Physicians' Industrial Action: An Interrupted Time Series Analysis Assessing Impact in 11 Kenyan Neonatal Units
- 1Rice360 Institute for Global Health Technologies, Rice University
Abstract
BackgroundSkilled healthcare workers are essential for neonatal survival; however, the Kenyan public health system has historically faced strikes compounded by a human resource crisis. Evidence on how strikes affect neonatal care and mortality remains limited. This study evaluated changes in neonatal admissions, clinical care processes, and inpatient mortality associated with 56 days of disruption during the 2024 Kenyan physicians strike.
MethodsWe conducted a retrospective interrupted time-series analysis of 12,184 admissions to 11 Kenyan neonatal units implementing with the NEST360 Alliance, recorded in the Neonatal Inpatient Dataset from December 2023 to August 2024. Weekly admissions and inpatient mortality were modeled over a 72-week window (27,638 admissions) using hospital-clustered generalized estimating equations with seasonal terms. Care processes, case fatality, and birthweight-specific mortality were compared across study periods.
ResultsWeekly admissions fell from 413 to 189 during the strike (incidence rate ratio (IRR) 0.49, 95% confidence interval (CI) 0.31-0.75), approximately 1,700 fewer admissions than expected, and returned to baseline afterward (IRR 1.00, CI 0.81-1.23). Newborns admitted during the strike were of lower birthweight, more often premature, and more often outborn. Admissions fell across all birth-location categories, most steeply among inborn neonates. No measurable change was detected in documented inpatient coverage of care measures, in crude mortality (12.5% to 14.9%; risk ratio (RR) 1.07, CI 0.85-1.33), or in trend-adjusted mortality (IRR 0.88, CI 0.53-1.45). Case fatality among neonates with recorded infection doubled, from 4.7% to 9.6% (RR 2.06, CI 1.18-3.58; adjusted p = 0.047).
ConclusionsThe 2024 physicians strike was associated with severe disruption to neonatal service utilization, with admissions returning to baseline when the strike ended. Among newborns who continued to reach care, inpatient mortality did not change measurably, but case fatality among those with recorded infection doubled. This analysis was confined to inpatient data; hence, the outcomes of newborns who did not reach the hospitals were not captured. Both inpatient and population-level data are needed to assess the full impact of the strike. Mitigating harm during future labor disruptions requires interventions such as resilient care models, formalized task-shifting protocols, and minimum service coverage agreements.
WHAT WAS KNOWN?O_LIThe public health care system in Kenya experiences recurrent healthcare worker strikes during which maternal and general health services utilization is disrupted C_LIO_LINeonates are among the most vulnerable populations in the Kenyan public health system. However, few publications have quantified the impact of healthcare provider strikes on neonatal outcomes and processes C_LI
WHAT WAS DONE THAT IS NEW?O_LIData from 11 Kenyan neonatal units, comprising 12,184 admission records from December 2023 to August 2024, were analyzed to evaluate changes in neonatal admissions, case mix, care processes, and inpatient mortality associated with a 56-day national physicians strike C_LIO_LIBecause the strike had an exact-dated onset and conclusion, both the disruption and recovery were estimated using an interrupted time series design, with hospital-clustered generalized estimating equations applied across all 11 units C_LI
WHAT WAS FOUND?O_LIWeekly admissions fell by approximately half during the strike, an estimated shortfall of around 1,700 admissions against seasonal expectations, and returned to seasonal baseline once the strike concluded C_LIO_LINewborns admitted during the strike period were of lower birthweight, more often premature, and more often outborn. Admissions fell across every birth-location category but most steeply among neonates born in the admitting hospital C_LIO_LIThere was no measurable change detected in documented coverage of seven screening and intervention measures, or in inpatient mortality overall or by birthweight band. Case fatality among neonates with infection as the primary discharge diagnosis doubled. C_LI
WHAT NEXT?O_LIInpatient data do not capture the outcomes of newborns who failed to access hospitals. Community-level data are necessary to quantify the full impact of service disruption. C_LIO_LIAs industrial actions continue to be increasingly prevalent with frequent disruption of services, mitigation strategies should be put in place to protect vulnerable patients. C_LI
Related
- A neonatal extra-anatomical bypass for a “corkscrew” descending aorta associated with interrupted right aortic arch
- Drug-cost trajectories after national volume-based procurement in Chinese public hospitals: a 31-province interrupted time-series analysis
- Mind the gap: Pulmonary artery autograft patch for repair of a long-gap interrupted aortic arch type A
- HIV service delivery after the PEPFAR and USAID HIV funding withdrawal in Uganda and Zimbabwe: an interrupted time-series study
- Impact of Mass Resignation of Junior Doctors in Korea on Major Interventions: Interrupted Time Series Analysis
BibTeX
@misc{manyasi2026physicians,
title = {{Physicians' Industrial Action: An Interrupted Time Series Analysis Assessing Impact in 11 Kenyan Neonatal Units}},
