Fred Were
University of Nairobi, Kenya, Paediatrics and child health, Faculty Member
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Research Interests: Plant Biology, Quality Improvement, Kenya, F Mri Research, Medicine, and 15 moreDiarrhea, Humans, Female, Male, Research article, Prevalence, Anti-Bacterial Agents, Open Peer Review, Guidance and Counseling Intervention Programs, Logistic Models, Inappropriate Prescribing, Child preschool, BMC, Medical and Health Sciences, and Paediatrics and reproductive medicine
Research Interests: Pediatrics, Kenya, Medicine, HIV, Malnutrition, and 15 moreHumans, Child, Female, Male, Confidence intervals, Infant, Neoplasms, Chickenpox, Seroprevalence, Cross Sectional Studies, Enzyme Linked Immunosorbent Assay, Child preschool, Medical and Health Sciences, HIV infections, and Chickenpox Vaccine
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Research Interests: Acute kidney injury, Medicine, Comorbidity, Birth Weight, Prospective studies, and 15 moreHumans, Internal Medicine, Female, Male, Infant, Pediatric Nephrology, Odds ratio, Acute Phase Proteins, Predictive value of tests, Creatinine, Asphyxia neonatorum, Cohort Studies, Perinatal Asphyxia, Prospective Cohort Study, and Paediatrics and reproductive medicine
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World Health Organization (WHO) preferred product characteristics describe preferences for product attributes that would help optimize value and use to address global public health needs, with a particular focus on low- and middle-income... more
World Health Organization (WHO) preferred product characteristics describe preferences for product attributes that would help optimize value and use to address global public health needs, with a particular focus on low- and middle-income countries. Having previously published preferred product characteristics for both maternal and paediatric respiratory syncytial virus (RSV) vaccines, WHO recently published preferred product characteristics for monoclonal antibodies to prevent severe RSV disease in infants. This article summarizes the key attributes from the preferred product characteristics and discusses key considerations for future access and use of preventive RSV monoclonal antibodies.
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BackgroundThe impact of COVID-19 in Africa remains poorly defined. We sought to describe trends in hospitalisation due to all medical causes, pneumonia-specific admissions, and inpatient mortality in Kenya before and during the first five... more
BackgroundThe impact of COVID-19 in Africa remains poorly defined. We sought to describe trends in hospitalisation due to all medical causes, pneumonia-specific admissions, and inpatient mortality in Kenya before and during the first five waves of the COVID-19 pandemic in Kenya.MethodsWe conducted a hospital-based, multi-site, longitudinal observational study of patients admitted to 13 public referral facilities in Kenya from January 2018 to December 2021. The pre-COVID population included patients admitted before 1 March 2020. We fitted time series models to compare observed and predicted trends for each outcome. To estimate the impact of the COVID-19 pandemic, we calculated incidence rate ratios (IRR) and corresponding 95% confidence intervals (CI) from negative binomial mixed-effects models.ResultsOut of 302,703 patients hospitalised across the 13 surveillance sites (range 11547 to 57011), 117642 (39%) were admitted to adult wards. Compared with the pre-COVID period, hospitalisat...
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Background Kenya has significantly expanded its medical school numbers and internship training hospital numbers to address its workforce gap. The majority of newly accredited internship hospitals are first-level referral/district... more
Background Kenya has significantly expanded its medical school numbers and internship training hospital numbers to address its workforce gap. The majority of newly accredited internship hospitals are first-level referral/district hospitals, which are considered to have shortage of staff, medications, have limited service capacity and are described as “not organized for training purpose”. Using data from the Kenya Harmonized Health Facility Assessment (KHFA) 2018, we characterise the readiness and capacity of 61 internship hospitals to understand whether they are suitable to provide internship training for medical doctors. Methods We used secondary data from KHFA 2018, which sampled 61 out of all 74 internship hospitals in Kenya. Comparing against the minimum requirement outlined in the national guidelines for medical officer interns, we filtered and identified 166 indicators from the KHFA survey questionnaire and grouped them into 12 domains. An overall readiness and capacity index ...
