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The Clinical Information Network (coordinators: Mike English, Sam Akech, Ambrose Agweyu and Jalemba Aluvaala) is a partnership between Oxford, KEMRI-Wellcome Trust, the Kenyan Ministry of Health, County Hospitals and the Kenya Paediatric Association. It works to promote the generation and use of high quality routine information on hospital admissions to paediatric and neonatal wards in the form of a low-cost ‘learning health system’.

Members of CIN, the Clinical Information Network, all standing in front of a research building

The Kenyan Clinical Information Network (CIN) was initiated in 2013 and now involves 16 hospitals. The CIN enhance the generation and use of data derived from routine clinical encounters and captured in improved medical records. CIN uses these data to promote and track guideline adherence and the adoption of basic technologies and contribute to local quality improvement efforts. As part of the approach CIN provides with detailed, 3-monthly audit and feedback reports on key quality of care indicators.

CIN, the Clinical Information Network, working group members, sitting around tables and participating in a work discussionWithin CIN major improvements in medical documentation and some clinical practices (eg. ascertaining HIV status and screening for malnutrition using MUAC) have been observed while many lessons have been learned about the challenges of implementation of even basic technologies that require specific additional resources (eg. screening for hypoglycaemia) or that conflict with long-established norms.

The same CIN data also support large scale analyse addressing contextually appropriate research questions to enable understanding of illness outcomes and system constraints. For example, data from the first 3 years of CIN supported the analysis of risk factors for mortality for over 17,000 children admitted with pneumonia and almost 10,000 children admitted with diarrhoea. Further, reports on severe childhood malnutrition, malaria, rickets, and quality of medical and nursing care all employ data form the CIN system.

In the next few years the CIN will in addition support evaluation of the implementation of the new malaria vaccine in western Kenya and the conduct of a major, individually randomised pragmatic trial testing alternative therapeutic options in severe childhood pneumonia. Most recently plans have been made so the CIN supports efforts to gain preliminary data on antimicrobial resistance of bacterial pathogens from multiple sites across Kenya.