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Article ; Online: Lessons from the design, development and implementation of a three-dimensional (3D) neonatal resuscitation training smartphone application: Life-saving Instruction for Emergencies (LIFE app).

Wanyama, Conrad / Nagraj, Shobhana / Muinga, Naomi / Tuti, Timothy / Edgcombe, Hilary / Geniets, Anne / Winters, Niall / English, Mike / Rossner, Jakob / Paton, Chris

Advances in simulation (London, England)

2022 Volume 7, Issue 1, Page(s) 2

Abstract: Neonatal mortality remains disproportionately high in sub-Saharan Africa partly due to insufficient numbers of adequately trained and skilled front-line health workers. Opportunities for improving neonatal care may result from upskilling frontline health ...

Abstract	Neonatal mortality remains disproportionately high in sub-Saharan Africa partly due to insufficient numbers of adequately trained and skilled front-line health workers. Opportunities for improving neonatal care may result from upskilling frontline health workers using innovative technological approaches. This practice paper describes the key steps involved in the design, development and implementation of an innovative smartphone-based training application using an agile, human-centred design approach. The Life-saving Instruction for Emergencies (LIFE) app is a three-dimension (3D) scenario-based mobile app for smartphones and is free to download. Two clinical modules are currently included with further scenarios planned. Whilst the focus of the practice paper is on the lessons learned during the design and development process, we also share key learning related to project management and sustainability plans, which we hope will help researchers working on similar projects.
Language	English
Publishing date	2022-01-10
Publishing country	England
Document type	Journal Article
ISSN	2059-0628
ISSN (online)	2059-0628
DOI	10.1186/s41077-021-00197-7
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Evaluation of Adaptive Feedback in a Smartphone-Based Game on Health Care Providers' Learning Gain: Randomized Controlled Trial.

Tuti, Timothy / Winters, Niall / Edgcombe, Hilary / Muinga, Naomi / Wanyama, Conrad / English, Mike / Paton, Chris

Journal of medical Internet research

2020 Volume 22, Issue 7, Page(s) e17100

Abstract: Background: Although smartphone-based emergency care training is more affordable than traditional avenues of training, it is still in its infancy, remains poorly implemented, and its current implementation modes tend to be invariant to the evolving ... ...

Abstract	Background: Although smartphone-based emergency care training is more affordable than traditional avenues of training, it is still in its infancy, remains poorly implemented, and its current implementation modes tend to be invariant to the evolving learning needs of the intended users. In resource-limited settings, the use of such platforms coupled with gamified approaches remains largely unexplored, despite the lack of traditional training opportunities, and high mortality rates in these settings. Objective: The primary aim of this randomized experiment is to determine the effectiveness of offering adaptive versus standard feedback, on the learning gains of clinicians, through the use of a smartphone-based game that assessed their management of a simulated medical emergency. A secondary aim is to examine the effects of learner characteristics and learning spacing with repeated use of the game on the secondary outcome of individualized normalized learning gain. Methods: The experiment is aimed at clinicians who provide bedside neonatal care in low-income settings. Data were captured through an Android app installed on the study participants' personal phones. The intervention, which was based on successful attempts at a learning task, included adaptive feedback provided within the app to the experimental arm, whereas the control arm received standardized feedback. The primary end point was completion of the second learning session. Of the 572 participants enrolled between February 2019 and July 2019, 247 (43.2%) reached the primary end point. The primary outcome was standardized relative change in learning gains between the study arms as measured by the Morris G effect size. The secondary outcomes were the participants individualized normalized learning gains. Results: The effect of adaptive feedback on care providers' learning gain was found to be g=0.09 (95% CI -0.31 to 0.46; P=.47). In exploratory analysis, using normalized learning gains, when subject-treatment interaction and differential time effect was controlled for, this effect increased significantly to 0.644 (95% CI 0.35 to 0.94; P<.001) with immediate repetition, which is a moderate learning effect, but reduced significantly by 0.28 after a week. The overall learning change from the app use in both arms was large and may have obscured a direct effect of feedback. Conclusions: There is a considerable learning gain between the first two rounds of learning with both forms of feedback and a small added benefit of adaptive feedback after controlling for learner differences. We suggest that linking the adaptive feedback provided to care providers to how they space their repeat learning session(s) may yield higher learning gains. Future work might explore in more depth the feedback content, in particular whether or not explanatory feedback (why answers were wrong) enhances learning more than reflective feedback (information about what the right answers are). Trial registration: Pan African Clinical Trial Registry (PACTR) 201901783811130; https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=5836. International registered report identifier (irrid): RR2-10.2196/13034.
MeSH term(s)	Adult ; Double-Blind Method ; Feedback ; Female ; Health Personnel/trends ; Humans ; Learning Health System/trends ; Male ; Smartphone/instrumentation ; Smartphone/standards ; Video Games/psychology
Language	English
Publishing date	2020-07-06
Publishing country	Canada
Document type	Journal Article ; Randomized Controlled Trial ; Research Support, Non-U.S. Gov't
ZDB-ID	2028830-X
ISSN	1438-8871 ; 1439-4456
ISSN (online)	1438-8871
ISSN	1439-4456
DOI	10.2196/17100
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Protocol for the Pathways Study: a realist evaluation of staff social ties and communication in the delivery of neonatal care in Kenya.

