Summary
A retrospective analysis of 11 Kenyan neonatal units found weekly admissions nearly halved during the 2024 physicians’ strike and returned to baseline afterward. Inpatient mortality showed no measurable overall change, while case fatality among newborns with recorded infection doubled.
A 56-day physicians’ strike in Kenya in 2024 coincided with a near-halving of weekly admissions across 11 neonatal units, according to a retrospective analysis posted as a medRxiv preprint. Admissions fell from 413 to 189 a week and returned to baseline after the strike. Among newborns admitted, inpatient mortality showed no measurable overall change, while case fatality among those with recorded infection doubled.
Admissions fell during the strike
The researchers analysed records from neonatal units implementing the NEST360 Alliance’s work. For weekly admission and mortality trends, they used a 72-week time series covering 27,638 admissions. An interrupted time-series analysis compares patterns before, during and after an event; the models also accounted for seasonal patterns and clustering by hospital.
During the strike, the admission rate was about half the comparison level (incidence rate ratio 0.49; 95% confidence interval 0.31–0.75). The researchers estimated that roughly 1,700 fewer newborns were admitted than expected. After the strike ended, admissions returned to baseline (incidence rate ratio 1.00; 95% CI 0.81–1.23).
Admissions declined across birth-location categories, with the steepest fall among babies born in the hospitals. Those admitted during the strike were more often premature, had lower birthweights and were more often born outside the hospital. The study found no measurable change in documented inpatient coverage of the care measures it assessed.
Mortality findings and the limits of inpatient data
Overall inpatient mortality did not show a statistically measurable change. Crude mortality rose from 12.5% to 14.9%, but the reported risk ratio was 1.07 (95% CI 0.85–1.33). In a trend-adjusted analysis, the mortality incidence rate ratio was 0.88 (95% CI 0.53–1.45). These estimates do not indicate a clear overall change among the newborns who reached the units.
A different pattern appeared among newborns with recorded infection: case fatality rose from 4.7% to 9.6% (risk ratio 2.06; 95% CI 1.18–3.58; adjusted p = 0.047). This finding concerns that recorded-infection subgroup, rather than overall inpatient mortality.
The records cover newborns admitted to the participating units, not those who could not reach them. The study therefore describes disruption to hospital service use and outcomes among admitted newborns, but not the full population impact of the strike. The authors point to resilient care models, formal task-shifting protocols and minimum service coverage agreements as possible ways to protect neonatal services during future labour disruptions.