The feasibility and acceptability of an early warning score system for preterm and low-birth weight infants in Kenya

Project 5 Jul 2021

Globally 15 million babies are born preterm or "born too soon" each year. Nearly two-thirds of such births happen in sub-Saharan Africa and Asia. Premature birth is the cause for a third of all deaths in the first month of life. In Kenya, over 200,000 babies are "born too soon" and despite recent reductions, deaths in the first month of life remain highat 20 per 1000; 7 times higher than in the UK.

Kenya suffer from a shortage of resources including lack of trained neonatal doctors and nurses. Poor record keeping in hospital causes delays in recognising poorly babies, in providing treatment and leads to poor outcomes. Early warning scores (EWS) are a streamlined way to monitor patients and prompt treatment to

prevent deterioration that could lead to death. The "Newborn Early Warning Track and Trigger" (NEWTT) used in the UK uses a simple paper-based form, which has a "traffic-light system" to easily plot infants' vital signs (temperature, heart rate and respiratory rate). This promptly alerts healthcare professionals to take actions if signs are in the red or amber zones. Closer monitoring of preterm infants with a system that more easily identifies sicker infants could help resource-limited staff to reduce deaths and illness in this very vulnerable group.

This study aims to test how feasible and acceptable it is to implement an EWS in neonatal units in Kenya. We will implement the paper-based EWS in three neonatal units and ask staff to complete this for all preterm or LBW infants over a 4-week period. In order to include a range of opinions, we will aim to include 2-3 interviews with each type of staff, resulting in around 24-30 interviews.

Study time (including delays of COVID-19): September 2020- December 2021.