Wanyama, Conrad / Blacklock, Claire / Jepkosgei, Juliet / English, Mike / Hinton, Lisa / McKnight, Jacob / Molyneux, Sassy / Boga, Mwanamvua / Musitia, Peris Muoga / Wong, Geoff

BMJ open

2023 Volume 13, Issue 3, Page(s) e066150

Abstract: Introduction: The informal social ties that health workers form with their colleagues influence knowledge, skills and individual and group behaviours and norms in the workplace. However, improved understanding of these 'software' aspects of the ... ...

Abstract	Introduction: The informal social ties that health workers form with their colleagues influence knowledge, skills and individual and group behaviours and norms in the workplace. However, improved understanding of these 'software' aspects of the workforce (eg, relationships, norms, power) have been neglected in health systems research. In Kenya, neonatal mortality has lagged despite reductions in other age groups under 5 years. A rich understanding of workforce social ties is likely to be valuable to inform behavioural change initiatives seeking to improve quality of neonatal healthcare.This study aims to better understand the relational components among health workers in Kenyan neonatal care areas, and how such understanding might inform the design and implementation of quality improvement interventions targeting health workers' behaviours. Methods and analysis: We will collect data in two phases. In phase 1, we will conduct non-participant observation of hospital staff during patient care and hospital meetings, a social network questionnaire with staff, in-depth interviews, key informant interviews and focus group discussions at two large public hospitals in Kenya. Data will be collected purposively and analysed using realist evaluation, interim analyses including thematic analysis of qualitative data and quantitative analysis of social network metrics. In phase 2, a stakeholder workshop will be held to discuss and refine phase one findings.Study findings will help refine an evolving programme theory with recommendations used to develop theory-informed interventions targeted at enhancing quality improvement efforts in Kenyan hospitals. Ethics and dissemination: The study has been approved by Kenya Medical Research Institute (KEMRI/SERU/CGMR-C/241/4374) and Oxford Tropical Research Ethics Committee (OxTREC 519-22). Research findings will be shared with the sites, and disseminated in seminars, conferences and published in open-access scientific journals.
MeSH term(s)	Infant, Newborn ; Humans ; Child, Preschool ; Kenya ; Delivery of Health Care ; Focus Groups ; Quality Improvement ; Communication
Language	English
Publishing date	2023-03-13
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2599832-8
ISSN	2044-6055 ; 2044-6055
ISSN (online)	2044-6055
ISSN	2044-6055
DOI	10.1136/bmjopen-2022-066150
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Article: Evaluation of Adaptive Feedback in a Smartphone-Based Serious Game on Health Care Providers' Knowledge Gain in Neonatal Emergency Care: Protocol for a Randomized Controlled Trial.

Tuti, Timothy / Winters, Niall / Muinga, Naomi / Wanyama, Conrad / English, Mike / Paton, Chris

JMIR research protocols

2019 Volume 8, Issue 7, Page(s) e13034

Abstract: Background: Although smartphone-based clinical training to support emergency care training is more affordable than traditional avenues of training, it is still in its infancy and remains poorly implemented. In addition, its current implementations tend ... ...