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Background:With the growth of Community-Based Health Information (CBHIS) for decision making and service provision in the low income settings, innovative models of addressing Maternal and Newborn Health (MNH) morbidity and mortality are... more
Background:With the growth of Community-Based Health Information (CBHIS) for decision making and service provision in the low income settings, innovative models of addressing Maternal and Newborn Health (MNH) morbidity and mortality are necessary. World Health Organization (WHO) estimates that five hundred thousand mothers and about three million newborns die each year in middle and low income countries.Objectives: To stimulate interest in utilisation CBHIS for research and interventions, with an illustration of potential using on Motivational Interviewing intervention.Data Source:Literature searched electronically, discussion with behavioural experts, health system researchers, and maternal and Newborn Health (MNH) experts, and book reviews.Study Selection:Broad selection criteria including all current literature relevantsubjects including CBHIS, behaviour change methods and Community MNH.Data Extraction: A checklist for relevance was used to identify the relevant behaviour change ...
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ObjectiveTo characterise the capacity of Kenya internship hospitals to understand whether they are suitable to provide internship training for medical doctors.DesignA secondary data analysis of a cross-sectional health facility assessment... more
ObjectiveTo characterise the capacity of Kenya internship hospitals to understand whether they are suitable to provide internship training for medical doctors.DesignA secondary data analysis of a cross-sectional health facility assessment (Kenya Harmonized Health Facility Assessment (KHFA) 2018).Setting and populationWe analysed 61 out of all 74 Kenyan hospitals that provide internship training for medical doctors.Outcome measuresComparing against the minimum requirement outlined in the national guidelines for medical officer interns, we filtered and identified 166 indicators from the KHFA survey questionnaire and grouped them into 12 domains. An overall capacity index was calculated as the mean of 12 domain-specific scores for each facility.ResultsThe average overall capacity index is 69% (95% CI 66% to 72%) for all internship training centres. Hospitals have moderate capacity (over 60%) for most of the general domains, although there is huge variation between hospitals and only 29...
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Example of hospital-specific pneumonia feedback sheet provided to the enhanced feedback arm. (DOCX 87 kb)
Pneumonia severity classification during intervention period according to trial arm. (PPTX 47 kb)
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A cross-sectional survey was conducted in neonatal and maternity units of five Kenyan district public hospitals. Data for 1 year were obtained: 3999 maternal and 1836 neonatal records plus tallies of maternal deaths, deliveries and... more
A cross-sectional survey was conducted in neonatal and maternity units of five Kenyan district public hospitals. Data for 1 year were obtained: 3999 maternal and 1836 neonatal records plus tallies of maternal deaths, deliveries and stillbirths. There were 40 maternal deaths [maternal mortality ratio: 276 per 100 000 live births, 95% confidence interval (CI): 197-376]. Fresh stillbirths ranged from 11 to 43 per 1000 births. A fifth (19%, 263 of 1384, 95% CI: 11-30%) of the admitted neonates died. Compared with normal birth weight, odds of death were significantly higher in all of the low birth weight (LBW, <2500 g) categories, with the highest odds for the extremely LBW (<1000 g) category (odds ratio: 59, 95% CI: 21-158, p < 0.01). The observed maternal mortality, stillbirths and neonatal mortality call for implementation of the continuum of care approach to intervention delivery with particular emphasis on LBW babies.
Research Interests: Kenya, Medicine, Maternal Mortality, Pregnancy, Humans, and 15 moreHospitalization, Female, Male, Infant, Newborn Infant, Morbidity, Infant Mortality, Oxford university, Retrospective Studies, Cross Sectional Studies, Logistic Models, Pregnancy Outcome, Cause of death, Asphyxia, and Paediatrics and reproductive medicine
ObjectiveAn audit of neonatal care services provided by clinical training centres was undertaken to identify areas requiring improvement as part of wider efforts to improve newborn survival in Kenya.DesignCross-sectional study using... more
ObjectiveAn audit of neonatal care services provided by clinical training centres was undertaken to identify areas requiring improvement as part of wider efforts to improve newborn survival in Kenya.DesignCross-sectional study using indicators based on prior work in Kenya. Statistical analyses were descriptive with adjustment for clustering of data.SettingNeonatal units of 22 public hospitals.PatientsNeonates aged <7 days.Main outcome measuresQuality of care was assessed in terms of availability of basic resources (principally equipment and drugs) and audit of case records for documentation of patient assessment and treatment at admission.ResultsAll hospitals had oxygen, 19/22 had resuscitation and phototherapy equipment, but some key resources were missing—for example kangaroo care was available in 14/22. Out of 1249 records, 56.9% (95% CI 36.2% to 77.6%) had a standard neonatal admission form. A median score of 0 out of 3 for symptoms of severe illness (IQR 0–3) and a median sc...
