English, Mike; Tosas-Auguet, Olga
    Inappropriate use of antibiotics can lead to the development of resistant pathogens. Ensuring proper use of these important drugs in all healthcare facilities is essential. Unfortunately, however, very little is known about how antibiotics are used in LMIC clinical settings, nor to what degree antibiotic stewardship programmes are in place and effective. Objective: We aimed to record all Antibiotic Stewardship policies and structures in place in 16 Kenyan hospitals. We also wanted to examine the context of antibiotic-related practices in these hospitals. Methods: We generated a set of questions intended to assess the knowledge and application of antibiotic stewardship policies and practices in Kenya. Using a set of 17 indicators grouped into four categories, we surveyed 16 public hospitals across the country. Additionally, we conducted 31semi-structured interviews with frontline healthcare workers and hospital managers to explore the context of, and reasons for, the results. Results: Only one hospital had a resourced ABS policy in place. In all other hospitals, our survey teams commonly identified structures, resources and processes that in some way demonstrated partial or full control of antibiotic usage. This was verified by the qualitative interviews that identified common underlying issues. Most positively, we find evidence discipline-specific clinical guidelines have been well accepted and have conditioned and restricted antibiotic use. Conclusion: Only one hospital had an official ABS programme, but many facilities had existing structures and resources that could be used to improve antibiotic use. Thus, ABS Strategies should be built upon existing practices with national ABS policies taking maximum advantage of existing structures to manage the supply and prescription of antimicrobials. We conclude that ABS interventions that build on established responsibilities, methods and practices would be more efficient than interventions that presume a need to establish new ABS apparatus.
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    What do we know about maternal and perinatal mortality and morbidity audits in sub-Saharan Africa? A scoping literature review
    (Emerald, 2019-07-19) Lusambili, Adelaide; Jepkosgei, Joyline; Nzinga, Jacinta; English, Mike
    Purpose The purpose of this paper is to provide a situational overview of the facility-based maternal and perinatal morbidity and mortality audits (MPMMAs) in SSA, their current efficacy at reducing mortality and morbidity rates related to childbirth. Design/methodology/approach This is a scoping literature review based on the synthesis of secondary literature. Findings Not all countries in SSA conduct MPMMAs. Countries where MPMMAs are conducted have not instituted standard practice, MPMMAs are not done on a national scale, and there is no clear best practice for MPMMAs. In addition, auditing process of pediatrics and maternal deaths is flawed by human and organizational barriers. Thus, the aggregated data collected from MPMMAs are not adequate enough to identify and correct systemic flaws in SSA childbirth-related health care. Research limitations/implications There are a few published literature on the topic in sub-Saharan Africa. Practical implications This review exposes serious gaps in literature and practice. It provides a platform upon which practitioners and policy makers must begin to discuss ways of embedding mortality audits in SSA in their health systems as well as health strategies. Social implications The findings of this paper can inform policy in sub-Saharan Africa that could lead toward better outcomes in health and well-being. Originality/value The paper is original