The role of the district hospital in child survival at the Kenyan Coast.

Strategies for improving child survivorship in sub-Saharan Africa by the year 2000 have focused on low-cost, peripheral preventative and curative activities often with little reference to essential clinical services offered by hospitals at the district level. However, the recent World Bank World Development Report has re-emphasised the potential of district hospitals within selective PHC activities. We have estimated the likely impact of in-patient care offered by a rural district hospital on the Kenyan coast on under 5's mortality through comprehensive demographic and hospital surveillance. Within this population, childhood mortality may have been reduced by 44% as a result of hospital in-patient care. Strengthened referral systems, improvements in hospital accessibility, and better hospital care should be an integral part of PHC and other health promotion activities in sub-Saharan Africa.