Physicians' Industrial Action: An Interrupted Time Series Analysis Assessing Impact in 11 Kenyan Neonatal Units

Background. Skilled 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. Methods. We 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. Results. Weekly 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). Conclusions. The 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.