author = {C. Manyasi and M. M. Paral and J. Wainaina and G. Okello and D. R. Mochache and H. Mwaniki and D. M. Muinde and F. O. Okech and J. E. Lawn and N. R. Rhoda and R. Richards-Kortum and Z. M. Oden and L. R. Hirschhorn and C. A. Bohne and W. M. Macharia and NEST360 Neonatal Inpatient Dataset and Data Systems Collaborative Group and Context Tracker},
howpublished = {medRxiv},
year = {2026},
month = oct,
doi = {10.64898/2026.10.07.26364929},
url = {https://www.medrxiv.org/content/10.64898/2026.10.07.26364929v1},
note = {CC BY},
}
RIS
TY - UNPB
TI - Physicians' Industrial Action: An Interrupted Time Series Analysis Assessing Impact in 11 Kenyan Neonatal Units
AU - C. Manyasi
AU - M. M. Paral
AU - J. Wainaina
AU - G. Okello
AU - D. R. Mochache
AU - H. Mwaniki
AU - D. M. Muinde
AU - F. O. Okech
AU - J. E. Lawn
AU - N. R. Rhoda
AU - R. Richards-Kortum
AU - Z. M. Oden
AU - L. R. Hirschhorn
AU - C. A. Bohne
AU - W. M. Macharia
AU - NEST360 Neonatal Inpatient Dataset and Data Systems Collaborative Group and Context Tracker
PY - 2026
DA - 2026/10/07
PB - medRxiv
DO - 10.64898/2026.10.07.26364929
UR - https://www.medrxiv.org/content/10.64898/2026.10.07.26364929v1
AB - BackgroundSkilled healthcare workers are essential for neonatal survival; however, the Kenyan public health system has historically faced strikes compounded by a human resource crisis. Evidence on how strikes affect neonatal care and mortality remains limited. This study evaluated changes in neonatal admissions, clinical care processes, and inpatient mortality associated with 56 days of disruption during the 2024 Kenyan physicians strike. MethodsWe conducted a retrospective interrupted time-series analysis of 12,184 admissions to 11 Kenyan neonatal units implementing with the NEST360 Alliance, recorded in the Neonatal Inpatient Dataset from December 2023 to August 2024. Weekly admissions and inpatient mortality were modeled over a 72-week window (27,638 admissions) using hospital-clustered generalized estimating equations with seasonal terms. Care processes, case fatality, and birthweight-specific mortality were compared across study periods. ResultsWeekly admissions fell from 413 to 189 during the strike (incidence rate ratio (IRR) 0.49, 95% confidence interval (CI) 0.31-0.75), approximately 1,700 fewer admissions than expected, and returned to baseline afterward (IRR 1.00, CI 0.81-1.23). Newborns admitted during the strike were of lower birthweight, more often premature, and more often outborn. Admissions fell across all birth-location categories, most steeply among inborn neonates. No measurable change was detected in documented inpatient coverage of care measures, in crude mortality (12.5% to 14.9%; risk ratio (RR) 1.07, CI 0.85-1.33), or in trend-adjusted mortality (IRR 0.88, CI 0.53-1.45). Case fatality among neonates with recorded infection doubled, from 4.7% to 9.6% (RR 2.06, CI 1.18-3.58; adjusted p = 0.047). ConclusionsThe 2024 physicians strike was associated with severe disruption to neonatal service utilization, with admissions returning to baseline when the strike ended. Among newborns who continued to reach care, inpatient mortality did not change measurably, but case fatality among those with recorded infection doubled. This analysis was confined to inpatient data; hence, the outcomes of newborns who did not reach the hospitals were not captured. Both inpatient and population-level data are needed to assess the full impact of the strike. Mitigating harm during future labor disruptions requires interventions such as resilient care models, formalized task-shifting protocols, and minimum service coverage agreements. WHAT WAS KNOWN?O_LIThe public health care system in Kenya experiences recurrent healthcare worker strikes during which maternal and general health services utilization is disrupted C_LIO_LINeonates are among the most vulnerable populations in the Kenyan public health system. However, few publications have quantified the impact of healthcare provider strikes on neonatal outcomes and processes C_LI WHAT WAS DONE THAT IS NEW?O_LIData from 11 Kenyan neonatal units, comprising 12,184 admission records from December 2023 to August 2024, were analyzed to evaluate changes in neonatal admissions, case mix, care processes, and inpatient mortality associated with a 56-day national physicians strike C_LIO_LIBecause the strike had an exact-dated onset and conclusion, both the disruption and recovery were estimated using an interrupted time series design, with hospital-clustered generalized estimating equations applied across all 11 units C_LI WHAT WAS FOUND?O_LIWeekly admissions fell by approximately half during the strike, an estimated shortfall of around 1,700 admissions against seasonal expectations, and returned to seasonal baseline once the strike concluded C_LIO_LINewborns admitted during the strike period were of lower birthweight, more often premature, and more often outborn. Admissions fell across every birth-location category but most steeply among neonates born in the admitting hospital C_LIO_LIThere was no measurable change detected in documented coverage of seven screening and intervention measures, or in inpatient mortality overall or by birthweight band. Case fatality among neonates with infection as the primary discharge diagnosis doubled. C_LI WHAT NEXT?O_LIInpatient data do not capture the outcomes of newborns who failed to access hospitals. Community-level data are necessary to quantify the full impact of service disruption. C_LIO_LIAs industrial actions continue to be increasingly prevalent with frequent disruption of services, mitigation strategies should be put in place to protect vulnerable patients. C_LI
ER -