Research Interests: Quality of Mental Health Care, Quality Improvement, Health Services Research, Kenya, Medicine, and 11 moreHumans, Female, Male, Clinical Sciences, Newborn Infant, Public health systems and services research, Public Art Hospitals, Cross Sectional Studies, Medical Audit, Quality of health care, and Paediatrics and reproductive medicine
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Index case factors associated with active TB disease at baseline. (DOCX 16 kb)
This article was scanned from a hard copy of the East and Central Africa medical journal Vol.2 no1 2015
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Research Interests: Developing Countries, Health, Health Services Research, Kenya, Medicine, and 15 moreBritish medical history, Humans, Female, Male, Infant, Clinical Sciences, Health System, Newborn Infant, Patient Care Team, Low Income Countries, Child mortality, Nino, Child preschool, Delivery of Health Care, and Paediatrics and reproductive medicine
CONSORT checklist for reporting of cluster randomised trial. (DOCX 29 kb)
Dengue outbreaks and epidemics have been reported in all regions of Africa, and it is believed that all four dengue virus serotypes are in circulation. Available data suggest that dengue is endemic to 34 African countries and that Aedes... more
Dengue outbreaks and epidemics have been reported in all regions of Africa, and it is believed that all four dengue virus serotypes are in circulation. Available data suggest that dengue is endemic to 34 African countries and that Aedes aegypti mosquitoes – the primary vector for dengue transmission – are known to be present in all but five countries. Whether populations in Africa are susceptible to dengue at the same rates as in Asia and Latin America is difficult to determine from the available data. Several factors may affect the transmission of dengue in Africa, including vector efficiency, viral infectivity, host vulnerability and environmental factors, such as increasing urbanisation. Current dengue prevention strategies in Africa focus on vector control, although the primary aim of such efforts is typically the prevention of malaria. Further research is needed to characterise the epidemiology of dengue in Africa and to better understand the factors involved in differences in ...
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Background: African children have some of the highest rates of bacterial meningitis in the world. Bacterial meningitis in Africa is associated with high case fatality and frequent neuropsychological sequelae. The objective of this study... more
Background: African children have some of the highest rates of bacterial meningitis in the world. Bacterial meningitis in Africa is associated with high case fatality and frequent neuropsychological sequelae. The objective of this study is to present a comprehensive review of data on bacterial meningitis sequelae in children from the African continent. Methods: We conducted a systematic literature search to identify studies from Africa focusing on children aged between 1 month to 15 years with laboratory-confirmed bacterial meningitis. We extracted data on neuropsychological sequelae (hearing loss, vision loss, cognitive delay, speech/language disorder, behavioural problems, motor delay/impairment, and seizures) and mortality, by pathogen. Results: A total of 37 articles were included in the final analysis representing 21 African countries and 6,029 children with confirmed meningitis. In these studies, nearly one fifth of bacterial meningitis survivors experienced in-hospital sequel...
Background Regular assessment of quality of care allows monitoring of progress towards system goals and identifies gaps that need to be addressed to promote better outcomes. We report efforts to initiate routine assessments in a... more
Background Regular assessment of quality of care allows monitoring of progress towards system goals and identifies gaps that need to be addressed to promote better outcomes. We report efforts to initiate routine assessments in a low-income country in partnership with government. Methods A cross-sectional survey undertaken in 22 ‘internship training ’ hospitals across Kenya that examined availability of essential resources and process of care based on review of 60 case-records per site focusing on the common childhood illnesses (pneumonia, malaria, di-arrhea/dehydration, malnutrition and meningitis). Results Availability of essential resources was 75 % (45/61 items) or more in 8/22 hospitals. A total of 1298 (range 54–61) case records were reviewed. HIV testing remained suboptimal at 12 % (95 % CI 7–19). A routinely introduced structured pediatric admission record form im-proved documentation of core admission symptoms and signs (median score for signs 22/
Background: Selenoprotein Iodothyronine 5’Deiodonases activates pro-T3 to 3,3’5T3(Tri-iodothyronine) which is involved in growth through a gene mediated protein metabolism. Oestradiol (E2) enhances activity of selenoproteins in adult... more
Background: Selenoprotein Iodothyronine 5’Deiodonases activates pro-T3 to 3,3’5T3(Tri-iodothyronine) which is involved in growth through a gene mediated protein metabolism. Oestradiol (E2) enhances activity of selenoproteins in adult pre-menopausal women taking selenium supliments, however the effect of selenium supplementation on weight change of different gender of asymptomatic HIV positive pre-puberty children is still unknown. Methods: In this study of 25 Females and 25 Males randomly chosen asymptomatic HIV positive children 3 – 16 years old, 25 of the children were given, a fixed dose of 50μg yeast selenium while a matched control of 25 were put on placebo. Weight of children were taken at 3 months intervals up to 6 months, using electronic personal scale (model 10010), the resultant data was analyzed by Epi Info version 6,and SPSS version 16. Results: No significant difference in mean weight of children was observed at baseline between the controls and children on test . Chil...
