BackgroundIntrapartum fetal mortality can be prevented by quality emergency obstetrics and newborn care (EmONC) during pregnancy and childbirth. This study evaluated the effectiveness of a low-dose high-frequency onsite clinical mentorship in EmONC on the overall reduction in intrapartum fetal deaths in a busy hospital providing midwife-led maternity services in rural Kenya.MethodsA quasi-experimental (nonequivalent control group pretest – posttest) design in a midwife-led maternity care hospitals. Clinical mentorship and structured supportive supervision on EmONC signal functions was conducted during intervention. Maternity data at two similar time points: Oct 2015 to July 2016 (pre) and August 2016 to May 2017 (post) reviewed. Indicators of interest at Kirkpatrick’s levels 3 and 4 focusing on change in practice and health outcomes between the two time periods were evaluated and compared through a two-sample test of proportions. Proportions and p-values were reported to test the strength of the evidence after the intervention.ResultsSpontaneous vaginal delivery was the commonest route of delivery between the two periods in both hospitals. At the intervention hospital, assisted vaginal deliveries (vacuum extractions) increased 13 times (0.2 to 2.5%, P < 0.0001), proportion of babies born with low APGAR scores requiring newborn resuscitation doubled (1.7 to 3.7%, P = 0.0021), proportion of fresh stillbirths decreased 5 times (0.5 to 0.1%, P = 0.0491) and referred cases for comprehensive emergency obstetric care doubled (3.0 to 6.5%, P < 0.0001) with no changes observed in the control hospital. The proportion of live births reduced (98 to 97%, P = 0.0547) at the control hospital. Proportion of macerated stillbirths tripled at the control hospital (0.4 to 1.4%, P = 0.0039) with no change at the intervention hospital.ConclusionTargeted mentorship improves the competencies of nurse/midwives to identify, manage and/or refer pregnancy and childbirth cases and/or complications contributing to a reduction in intrapartum fetal deaths. Scale up of this training approach will improve maternal and newborn health outcomes.

Background Poor women in hard-to-reach areas are least likely to receive healthcare and thus carry the burden of maternal and perinatal mortality from complications of childbirth. This study evaluated the effect of an enhanced community midwifery model on skilled attendance during pregnancy/childbirth as well as on maternal and perinatal outcomes against the backdrop of protracted healthcare workers’ strikes in rural Kenya. Methods The study used a quasi-experimental (one-group pretest-posttest) design. The study spanned three time periods: December 2016-February 2017 when doctors were on strike (P1), March-May 2017 when no healthcare providers were on strike (P2), and June-October 2017 when nurses/midwives were on strike (P3), which was also the period when the project enhanced the capacity of community midwives (CMs) to provide services at the community level. Analysis entailed comparison of frequencies/means of maternal and newborn health service utilization data across the three periods. Results The monthly average number of clients obtaining services from CMs across the three time periods was: first antenatal care (ANC) (P1-1.8, P2-2.3, P3-9.9), fourth ANC (P1-1.4, P2-1.0, P3-7.1), skilled birth (P1-1.5, P2-1.7, P3-13.1) and the differences in means were statistically significant (p < 0.05). Over the period, the monthly average number of clients obtaining services from health facilities was: first ANC (P1-55.7, P2-70.8, P3-4.0), fourth ANC (P1-29.6, P2-38.1, P3-1.2) and skilled birth (P1-63.1, P2-87.4, P3-5.6), p < 0.05. There were no statistically significant differences in the average number of clients obtaining services from CMs or health facilities between P1 and P2 (p > 0.05). There was, however, a statistically significant increase in the average number of clients obtaining services from CMs in P3 accompanied by a statistically significant decline in the average number of clients obtaining services from health facilities (p < 0.05). First ANC increased by 68%, fourth ANC by 75%, skilled births by 68%, and postnatal care by 33% in P3 (p < 0.0001). There was a non-significant decline in macerated stillbirths and neonatal deaths in P3. Conclusions The findings underscore the importance of integrating community-level health service providers (CMs and health volunteers) into the primary health care system to complement service delivery according to their level of expertise, especially in low-resource settings.

Background Globally, poor women in hard-to-reach areas are least likely to receive healthcare and carry the burden of maternal and neonatal mortality related to complications of childbirth. Midwifery can avert 83% of all maternal & neonatal deaths and stillbirths. This study evaluated the effect of an enhanced community midwifery model (CMM) on skilled attendance during pregnancy and childbirth and maternal and perinatal outcomes against the background of protracted healthcare workers' strikes in rural Kenya. Methods A quasi-experimental (one-group pretest-posttest) designed. Six-months pretest period: December’2016-May’2017. Between Dec’2016-Feb’2017 (period 1) - a doctors’ strike and March-May’2017 (period 2), normal healthcare services resumed. An enhanced CMM (using 10 CMs linked to 6 health facilities) was implemented in the proceeding 5-months posttest period (period 3) – June-October’2017 during the national nurses/midwives’ strike. Differences in performance means for MNH variables of interest between the three periods were computed by ANOVA. Two-groups test of proportions for before and during/after the enhanced CMM computed. Results There were differences in mean monthly attendance for community midwifery services for the three periods: 1st ANC (1.8-2.3-9.9, P = 0.0087), 4th ANC (1.4-1.0-7.1, P = 0.0212), skilled births (1.5-1.7-13.1, P < 0.0001). Mean attendance at facility were: 1st ANC (55.7-70.8-4.0), 4th ANC (29.6-38.1-1.2) and skilled births (63.1-87.4-5.6), P ≤ 0.05. No differences in attendance between the doctors’ strike and normalcy period for both CMs and health facilities’ MNH services (P ≥ 0.05). However, significant increases for CMs MNH services during the nurses/midwives strike and significant reductions at the facility level during the same period (P ≤ 0.05). An increase of 68%, 74.5%, 67.8% and 33.3% in the proportion of 1st and 4th ANC, skilled births and PNC conducted by CMs during/after the CMM respectively (P ≤ 0.0001). A double and triple reduction in macerated stillbirths (0.70%-0.36%) and neonatal deaths (0.54%-0.18%) respectively and an increase in babies discharged alive (98.05%-100%) with no change in maternal deaths during/post intervention. Conclusions There was improvement in access/utilization of pregnancy and childbirth services from CMs. There is a golden opportunity to integrate the CMs to primary health care system to improve uptake of MNH care services through an enhanced CMM strategy in hard-to-reach communities.

