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Introduction: Quality of care is acknowledged as a critical facet of the unfinished maternal and newborn health agenda. Yet modalities of reorienting maternity services to respectful services are rare. This study investigated the effect of training health workers in cultural competence towards satisfaction with maternity service. Materials and Methods: This was a Cluster Randomized Controlled Trial undertaken in public hospitals. The intervention was provision of culturally sensitive maternity services by health workers after cultural competence training. Three hundred and seventy nine women were interviewed per group using exit and mystery client surveys. The effect was measured using standard mean difference (Cohen’s d) and t-test. Results: There was significant effect on satisfaction with provided information on delivery methods (F (1, 756) = 11.493, p < 0.001, ηp2 = .049). The mean of intervention group increased from 3.55 ±1.056 to 3.94, ±0.894 while the control changed from 3.57±1.187 to 3.62 ± 1.149. The mean changes tweaked the group variance from insignificant t (725) =0.290, p = 0.771 to significant t (713) =-4.336 p <0.001. Conclusion: Cultural competence training is effective in creating room for desired maternal needs and improving perceived satisfaction with maternity services. Consequently, there is a need to integrate cultural knowledge and skills into existing maternal policies and training.

Objectives This research sought to evaluate the effectiveness of innovative learning approaches in training health workers for effective management and control of diabetes and childhood asthma. Setting Assessment was conducted in Kilifi, Nyeri, Nairobi and Kakamega counties in Kenya in selected sub-counties in the 4 counties. Participants Health workforce were randomly selected. Selection was stratified by county and model of training then inflated to account for loss to follow up and 382 participated based on availability and saturation. Interventions Based on high burden of non-communicable diseases (NCDs) specifically Diabetes and asthma in Kenya, AMREF and partners implemented a three-year project (June 2015 - May 2018) aimed at building the capacity of health workers to effectively manage and control the NCDs. It was implemented in 4 counties. The trainings were done using face to face, blended, elearning and mlearning. Primary and secondary outcome measures The research measured the effectiveness of the training models in improving the capacity of health workers to effectively manage and control the NCDs. Results The trainings appreciation rate was 95% across the four approaches. Health workers were well equipped with skills to address asthma (85.6%) and diabetes (94.2%). Satisfaction though lower in eLearning (64%) due to reliability of internet and learning platform downtime against mlearning (89%) and face to face (90%), all the training models were found to contribute to improved knowledge. Conclusions The different training models were very effective. The training was successful in increasing knowledge, confidence and commitment to spearhead the preventive and curative aspects of the illnesses. No training model was superior in terms of the degree of satisfaction, improving knowledge, shaping behaviour change and organisational performance. Further research There is need to asses an elearning / mlearning training model that is purely technology based and compare that with the blended approaches of learning.

Background: Recognition of the vulnerabilities and differentials in maternal indicator is a pressing concern throughout safe motherhood literature. Uptake of skilled delivery by women in Marakwet remain 44%, compared to the national rate of 68%. Accountability for improving maternal indicators calls for interrogation of indigenous practices to amend complex social causes. Methods: This was a qualitative study conducted in the thirteen patrilineal clans of Marakwet.  Discussants were women of reproductive age while key informants included cultural anthropologist, traditionalist and gatekeepers. The data was analyzed manually through a process of data reduction, organization and emerging patterns interpretation then sub categories. Results: Pregnancy and delivery are not just biomedical process but culturally biosocial practice. Discipline and socialization are critical elements. Adequate self, family and community care lead to noble pregnancy outcome. The community and midwife uses knowledge to jumpstart childbirth practices for expectant women for healthy prenatal period, delivery and postnatal running.  Holiness and hygiene, controlled sex and sexual relationships, artefacts and dressing, food ways and diet, social interaction, livelihoods and lifestyle are key pregnancy and childbirth social aetiology. Conclusion: cultural stimuli and remedies inform maternal health seeking behaviour and practices of women. Continued care, hygiene, geophagy, controlled food ways and social interaction as well as avoiding heavy duties and events that trigger emotions and pressure are sound indigenous ways of improving maternal and child health. However, norms such as visiting a midwife for pregnancy confirmation and massage as well as folk activities such as the use of charms and repertoires for protection and cleansing ceremonies provide false protection. Recommendation: the results suggest the relative value for indigenous maternal health care services in enhancing client centered delivery health services. Review of policies and programs to integrate harmless indigenous practices into maternity care services may promote quality, satisfaction and uptake of facility based childbirth services.