Abstract	Background: Although smartphone-based clinical training to support emergency care training is more affordable than traditional avenues of training, it is still in its infancy and remains poorly implemented. In addition, its current implementations tend to be invariant to the evolving learning needs of the intended users. In resource-limited settings, the use of such platforms coupled with serious-gaming approaches remain largely unexplored and underdeveloped, even though they offer promise in terms of addressing the health workforce skill imbalance and lack of training opportunities associated with the high neonatal mortality rates in these settings. Objective: This randomized controlled study aims to assess the effectiveness of offering adaptive versus standard feedback through a smartphone-based serious game on health care providers' knowledge gain on the management of a neonatal medical emergency. Methods: The study is aimed at health care workers (physicians, nurses, and clinical officers) who provide bedside neonatal care in low-income settings. We will use data captured through an Android smartphone-based serious-game app that will be downloaded to personal phones belonging to the study participants. The intervention will be adaptive feedback provided within the app. The data captured will include the level of feedback provided to participants as they learn to use the mobile app, and performance data from attempts made during the assessment questions on interactive tasks participants perform as they progress through the app on emergency neonatal care delivery. The primary endpoint will be the first two complete rounds of learning within the app, from which the individuals' "learning gains" and Morris G intervention effect size will be computed. To minimize bias, participants will be assigned to an experimental or a control group by a within-app random generator, and this process will be concealed to both the study participants and the investigators until the primary endpoint is reached. Results: This project was funded in November 2016. It has been approved by the Central University Research Ethics Committee of the University of Oxford and the Scientific and Ethics Review Unit of the Kenya Medical Research Institute. Recruitment and data collection began from February 2019 and will continue up to July 31, 2019. As of July 18, 2019, we enrolled 541 participants, of whom 238 reached the primary endpoint, with a further 19 qualitative interviews conducted to support evaluation. Full analysis will be conducted once we reach the end of the study recruitment period. Conclusions: This study will be used to explore the effectiveness of adaptive feedback in a smartphone-based serious game on health care providers in a low-income setting. This aspect of medical education is a largely unexplored topic in this context. In this randomized experiment, the risk of performance bias across arms is moderate, given that the active ingredient of the intervention (ie, knowledge) is a latent trait that is difficult to comprehensively control for in a real-world setting. However, the influence of any resulting bias that has the ability to alter the results will be assessed using alternative methods such as qualitative interviews. Trial registration: Pan African Clinical Trials Registry PACTR201901783811130; https://pactr.samrc.ac.za/TrialDisplay. aspx?TrialID=5836. International registered report identifier (irrid): PRR1-10.2196/13034.
Language	English
Publishing date	2019-07-26
Publishing country	Canada
Document type	Journal Article
ZDB-ID	2719222-2
ISSN	1929-0748
ISSN	1929-0748
DOI	10.2196/13034
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Evaluation of Adaptive Feedback in a Smartphone-Based Game on Health Care Providers’ Learning Gain

Tuti, Timothy / Winters, Niall / Edgcombe, Hilary / Muinga, Naomi / Wanyama, Conrad / English, Mike / Paton, Chris

Journal of Medical Internet Research, Vol 22, Iss 7, p e

Randomized Controlled Trial

2020 Volume 17100

Abstract: BackgroundAlthough smartphone-based emergency care training is more affordable than traditional avenues of training, it is still in its infancy, remains poorly implemented, and its current implementation modes tend to be invariant to the evolving ... ...

Abstract	BackgroundAlthough smartphone-based emergency care training is more affordable than traditional avenues of training, it is still in its infancy, remains poorly implemented, and its current implementation modes tend to be invariant to the evolving learning needs of the intended users. In resource-limited settings, the use of such platforms coupled with gamified approaches remains largely unexplored, despite the lack of traditional training opportunities, and high mortality rates in these settings. ObjectiveThe primary aim of this randomized experiment is to determine the effectiveness of offering adaptive versus standard feedback, on the learning gains of clinicians, through the use of a smartphone-based game that assessed their management of a simulated medical emergency. A secondary aim is to examine the effects of learner characteristics and learning spacing with repeated use of the game on the secondary outcome of individualized normalized learning gain. MethodsThe experiment is aimed at clinicians who provide bedside neonatal care in low-income settings. Data were captured through an Android app installed on the study participants’ personal phones. The intervention, which was based on successful attempts at a learning task, included adaptive feedback provided within the app to the experimental arm, whereas the control arm received standardized feedback. The primary end point was completion of the second learning session. Of the 572 participants enrolled between February 2019 and July 2019, 247 (43.2%) reached the primary end point. The primary outcome was standardized relative change in learning gains between the study arms as measured by the Morris G effect size. The secondary outcomes were the participants individualized normalized learning gains. ResultsThe effect of adaptive feedback on care providers’ learning gain was found to be g=0.09 (95% CI −0.31 to 0.46; P=.47). In exploratory analysis, using normalized learning gains, when subject-treatment interaction and differential time effect was controlled ...
Keywords	Computer applications to medicine. Medical informatics ; R858-859.7 ; Public aspects of medicine ; RA1-1270
Subject code	150
Language	English
Publishing date	2020-07-01T00:00:00Z
Publisher	JMIR Publications
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Prospective Clinical Surveillance for Severe Acute Respiratory Illness in Kenyan Hospitals during the COVID-19 pandemic

