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Procedural pain in neonatal units in Kenya
  1. O'Brien Munyao Kyololo1,2,3,
  2. Bonnie Stevens2,3,
  3. Denise Gastaldo2,
  4. Peter Gisore4
  1. 1School of Nursing, Moi University, Eldoret, Kenya
  2. 2Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
  3. 3The Hospital for Sick Children, Toronto, Ontario, Canada
  4. 4Department of Paediatrics and Child Health, Moi University, Eldoret, Kenya
  1. Correspondence to O'Brien Kyololo, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College Street, Suite 300, Toronto, Ontario, Canada M5T 1P8; o.kyololo{at}; obrien.kyololo{at}


Objectives To determine the nature and frequency of painful procedures and procedural pain management practices in neonatal units in Kenya.

Design Cross-sectional survey.

Setting Level I and level II neonatal units in Kenya.

Patients Ninety-five term and preterm neonates from seven neonatal units.

Methods Medical records of neonates admitted for at least 24 h were reviewed to determine the nature and frequency of painful procedures performed in the 24 h period preceding data collection (6:00 to 6:00) as well as the pain management interventions (eg, morphine, breastfeeding, skin-to-skin contact, containment, non-nutritive sucking) that accompanied each procedure.

Results Neonates experienced a total of 404 painful procedures over a 24 h period (mean=4.3, SD 2.0; range 1–12); 270 tissue-damaging (mean=2.85, SD 1.1; range 1–6) and 134 non-tissue-damaging procedures (mean=1.41, SD 1.2; range 0–6). Peripheral cannula insertion (27%) and intramuscular injections (22%) were the most common painful procedures. Ventilated neonates and neonates admitted in level II neonatal units had a higher number of painful procedures than those admitted in level I units (mean 4.76 vs 2.96). Only one procedure had a pain intensity score documented; and none had been performed with any form of analgesia.

Conclusions Neonates in Kenya were exposed to numerous tissue-damaging and non-tissue-damaging procedures without any form of analgesia. Our findings suggest that education is needed on how to assess and manage procedural pain in neonatal units in Kenya.

  • Procedural Pain
  • Analgesia
  • Neonatal units
  • Procedures

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