The Impact of Scientific and Technical Training on Improving Databases’ Adequacy for Fetal Growth Chart Development in Limited-Resource Settings: A Case Study in the Province of South Kalimantan, Indonesia

Abstract

Objectives. To assess the impact of scientific and technical training on midwives’ abilities in collecting and recording the key performance indicators for fetal growth chart development in limited-resource settings. Methods. A descriptive design was used to describe midwives’ abilities in timely collecting and recording the minimum data required to estimate fetal weight and develop fetal growth chart. The study was conducted among 19 urban and rural midwives in South Kalimantan, Indonesia, between April 2016 and October 2017. The training provided access to antenatal care information on 4,946 women (retrospective cohort study) and 381 women (prospective cohort study). Results. The average amount of recorded antenatal care data on the key performance indicators of fetal growth assessment has been significantly improved (from 33.4% to 89.1%, p-value < 0.0005) through scientific and technical training. Conclusions. Scientific knowledge and technical abilities have enabled midwives to timely record routine data of the key performance indicators for fetal growth surveillance. Access to this information is vital during different stages of pregnancy. The information can be utilised as evidence-based guidelines to assess fetal risks through fetal weight estimation and to develop fetal growth chart that is currently not available in Indonesian primary healthcare systems.

The development of an alternative growth chart for estimated fetal weight in the absence of ultrasound: Application in Indonesia

“…A prospective cohort study, between June 1, 2016, and June 30, 2017, was carried out in South Kalimantan, Indonesia. The detailed procedures have been provided in previous publications [12,15]. The prospective data, both clinical and ultrasound information, were used to validate the existing ultrasonic-based and proposed clinical-based models for estimating fetal weight.…”

“…The data were obtained from one of the twenty selected primary health care centers that have access to both ultrasound measurement of fetal biometric characteristics and clinical assessment of fundal height (FH) at a given GA. All measurements (from the beginning of pregnancy to delivery) were performed by the dedicated midwife who runs the center. This midwife has had both ultrasound and scientific and technical training [12,15]. The selected midwife has experienced and been involved in both the provision and delivery of ANC services for � five years (actually 22 years).…”

“…Fetal growth charts have not been introduced in the Indonesian first level of health care systems. The growth charts are also not included in the current MCH booklet (Buku KIA) that is used to monitor individual mothers, fetuses, and newborns during ANC and postnatal care [12,15,16]. This study, therefore, set out with the aim of filling this gap, first by reviewing the existing studies on fetal growth charts, particularly for EFW.…”

“…However, in the majority of limited resource settings, the provision of ultrasound machines and skilled personnel is logistically not always available [1,29]. It has already been noted that the ultrasound method to estimate the fetal weight is not universally accessible in the current practice of ANC across Indonesian primary health care centers [12,15]. This hinders fetal weight estimation using the ultrasound prediction models that are commonly used in the existing fetal growth chart studies.…”

“…Access to routine data collection of EFW at a given GA is required to develop an evidencebased fetal growth chart. In Indonesia, however, such data collection remains challenging and is one of the reasons for the absence of a standard fetal growth chart [11][12][13][14][15]. There is no fetal growth chart for EFW available in the current ANC practice of Indonesian primary health care centers.…”