Lucinde, Ruth Khadembu / Gathuri, Henry / Isaaka, Lynda / Ogero, Morris / Mumelo, Livingstone / Kimego, Dennis / Mbevi, George / Wanyama, Conrad W / Otieno, Edwin Onyango / Mwakio, Stella / Saisi, Metrine / Isinde, ELizabeth / Oginga, Irene Njeri / Wachira, Alvin / Manuthu, Evans / Kariuki, Hazel / Nyikuli, Jared / Wekesa, Cyprian / Otedo, Amos /

Bosire, Hannah / Okoth, Steve Biko / Ongalo, Winston / Mukabi, David / Lusamba, Wilber / Muthui, Beatrice / Adembesa, Isaac / Mithi, Caroline W / Sood, Mohammed / Aliyan, Nadia / Gituma, Bernard / Giabe, Matiko / Omondi, Charles / Aman, Rashid / Amoth, Patrick / Kasera, Kadondi / Were, Fred / Nganga, Wangari / Berkley, James A / Tsofa, Benjamin A / Mwangangi, Joseph / Bejon, Phillip / Barasa, Edwine / English, Mike / Scott, J Anthony G / Akech, Samuel / Kagucia, E Wangeci / Agweyu, Ambrose / Etyang, Anthony O

medRxiv

Abstract: There are limited data from sub–Saharan Africa describing the pattern of admissions to public hospitals with severe acute respiratory infections during the COVID–19 pandemic. We conducted a prospective longitudinal hospital-based sentinel surveillance ... ...

Abstract	There are limited data from sub–Saharan Africa describing the pattern of admissions to public hospitals with severe acute respiratory infections during the COVID–19 pandemic. We conducted a prospective longitudinal hospital-based sentinel surveillance between May 2020 and December 2022 at 16 public hospitals in Kenya. All patients aged above 18 years admitted to adult medical wards in the participating hospitals were included. Demographic and clinical characteristics, COVID–19 infection and vaccination status and outcome data were collected. Of the 52,714 patients included in the study, 18,001 (35%) were admitted with severe acute respiratory illness (SARI). The mean age was 51 years. Patients were equally distributed across sexes. Pneumonia was the most common diagnosis at discharge. Hypertension, HIV and diabetes mellitus were the most common comorbidities. COVID–19 test results were positive in 2,370 (28%) of the 8,517 (47%) patients that underwent testing. Overall inpatient case fatality for SARI was 21% (n=3,828). After adjusting for age, sex and presence of a comorbidity, SARI patients had higher inpatient mortality compared to non-SARI patients regardless of their COVID–19 status (aHR 1.31, 95% CI 1.19 – 1.46). COVID–19 positive SARI patients had a higher inpatient mortality rate compared to their negative counterparts (aHR 1.31, 95% CI 1.12 – 1.54, p value < 0.0001). COVID-19 vaccine effectiveness against mortality due to SARI after adjusting for age, sex and presence of a comorbidity was 34% (95% CI 11% – 51%). We have provided a comprehensive description of the pattern of admissions with respiratory illnesses in Kenyan hospitals during the COVID–19 pandemic period. We have demonstrated the utility of routine surveillance activities within public hospitals in low-income settings which if strengthened can enhance the response to emerging health threats.
Keywords	covid19
Language	English
Publishing date	2024-03-04
Publisher	Cold Spring Harbor Laboratory Press
Document type	Article ; Online
DOI	10.1101/2024.03.03.24303690
Database	COVID19

