Essential Maternal and Newborn Care Skills Training for Midwives: Their Impact on Reducing Maternal and Neonatal Mortalities in Kenya

Continuing professional development (CPD) continues to gain acceptance as a model for health care professionals to engage in lifelong learning. Little is known about how CPD participants put the experience and the new knowledge into practice and whether it has impact on patient care outcomes. The primary objective of this study was to evaluate the effectiveness of CPD of Midwives on Essential Maternal and Newborn care skills on maternal and neonatal mortality in Embu County, Kenya. The study was an interventional non-randomized pretest post test study design of midwives from the participants of the 2010 ministry of health training on essential maternal and newborn care skills. Sixty (60) midwives working in maternity unit of Embu level five hospitals were targeted. The study was carried out in two phases. Phase one involved environmental scanning of the factors that support good performance in the workplace using a questionnaire. Phase two involved evaluation of the impact by testing a hypotheses using data collected by use of questionnaires, evaluation checklist and chart audit. Data were analyzed using qualitative content analysis and presented using percentages and frequency tables. Chi-square test and correlation analysis were used to show the association between variables, which are midwives essential maternal and newborn care skills and maternal and neonatal mortality. A chi-square χ2 = 14.143, df = 9 and a coefficient = 0.357. This coefficient is less than p-value at Alpha 0.05 and therefore is not significant, proving that the essential maternal and neonatal care skills do not contribute to reduction in mortalities as such two variables are almost independent of each other, whether one exists does not necessitate the existence of another nor does it reduce maternal and neonatal mortalities in Kenya.

Contextual Challenges in the Implementation of the Alliance for Maternal and Newborn Health Improvement, Prospective Cohort Study, an Experience from Rural Pakistan

Introduction: Improving maternal and newborn survival needs robust data on patterns of morbidity and mortality from well-characterized cohorts. It is equally important for researchers to document and understand the contextual challenges of data collection and how they are addressed. Methods: This was a prospective cohort study implemented from December 2012 to August 2014 in Matiari, Pakistan. A total of 11,315 pregnancies were enrolled. Participants were approached at home for sequential data collection through the standard pretested structured questionnaires. Some indicators were sourced through health facility records. Information on field challenges gathered through field diaries and minutes of meetings with field staff. Results: Inaccurate reporting of last menstrual period (LMP) dates caused difficulties in the planning and completion of antenatal data collection visits at scheduled gestational weeks. We documented ultrasound reports wherever available, relied on quickening technique, and implemented a seasonal event calendar to help mothers’ recall their LMP. Health system coordinators of public sector and private healthcare providers were individually approached for maximum data collection. But an unregulated private health system with poor record maintenance and health care providers’ reluctance for cooperation posed a greater challenge in data collection. Conclusions: Within a broader understanding of the health systems and socio-cultural environment, temporal and spatial feasibility of data collection should be considered thoroughly at the early stages of study designing, planning, resource allocation, and implementation. Pre-defined regular and need-based meetings with each tier of data collection teams and study managers help to reinvigorate field execution plans and optimize both quantity and quality of study data.

Strengthening Weak Healthcare Systems for Maternal and Neonatal Care in Low and Middle Income Countries: The Missing Link

Introduction: Preventable maternal and newborn mortalities still occur in local communities in Kenya since access to maternal and newborn healthcare services remains a big challenge. Barriers to access in resource-constrained settings have not been examined adequately in literature. The World Health Organization (WHO) has 6 building blocks for strengthening healthcare systems that informed this study. This paper examines how user-side and institutional factors influence access and use of Maternal and Newborn Healthcare (MNH) Services in Matayos sub-County-Busia County. Methods: A mixed method approach, with an ethnographic inquiry and a descriptive cross-sectional design, was adopted to assess access to MNH services in Matayos-Busia County, Western Kenya. Postpartum women who had delivered within the previous 12 months and health care providers in the study area were recruited as respondents. A total of 348 postpartum women were selected through stratified systematic random sampling for the survey. Purposive sampling was used to select postpartum women, conventional and traditional health care providers for 16 in-depth interviews and 7 focus group discussions. Data were analyzed using descriptive and inferential statistics. Qualitative data analysis was done thematically. Results: Institutional delivery was low at 68% and family planning at 75% although demand for services was high at 99%. User-side barriers to access included shared beliefs and practices in the community;high direct transport costs from home;and high costs for missing drugs and other supplies in hospitals. Middle (5th-7th) order deliveries occurred at home with traditional birth attendants. The choice of place of delivery in households was influenced by spouses to respondents and communities of residence where respondents lived or were married. All 6 WHO health system building blocks were weak in Matayos sub-County and needed system-wide strengthening involving all pillars. The user-community voice alone was insufficient and the 7th pillar for user-community engagement was absent. The underlying factors were weak governance and underfunding for healthcare. Conclusion: The six WHO building blocks were inadequate due to weak governance and inadequate funding. User-community engagement, the 7th Pillar, was absent in these resource-limited settings. We recommend user-community empowerment, engagement and participation, adoption of a system thinking approach and adequate funding.