Podcasts on Health systems research

Jalemba Aluvaala

Dr Jalemba Aluvaala works for SIRCLE, a Consortium for National Health Research, collaboration between KEMRI - Wellcome Trust Research Programme, the University of Nairobi, College of Health Sciences and the Ministry of Medical Services. SIRCLE aims to build capacity for high quality health services and implementation research, and promote clinical excellence by engaging trainee researchers in policy relevant research.

The KEMRI-Wellcome Trust research programme

The KEMRI-Wellcome Trust Research Programme is a major Wellcome Trust’s overseas programmes. Its work has had a major influence on national and international health policy. Research spans a wide variety of topics and disciplines including research on malaria and bacterial and viral infectious diseases, work to map disease risk and intervention coverage and work on research ethics and health systems strengthening.

Jalemba Aluvaala: Newborn care in Kenyan hospitals

My background is that I am a paediatrician by training. I have been a paediatrician for the last 5 years. I completed my training in paediatrics in 2009 and my basic training in general medicine in 2003. After completing my training in paediatrics I worked in a rural hospital in Kenya for 2 years before joining KEMRI Wellcome Trust in 2011. Since then I have been involved in health services research focusing on the quality of care for newborns in public hospitals. At the same time I was undertaking training in epidemiology, which I have just recently completed, based at the London School of Hygiene and Tropical Medicine.

My current interest is in quality of newborn care in hospitals. This is because newborn care is an area of interest both internationally and within Kenya because we have seen that the under-five mortality rate has been declining but neonatal mortality has not had much change. As a result, it is currently contributing the bulk of under-five mortality.

I think newborn health care is important because right now in Kenya neonatal mortality contributes up to 60% of the infant mortality rate. Whereas previously a large percentage of all babies were being born at home, currently the government is putting efforts towards increasing the number of births in hospitals. As more mothers deliver in hospital it is going to become increasingly important that the care that is delivered to these newborns in hospitals is in accordance with the best available evidence and that we can offer the best care possible, to increase the overall survival of newborns in our country.

Principally, we are focusing on two approaches. There is the traditional epidemiological approach which looks at what the burden of disease is and what are the underlying causes that are associated with the determinants of these diseases. We are also looking at it through the health services research angle which focuses on the quality of care, the effectiveness of treatments and also tries to look at the cost-effectiveness of the interventions that are applied to the newborns. We are also particularly interested in looking at the best available evidence from an evidence based medicine perspective, of course relevant to our context in terms of costs.

The key numbers that we are focusing on in terms of newborn morbidity and mortality in Kenya as it is right now is that we know that in the last few years particularly, the most recent estimate in 2009 showed that up to nearly 40,000 newborns died in Kenya and this contributed a significant chunk of the infant and under-five mortality rates, 60% and 40%, respectively. In so far as achieving the goal of reducing under-five mortality rate by 2015 the biggest reason why Kenya is not on track to achieve our target is because our newborn mortality rate has essentially been the same since 1990. As it stands the most recent estimate is that about 31 newborns per 1000 live births are dying in Kenya which is a high number.

What I think is interesting about my area if research relevant to young people is that this is an area of research which can potentially make impact on the lives of a large number of people for a lifetime as opposed to, for example, research in adult medicine when somebody has already formed as an adult. What happens in children, particularly newborns, has an impact on what happens to them for the rest of their lives.  So not just at a personal level but also at a country level the quality of life that people live in our country is impacted by what happens to them as newborns. It is a chance to make a huge impact on people throughout their lifetime and by extension also on the kind of people that we will have in our country long term.

Looking back at the point at which I got in to research, I wish I had gotten in to it much earlier on than before because I think that our traditional training has focused more on being a provider of health care services rather than being a generator of knowledge and that is the chance that research provides to you and the earlier you get in to it the better because you are able to form your research basis much earlier in your career as you are interacting with your patients even in practice you are able to gather interesting questions which you are able to answer through your research. Certainly the one thing I wish is to have gotten in to it much earlier, in particular in my undergraduate training.