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Article ; Online: Effects of the COVID-19 pandemic on hospital admissions and inpatient mortality in Kenya

Ogero, Morris / Isaaka, Lynda / Mumelo, Livingstone / Kimego, Dennis / Njoroge, Teresiah / Mbevi, George / Wanyama, Conrad / Lucinde, Ruth / Gathuri, Henry / Otiende, Mark / Nzioki, Charles / Wachira, Alvin / Mumbi, Felistus / Oeri, Geoffry / Mwangi, Ngina / Gitari, Renson / Mugambi, David / Namu, Sylvia / Ithondeka, Angeline /

Kariuki, Hazel / Kiama, Zacharia / Mwendwa, Lynne / Jowi, Elizabeth / Muthui, Beatrice / Kaara, Alex / Sitienei, Elkana / Thuranira, Lydia / Oginga, Irene / Njagi, Joseph / Kamau, Evelyn / Namulala, Emma / Wandera, Oscar / Oketch, Gregory / Odhiambo, Selestine / Adem, Achieng / Ochieng, Magdalene / Otedo, Amos / Otiende, Kennedy / Odondi, Adnan / Makokha, Felicitas / Lubanga, Dickens / Nyikui, Jared / Masoso, Wilfred / Manyonge, Mercy / Inginia, Rachel / Manuthu, Evans / Wafula, Dennis / Agutu, Cecilia / Malangachi, Roselyne / Biko, Steve / Simiyu, David / Obare, Jackson / Kimutai, David / Gituma, Bernard / Kyalo, Joshua / Timbwa, Molly / Otieno, Joyce / Oduol, Chris / Liru, Meshack / Nyabinda, Churchill / Otieno, Samuel / Aman, Rashid / Mwangangi, Mercy / Amoth, Patrick / Kasera, Kadondi / Ng'ang'a, Wangari / Tsegaye, Adino / Sherry, Christina / Singa, Benson / Tickell, Kirkby / Walson, Judd / Berkley, James / Were, Fredrick N / Mturi, Neema / Hamaluba, Mainga / Tsofa, Benjamin / Mwangangi, Joseph / Bejon, Philip / Barasa, Edwine / English, Mike / Nyaguara, Amek / Kagucia, Eunice W / Scott, Anthony / Akech, Samuel / Etyang, Anthony O / Agweyu, Ambrose

medRxiv

Abstract: Background: The 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 ... ...

Abstract	Background: The 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. Methods: We conducted a hospital-based 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. Results: Out of 302,703 patients (range 7453 to 27168) hospitalised across the 13 surveillance sites 84,337 (55.2%) were aged 15 years and older. Compared with the pre-COVID period, hospitalisations declined markedly among adult (IRR 0.68, 95% CI 0.63 to 0.73) and paediatric (IRR 0.67, 95% CI 0.62 to 0.73) patients. Adjusted in-hospital mortality also declined among both adult (IRR 0.83, 95% CI 0.77 to 0.89) and paediatric (IRR 0.85, 95% CI 0.77 to 0.94) admissions. Pneumonia-specific admissions among adults were higher during the pandemic (IRR 1.75, 95% CI 1.18 to 2.59), while the paediatric pneumonia cases were lower than pre-pandemic levels in the first year of the pandemic and elevated in late 2021 (IRR 0.78, 95% CI 0.51 to 1.20). Conclusions: Contrary to initial predictions, the COVID-19 pandemic was associated with lower rates of hospitalisation and in-hospital mortality, despite increased pneumonia admissions among adults. These trends were sustained after the withdrawal of containment measures that resulted in the disruption of essential health services, suggesting a role for additional factors that warrant further investigation.
Keywords	covid19
Language	English
Publishing date	2022-10-26
Publisher	Cold Spring Harbor Laboratory Press
Document type	Article ; Online
DOI	10.1101/2022.10.25.22281489
Database	COVID19

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Article ; Online: Effects of the COVID-19 pandemic on hospital admissions and inpatient mortality in Kenya

