Cookies on this website

We use cookies to ensure that we give you the best experience on our website. If you click 'Accept all cookies' we'll assume that you are happy to receive all cookies and you won't see this message again. If you click 'Reject all non-essential cookies' only necessary cookies providing core functionality such as security, network management, and accessibility will be enabled. Click 'Find out more' for information on how to change your cookie settings.

Nurses in Kenyan hospital are very busy, with high nurse to patients ratios. They face an extremely stressful enviroment, exacerbated by bad reports in the press. Babies are particularly vulnerable during their first two days of life. A better understanding of the coping mechanisms put in place by those nurses could help us ensure a better survival rate for these babies.

Q: Can you tell us about nursing care for sick babies in Kenya?

Jacob McKnight: I am a small part of a big team in Nairobi and while I am helping organise, the people doing the hard work are out there and probably doing night shifts, last night in fact. What I can tell you about neonatal nursing in Nairobi is that these nurses are extremely busy. They have very busy working lives but also personal lives. In the hospital we see very big ratios of nurse to patients. Perhaps one nurse to 45 sick babies on the worst shifts. There is a lack of resources and a lack of appreciation as well. These nurses have families and sometimes they need other jobs to pay the rent. They are very busy and very stressed as a result of this particular situation. These are the most immediate issues but there are other things such as management styles, the way that the wards themselves are run, and more cultural issues about how these tiny, very sick children are seen.

Q: What are the ethnographic challenges?

JMK: The ethnographic challenges are quite significant. The first of them is this period of scandals in nursing, in Nairobi in particular, at the moment. The national press has covered significant scandals in some of the hospitals we are working in. In addition, there are strikes and legal cases, so nurses are very reticent to talk. We are in these extremely busy wards, studying why nurses are so busy, and we don't want to take up their time so getting the work done can be quite difficult.

Q: Can you tell us about your team's research?

JMK: We are finding some very interesting stuff around the immense pressure that these nurses are under. But they still turn up for work. How do they do on their shift, how do they get through it? They put in significant efforts to cope with these extremely stressful environments, in this very emotional job. There are certain tasks they elevate within their job to give them some kind of a reprieve. This is ongoing research, these are all very early findings but it is a very peculiar and interesting field because of the stress that is on these nurses.

Q: What are the most important lines of research that have developed in the past 5 or 10 years?

JMK: I think what I am most proud of in this project, and the reason that I am involved really, is that we have given ourselves a chance to learn about the environment before we jump in with any particular intervention. This is a very particular situation: the nurses are very stressed, there is a lot of political context and economical context to their working lives. By conducting ethnography, we have the chance to learn about all of that before we devise a strategy to go in and help. I am part of a larger team which will draw together various strands of evidence to try and design something that fits, based on the best evidence rather than just something that we thought of or something that we took from the international literature and just dropped in to a new context.

Q: Why does your line of research matter, why should we put money into it?

JMK: It is quite novel in the field, and I think that the larger field of public health could do with a bit more of that. In particular with newborns, in sub-Saharan Africa we've missed quite a few of the millennium development goals and some of the other targets that have been set. It has been identified that in the first two days of a child's life, they are particularly vulnerable. For children that are born in hospitals the survival rates can be quite poor. This is an area where if we get it right we could have a really large effect, which is what we are aiming for.

Q: How does your research fit into Translational Medicine within the Department?
JMK: Some of the things how this project is different are also part of the larger trend of translational medicine. I understand this term in meaning that we need to be more careful about how you bring new ideas, new treatments etc., to the field. Here we are spending a lot of time in the field before bringing through interventions. I think this is very much an example of that, albeit in health system strengthening rather than in drug development, where that phrase is often used.

Jacob McKnight

Newborn Study

Dr Jacob McKnight is a post-doctoral researcher with an interest in health systems and reform. After working for Medecins Sans Frontieres, he completed a PhD focused on hospital management in Ethiopia. He used organisational and marketing theory to provide new perspectives on public health problems. Jacob leads the ethnographic element of the Nairobi Newborn Study.

More podcasts related to Global Health

Mike English: Health services that deliver for newborns

Basic hospital care may be key to saving newborn lives. Professor Mike English outlines a multidisciplinary project engaging policy-makers and practitioners in Kenya. This project demonstrated poor coverage of Nairobi’s 4.25 million population if a sick newborn baby needs quality hospital care. Using novel research approaches the team also identified how severe shortages of nurses contribute to poor quality of care for patients and negatively affect nurses themselves.

Tran Hien: Infectious diseases in the tropics

Although incidence of malaria has decreased in Vietnam, the burden of infectious diseases remains high and weighs heavily on the health care system. Clinical research aims to allow investments to go further: findings in the laboratory, tested in clinical trials and then applied to the community, help improve diagnosis and management.

Ronald Geskus: Sophisticated biostatistics for complex clinical research

The role of biostatisticians in clinical research is to contribute to trial design, by calculating sample size for example, and to help draw correct conclusions from the data, discriminating important information from noise. They are instrumental in the translation of a practical problem into a statistical model, and the translation of the result into practice.

Rogier Van Doorn: Research at OUCRU Hanoi

Antibiotics are widely used in Vietnam, leading to widespread antimicrobial resistance. Monitoring antibiotic use helps inform the government to change treatment guidelines and implement antibiotic stewardship programmes. This may also prevent the transmission of resistant bacteria outside the country.

Heiman Wertheim: Clinical research in low and middle-income countries

Drug resistant infections are a global crisis and we cannot focus on our own country only. Clinical trials in low and middle income countries where the burden is highest, as well as work with local communities and engagement with policy makers help influence public health policies.

Guy Thwaites: Tuberculosis meningitis

Tuberculosis meningitis affects a fractions of TB patients but causes high levels of mortality and morbidity. A recent trial at OUCRU showed that aspirin can greatly improve outcomes. Such trial is typical of the work done in our Vietnam units, where all the research is focussed on improving the outcome for patients directly.

Motiur Rahman: OUCRU laboratory management

OUCRU laboratories provide support to the unit’s extensive clinical research programme, from level 2 laboratory to SAPO 4 laboratory for high-risk pathogens responsible for zoonotic infections. Early diagnosis and detection of antimicrobial resistance helps prescribe the right medicine in time, contributing to better patient management.

Raph Hamers: Developing collaborative clinical trials in Indonesia

Indonesia is a very populous country with a huge burden of infectious diseases such as TB, malaria, HIV and CNS infections. Running clinical trials requires high levels of expertise, currently developed and strengthened by institutions such as IOCRL (Universities of Indonesia and Oxford Clinical Research laboratory). Better collaborations will also help great ideas make a bigger impact.

Jeremy Day: Central nervous system and HIV infections in Vietnam

Brain infections such as meningitis and encephalitis are highly debilitating diseases, and an accurate diagnostic is essential to give patients the best treatment available. For cryptococcal meningitis, clinical trials focus on prevention, for an early diagnosis, and novel ways to use existing treatments or repurpose old drugs.

Abhilasha Karkey: Connecting research with communities in Nepal

Antimicrobial resistance is a huge burden in Nepal, particularly in hospitals where many nosocomial infections are caused by resistant pathogens. With limited resources, little infection controls and proper guidelines in place, finding out the main risk factors helps reduce infection rates within a hospital and better target vaccination campaigns.

Translational Medicine

From Bench to Bedside

Ultimately, medical research must translate into improved treatments for patients. At the Nuffield Department of Medicine, our researchers collaborate to develop better health care, improved quality of life, and enhanced preventative measures for all patients. Our findings in the laboratory are translated into changes in clinical practice, from bench to bedside.