ArticleArchives of disease in childhood2008
Health systems research in a low-income country: easier said than done.
Article in Archives of disease in childhood, 2008. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 25 papers, 2 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
25 citing papers in PubMed, 2 syntheses or guidelines pooled it, 41 citations in OpenAlex.
- The ability of non-physician health workers to identify chest indrawing to detect pneumonia in children below five years of age in low- and middle-income countries: A systematic review and meta-analysis.Journal of global health · 2023Pooled it
- Decentralization of health systems in low and middle income countries: a systematic review.International journal of public health · 2017Pooled it
- Effect of a multi-faceted quality improvement intervention on inappropriate antibiotic use in children with non-bloody diarrhoea admitted to district hospitals in Kenya.BMC pediatrics · 2011Trial
- A multifaceted intervention to implement guidelines and improve admission paediatric care in Kenyan district hospitals: a cluster randomised trial.PLoS medicine · 2011Trial
- Implementation of Smart Triage combined with a quality improvement program for children presenting to facilities in Kenya and Uganda: An interrupted time series analysis.PLOS digital health · 2025Article
- Assessment of Attitudes Toward the Emergency Triage System in Belize.Global pediatric health · 2020Article
- Measuring health systems strength and its impact: experiences from the African Health Initiative.BMC health services research · 2017Article
- The Paediatric Admission Quality of Care (PAQC) score: designing a tool to measure the quality of early inpatient paediatric care in a low-income setting.Tropical medicine & international health : TM & IH · 2016Article
- Health system context and implementation of evidence-based practices-development and validation of the Context Assessment for Community Health (COACH) tool for low- and middle-income settings.Implementation science : IS · 2015Article
- Review
- Using health worker opinions to assess changes in structural components of quality in a Cluster Randomized Trial.BMC health services research · 2014Article
- Evaluation of the effectiveness of an outreach clinical mentoring programme in support of paediatric HIV care scale-up in Botswana.AIDS care · 2013Article
- Knowledge translation in Uganda: a qualitative study of Ugandan midwives' and managers' perceived relevance of the sub-elements of the context cornerstone in the PARIHS framework.Implementation science : IS · 2012Article
- A multifaceted intervention to improve the quality of care of children in district hospitals in Kenya: a cost-effectiveness analysis.PLoS medicine · 2012Article
- Article
- Explaining the effects of a multifaceted intervention to improve inpatient care in rural Kenyan hospitals--interpretation based on retrospective examination of data from participant observation, quantitative and qualitative studies.Implementation science : IS · 2011Article
- Quality of hospital care for sick newborns and severely malnourished children in Kenya: a two-year descriptive study in 8 hospitals.BMC health services research · 2011Article
- Viewpoint: Economic evaluation of package of care interventions employing clinical guidelines.Tropical medicine & international health : TM & IH · 2011Article
- Syndromic management of common illnesses in hospitalized children and neonates: a cost identification study.Indian journal of pediatrics · 2010Article
- Are hospitals prepared to support newborn survival? - An evaluation of eight first-referral level hospitals in Kenya.Tropical medicine & international health : TM & IH · 2009Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
7 authors at 4 institutions in 2 countries.
Funding
Abstract
Small hospitals sit at the apex of the pyramid of primary care in the health systems of many low-income countries. If the Millennium Development Goal for child survival is to be achieved, hospital care for referred severely ill children will need to be improved considerably in parallel with primary care in many countries. Yet little is known about how to achieve this. This article describes the evolution and final design of an intervention study that is attempting to improve hospital care for children in Kenyan district hospitals. It illustrates many of the difficulties involved in reconciling epidemiological rigour and feasibility in studies at a health system, rather than an individual, level and the importance of the depth and breadth of analysis when trying to provide a plausible answer to the question: does it work? Although there are increasing calls for more health systems research in low-income countries, the importance of strong, broadly based local partnerships and long-term commitment even to initiate projects is not always appreciated.
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Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.