Background: Poor women in hard-to-reach areas are least likely to receive healthcare and thus carry the burden of maternal and perinatal mortality from complications of childbirth. This study evaluated the effect of an enhanced community midwifery model on skilled attendance during pregnancy/childbirth as well as on maternal and perinatal outcomes against the backdrop of protracted healthcare workers' strikes in rural Kenya. Methods: The study used a quasi-experimental (one-group pretest-posttest) design. The study spanned three time periods: December 2016-February 2017 when doctors were on strike (P1), March-May 2017 when no healthcare providers were on strike (P2), and June-October 2017 when nurses/midwives were on strike (P3), which was also the period when the project enhanced the capacity of community midwives (CMs) to provide services at the community level. Analysis entailed comparison of frequencies/means of maternal and newborn health service utilization data across the three periods. Results: The monthly average number of clients obtaining services from CMs across the three time periods was: first antenatal care (ANC) (P1-1.8, P2-2.3, P3-9.9), fourth ANC (P1-1.4, P2-1.0, P3-7.1), skilled birth (P1-1.5, P2-1.7, P3-13.1) and the differences in means were statistically significant (p<0.05). Over the period, the monthly average number of clients obtaining services from health facilities was: first ANC (P1-55.7, P2-70.8, P3-4.0), fourth ANC (P1-29.6, P2-38.1, P3-1.2) and skilled birth (P1-63.1, P2-87.4, P3-5.6), p<0.05. There were no statistically significant differences in the average number of clients obtaining services from CMs or health facilities between P1 and P2 (p>0.05). There was, however, a statistically significant increase in the average number of clients obtaining services from CMs in P3 accompanied by a statistically significant decline in the average number of clients obtaining services from health facilities (p<0.05). First ANC increased by 68%, fourth ANC by 75%, skilled births by 68%, and postnatal care by 33% in P3 (p<0.0001). There was a non-significant decline in macerated stillbirths and neonatal deaths in P3. Conclusions: The findings underscore the importance of integrating community-level health service providers (CMs and health volunteers) into the primary health care system to complement service delivery according to their level of expertise, especially in low-resource settings.

Background: Poor women in hard-to-reach areas are least likely to receive healthcare and carry the burden of maternal and perinatal mortality from complications of childbirth. This study evaluated the effect of an enhanced community midwifery model on skilled attendance during pregnancy/childbirth as well as on maternal and perinatal outcomes against the backdrop of protracted healthcare workers' strikes in rural Kenya. Methods: The study used a quasi-experimental (one-group pretest-posttest) design. The study spanned three time periods (P), including December’2016-February’2017 when medical doctors were on strike (P1), March -May’2017 when no healthcare providers were on strike (P2), and June-October’2017 when nurses/midwives were on strike (P3), which was also the period when the project enhanced the capacity of community midwives (CMs) to provide services at the community level. Analysis entailed comparison of frequencies and means of maternal and newborn health service utilization data across the three time periods. Results: The monthly average number of clients obtaining services from CMs across the three time periods (P1-P2-P3) was as follows: first antenatal care (ANC) (1.8-2.3-9.9), fourth ANC (1.4-1.0-7.1), skilled birth (1.5-1.7-13.1) and the differences in means were statistically significant (p<0.05). Over the period, the monthly average number of clients obtaining services from health facilities was as follows: first ANC (55.7 -70.8-4.0), fourth ANC (29.6-38.1-1.2) and skilled birth (63.1-87.4-5.6), p<0.05. There were no statistically significant differences in the average number of clients obtaining services from CMs or health facilities between P1 and P2 (p>0.05). There was, however, a statistically significant increase in the average number of clients obtaining services from CMs in P3, which was accompanied by a statistically significant decline in the average number of clients of obtaining services from health facilities (p<0.05). First ANC increased by 68, fourth ANC by 75, skilled births by 68, and postnatal care by 33 percentage points in P3 (p<0.0001). There was a non-significant decline in macerated stillbirths and neonatal deaths in P3.Conclusions: The findings underscore the importance of integrating community-level health service providers (CMs and health volunteers) into the primary health care system to complement service delivery according to their level of expertise, especially in low-resource settings.