G322(P) Leaving a legacy after a three year global links project at a rural kenyan hospital

Introduction The Royal College of Paediatrics and Child Health’s Global Links (GL) Programme, has worked in collaboration with the Kenyan Paediatric Association since 2012. One alliance involved Paediatric trainees from one deanery supporting a hospital in rural Kenya, aiming to implement training and quality improvement projects, providing sustainable improvements and benefit to the hospital and workforce. This link ended in July 2016. Methods Between 2013 and 2016, 6 trainees undertook six 6 month placements. Improvements in Neonatal care included; hand hygiene, thermal care, and introduction of CPAP (continuous positive pressure ventilation). In Paediatrics, projects included; introducing regular ETAT (Emergency Treatment, Assessment and Triage) training, evaluation of inpatient nutritional status and improving standards of assessment and documentation according to the Kenyan Basic Paediatric Protocols alongside developing a Paediatric Handbook for the hospital. Results In Neonates, the annual mortality rate fell from 21.6% (2014) to 6.9% (2016 to date). Admissions increased from a mean of 13 to 17 per month. Total mortalities reduced from a mean of 2.75 to 1.2 per month. Hand hygiene compliance improved from 66% (2013) to 93.7% (2015). However in the four months since leaving, the monthly mortality rate was 15%, mean admission numbers - 16 and mean total monthly deaths - 2. In Paediatrics, admission weight documentation increased from 76% (2014) to 94% (2016). Malnutrition status documentation improved from 0% (2014) to 55% (2016). Conclusions A GL Volunteer presence appears to be associated with significant improvements in the quality of care at this hospital. The unique link with a single deanery enabled close communication between volunteers, allowing each to develop and improve on their predecessors projects. Recent data shows these results are challenging to sustain in a low resource environment with a high staff turnover without volunteer support. Further data is required to evaluate the longevity of any legacy as results may be skewed by variations in pathology. However we hope those trained by the volunteers will transfer their skills and knowledge to their future practice, helping support child health in low resource settings.