Children likely to die if operated on over the weekend

The number of children dying after surgery in local hospitals is 200 times higher than in developed countries.

The main cause of these high death rates, a study in 24 local hospitals indicates is failure of medical teams to use the recommended surgery guidelines.

Most children, the study shows are more likely to die if operated on over the weekend or at night.

The shocking findings were published on December 3 by a team from AIC Kijabe Hospital, University of Nairobi, Kenyatta National Hospital and Vanderbilt University, US.

The study analysed 6,005 surgeries in 24 government and non-government facilities at primary, secondary and tertiary levels from across Kenya for a three-year period. Deaths, the report shows were higher in primary hospitals compared to secondary or tertiary hospitals.

“Our findings indicate deaths from pediatric surgery are 100-200 times greater than in a high-income country,” reports the study published in the journal Anesthesiology.

Many deaths were linked to failure by the health facilities to use the globally and locally recommended and available Safe Surgery Checklist.

“We found a link between failure to use the Safe Surgery Checklist and mortality,” said lead author, Dr Mark Newton in a statement.

The consequences of not using the Safe Surgery Checklist were dramatised in 2018 when doctors at Kenyatta National Hospital performed a brain surgery on the wrong patient.

The mix up, which shocked Kenyans, involved one patient who needed surgery for a blood clot on the brain, and another who only needed non-invasive treatment for a swelling.

But a horrifying mix-up of identification tags saw the wrong man undergo surgery. Use of the checklist which among others has a redundant patient identification procedure experts say could have helped avoid the mix-up.

Earlier a study on the use of the checklist at KNH had shown this was not an isolated problem because only 19 per cent of surgical staff uses the life-saving tool. The study showed that while almost 60 per cent of the surgical team at KNH said they knew about the checklist most said it was not available at the hospital.

The authors, however including Dr Thomas Chokwe of the Department of Surgery at KNH and a lecturer at the University of Nairobi concluded what was lacking was not the checklist but enthusiasm among surgical staff. Dr Chokwe and the team had recommended that the Ministry of Health issue and follow up directives for the checklist’s implementation in all hospitals that conduct surgery in order to improve outcomes.

In the current study the failure to use the Safe Surgery Checklist was even more dramatic. “Our study has shown that not using the Safe Surgery Checklist in the pediatric surgery population was associated with a 218 per cent increase in number of deaths across all hospital levels.”

Miss life-saving tasks

The study also found children operated at night and over the weekend were at a higher risk of dying compared to those on daylight and weekday surgeries. This, the authors attribute to reduced personnel and support systems otherwise available during normal working hours.

The study however does not compare the difference in number of deaths, if any between public and faith based institutions.

However, a study by among others the Kenya Medical Research Institute (Kemri) and the Nursing Council of Kenya, shows care of children in public hospitals compared to the private sector is highly compromised.

The study published in the January 2020 issue of the BMJ Quality and Safety journal has analysed the quality of care for 216 newborns in six high volume hospitals in Nairobi. The six include two facilities each from the private, public and mission sectors.

The team says newborns in all type of facilities were found to miss crucial life-saving tasks including feeding, monitoring of vital signs and appropriate use of fluids and oxygen.

“The minimum threshold recommended for adequate care was only achieved in 14 per cent of the babies,” says the study.

The worst performance was recorded in public hospitals, which is attributed to an acute shortage of nursing staff taking care of sick babies.

Comparatively while in the private sector a nurse was taking care of a maximum of seven babies their counterpart in the public facilities was caring for 25 children.

“Private sector facilities had a median ratio of babies to nurses of 3, with a maximum of 7 babies per nurse. In the public sector, the median ratio was 19 babies and a maximum exceeding 25 babies per nurse,” says the report.

Gatonye Gathura

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