Kariuki, Hazel / Kiama, Zacharia / Mwendwa, Lynne / Jowi, Elizabeth / Muthui, Beatrice / Kaara, Alex / Sitienei, Elkana / Thuranira, Lydia / Oginga, Irene / Njagi, Joseph / Kamau, Evelyn / Namulala, Emma / Wandera, Oscar / Oketch, Gregory / Odhiambo, Selestine / Adem, Achieng / Ochieng, Magdalene / Otedo, Amos / Otiende, Kennedy / Odondi, Adnan / Makokha, Felicitas / Lubanga, Dickens / Nyikui, Jared / Masoso, Wilfred / Manyonge, Mercy / Inginia, Rachel / Manuthu, Evans / Wafula, Dennis / Agutu, Cecilia / Malangachi, Roselyne / Biko, Steve / Simiyu, David / Obare, Jackson / Kimutai, David / Gituma, Bernard / Kyalo, Joshua / Timbwa, Molly / Otieno, Joyce / Oduol, Chris / Liru, Meshack / Nyabinda, Churchill / Otieno, Samuel / Aman, Rashid / Mwangangi, Mercy / Amoth, Patrick / Were, Ian / Mwangi, Caroline / Kasera, Kadondi / Ng'ang'a, Wangari / Tsegaye, Adino / Sherry, Christina / Singa, Benson / Tickell, Kirkby / Walson, Judd / Berkley, James / Were, Fredrick N / Mturi, Neema / Hamaluba, Mainga / Tsofa, Benjamin / Mwangangi, Joseph / Bejon, Philip / Barasa, Edwine / English, Mike / Nyaguara, Amek / Kagucia, Eunice W / Scott, Anthony / Akech, Samuel / Etyang, Anthony O / Agweyu, Ambrose

medRxiv

Abstract	Background: The 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. Methods: We conducted a hospital-based 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. Results: Out of 302,703 patients (range 7453 to 27168) hospitalised across the 13 surveillance sites 84,337 (55.2%) were aged 15 years and older. Compared with the pre-COVID period, hospitalisations declined markedly among adult (IRR 0.68, 95% CI 0.63 to 0.73) and paediatric (IRR 0.67, 95% CI 0.62 to 0.73) patients. Adjusted in-hospital mortality also declined among both adult (IRR 0.83, 95% CI 0.77 to 0.89) and paediatric (IRR 0.85, 95% CI 0.77 to 0.94) admissions. Pneumonia-specific admissions among adults were higher during the pandemic (IRR 1.75, 95% CI 1.18 to 2.59), while the paediatric pneumonia cases were lower than pre-pandemic levels in the first year of the pandemic and elevated in late 2021 (IRR 0.78, 95% CI 0.51 to 1.20). Conclusions: Contrary to initial predictions, the COVID-19 pandemic was associated with lower rates of hospitalisation and in-hospital mortality, despite increased pneumonia admissions among adults. These trends were sustained after the withdrawal of containment measures that resulted in the disruption of essential health services, suggesting a role for additional factors that warrant further investigation.
Keywords	covid19
Language	English
Publishing date	2022-10-27
Publisher	Cold Spring Harbor Laboratory Press
Document type	Article ; Online
DOI	10.1101/2022.10.25.22281489
Database	COVID19

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Article ; Online: Lessons from the design, development and implementation of a three-dimensional (3D) neonatal resuscitation training smartphone application: Life-saving Instruction for Emergencies (LIFE app).

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Article ; Online: Evaluation of Adaptive Feedback in a Smartphone-Based Game on Health Care Providers' Learning Gain: Randomized Controlled Trial.

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Article ; Online: Protocol for the Pathways Study: a realist evaluation of staff social ties and communication in the delivery of neonatal care in Kenya.

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Article: Evaluation of Adaptive Feedback in a Smartphone-Based Serious Game on Health Care Providers' Knowledge Gain in Neonatal Emergency Care: Protocol for a Randomized Controlled Trial.

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Article ; Online: Evaluation of Adaptive Feedback in a Smartphone-Based Game on Health Care Providers’ Learning Gain

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Article ; Online: Prospective Clinical Surveillance for Severe Acute Respiratory Illness in Kenyan Hospitals during the COVID-19 pandemic

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Article ; Online: Effects of the COVID-19 pandemic on hospital admissions and inpatient mortality in Kenya

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Article ; Online: Effects of the COVID-19 pandemic on hospital admissions and inpatient mortality in Kenya

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Inter-library loan at ZB MED