Reducing intrapartum fetal deaths through low-dose high frequency clinical mentorship in a rural hospital in Western Kenya: a quasi-experimental study

Abstract

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.

Assisted Birth Delivery In Ghana: Evidence From Ghana Demographic And Health Survey 1988 - 2014

“…This con rms the cross-sectional study by [25], that among women who had ever given birth, the proportion of birth assisted by nurses/midwives had increased to about 79 percent. Also, the study by [34] conducted at Kenya con rms this nding. On the other hand, [24] concluded that the proportion of birth assisted by skilled birth attendants such as nurses/midwives has been low.…”

“…[31] concluded in multivariate regression that the odds of being assisted by nurses/midwives during delivery increased with mother's education. Also, a study in Kenya [34], Sierra Leon, Niger and Mali [12] and Ghana [13] established that women with higher education were more likely to use skilled attendant such as nurses/midwives.…”

Mentors’ perspectives on strengths and weaknesses of a novel clinical mentorship programme in Rwanda: a qualitative study

“…10 Evidence suggests that post-training supportive supervision and mentorship are effective in strengthening learning processes, and improving provider motivation and clinical performance. [11][12][13] Studies conducted in Rwanda suggested that some of the reasons for low performance among healthcare providers can be traced through limited supervision and mentorship as well as insufficient support systems consistent with challenges reported in other similar settings. 8 14 15 Increasing the number of healthcare providers and training them to deliver quality care is a core component of health systems strengthening needed to achieve universal health coverage.…”

Assistência dos profissionais de saúde em situação de perda gestacional: revisão integrativa

“…A intervenção melhorou as competências da enfermeira/parteira para detectar, gerenciar e/ou encaminhar casos e/ou complicações de gravidez e parto, contribuindo para a redução das mortes fetais durante o parto. 20 Nesse contexto, pesquisa exploratório-descritiva de abordagem qualitativa, realizada em um município do interior do Rio Grande do Sul, que buscou conhecer a influência da atuação da Enfermagem entre os pais que vivenciam a morte do feto viável, não revelou influência significativa da assistência na vivência da morte fetal. Isso enfatizou a necessidade e importância do preparo profissional para atuar diante de situações extremas, como na perda fetal.…”