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Background: Preterm birth causes about 75% of neonatal deaths that are not attributable to congenital malformations. Antenatal corticosteroids (ACS) given to mothers at risk of preterm birth reduce the incidence/severity of RDS,... more
Background: Preterm birth causes about 75% of neonatal deaths that are not attributable to congenital malformations. Antenatal corticosteroids (ACS) given to mothers at risk of preterm birth reduce the incidence/severity of RDS, intraventricular haemmorhage, necrotizing enterocolitis and neonatal deaths. The WHO recommends use of antenatal steroids for all pregnant women 26-34 weeks gestation at risk of preterm delivery and after 34 weeks gestation only if there is evidence of fetal pulmonary immaturity. Despite this, ACS are widely used locally across all gestational periods. Objective: To determine the frequency of administration and impact of ACS in reducing the morbidity and mortality in preterm neonates born 28- 37 weeks gestation at Kenyatta National Hospital. Design: This was a hospital-based retrospective cohort study. Setting: Kenyattah National Hospital labour ward, antenatal wards, NBU, NICU. Methods: The study compared the neonatal outcomes of mothers with preterm birth ...
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ObjectiveTo examine the availability of paediatricians in Kenya and plans for their development.DesignReview of policies and data from multiple sources combined with local expert insight.SettingKenya with a focus on the public,... more
ObjectiveTo examine the availability of paediatricians in Kenya and plans for their development.DesignReview of policies and data from multiple sources combined with local expert insight.SettingKenya with a focus on the public, non-tertiary care sector as an example of a low-income and middle-income country aiming to improve the survival and long-term health of newborns, children and adolescents.ResultsThere are 305 practising paediatricians, 1.33 per 100 000 individuals of the population aged <19 years which in total numbers approximately 25 million. Only 94 are in public sector, non-tertiary county hospitals. There is either no paediatrician at all or only one paediatrician in 21/47 Kenyan counties that are home to over a quarter of a million under 19 years of age. Government policy is to achieve employment of 1416 paediatricians in the public sector by 2030, however this remains aspirational as there is no comprehensive training or financing plan to reach this target and healt...
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In a companion paper, we showed how local hospital leaders could assess systems and identify key safety concerns and targets for system improvement. In the present paper, we consider how these leaders might implement practical, low-cost... more
In a companion paper, we showed how local hospital leaders could assess systems and identify key safety concerns and targets for system improvement. In the present paper, we consider how these leaders might implement practical, low-cost interventions to improve safety. Our focus is on making immediate safety improvements both to directly improve patient care and as a foundation for advancing care in the longer-term. We describe a ‘portfolio’ approach to safety improvement in four broad categories: prioritising critical processes, such as checking drug doses; strengthening the overall system of care, for example, by introducing multiprofessional handovers; control of known risks, such as only using continuous positive airway pressure when appropriate conditions are met; and enhancing detection and response to hazardous situations, such as introducing brief team meetings to identify and respond to immediate threats and challenges. Local clinical leaders and managers face numerous chal...
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There are global calls for research to support health system strengthening in low-income and middle-income countries (LMICs). To examine the nature and magnitude of gaps in access and quality of inpatient neonatal care provided to a... more
There are global calls for research to support health system strengthening in low-income and middle-income countries (LMICs). To examine the nature and magnitude of gaps in access and quality of inpatient neonatal care provided to a largely poor urban population, we combined multiple epidemiological and health services methodologies. Conducting this work and generating findings was made possible through extensive formal and informal stakeholder engagement linked to flexibility in the research approach while keeping overall goals in mind. We learnt that 45% of sick newborns requiring hospital care in Nairobi probably do not access a suitable facility and that public hospitals provide 70% of care accessed with private sector care either poor quality or very expensive. Direct observations of care and ethnographic work show that critical nursing workforce shortages prevent delivery of high-quality care in high volume, low-cost facilities and likely threaten patient safety and nurses’ we...