The Effect Of Free Delivery Services On Partograph Utilization At Naivasha District Hospital
Background: The Kenyan Maternal Mortality Ratio is estimated at 488/100,000 live births. Millennium Development Goals 4 and 5 to reduce child mortality and improve maternal health, remain important global health challenges and ensuring skilled birth attendance is a crucial intervention for achieving these goals. In order to try to circumvent one of the barriers to increased skilled birth attendance, the Government of Kenya, on June 1st 2013, initiated a policy of free maternity services in all public facilities, effective immediately. Purpose of the Study: The study aims at assessing the effect of initiation of free delivery services at Naivasha District Hospital (county hospital in Naivasha-Kenya, a peri-urban area) by measuring a key process indicator for delivery services, partograph utilization, before and after the initiation of free maternity care. Methodology: A before and after design (quasi-experimental design) was used in which, partograph data for two groups were collected at two different but commensurate periods in the period before and after initiation of free delivery services policy (“After” period: July to September 2013 and October to December 2013; “Before” period: July to September 2012 and October to December 2012). The study site was Naivasha District Hospital (model Level 4 county hospital). Partographs in the stipulated periods were retrieved, and randomly sampled to obtain the calculated sample size. Using a structured questionnaire, data from the partograph was extracted for: completeness, adequacy of filling, intervention characteristics (timeliness and appropriateness) and outcome indicators (delivery outcome and fetal outcome). The data were analyzed for descriptive statistics and tests of association carried out. The results for the „before‟ and „after‟ period were then compared for any similarities or significant differences. Results: There was a statistically significant decrease in the overall completeness of the partographs both in the immediate post-intervention period (28.4% to 10.2%) and short term post-intervention period (36.4% to 20.5%). Adequacy of filling of the fetal heart rate and progress of labour parameters was generally adequate (>70%) and there were no major differences both in the immediate term and short term post-intervention periods. Adequacy of filling of the maternal parameters was generally inadequate (<50%) and there was no statistically significant change in its recording both in the immediate term and short term. xvi Overall recording of the neonatal parameters was generally adequate (>80%) and there was no major change in its recording in the immediate and short term post-intervention. There was also no significant change in the intervention characteristics (timeliness/appropriateness of intervention). There was a slight rise in the SVD rate in the immediate term (89.8% to 90.9%), but a slight decline in the short term (93.2% to 78.4%). There was a decrease that was not statistically significant (P=0.301) in the emergency caeserian rate in the short term (10.2% to 5.9%) and a statistically significant (P=0.047) rise in the short term (6.8%-16.9%). There was a slight rise in the bad APGAR scores at 5 minutes in both the immediate term (5.7%-8.0%) and short term (3.4% to 6.8%). These changes were however not statistically significant (P=0.159) Conclusion: Overall completeness of the partographs decreased both in the immediate and short term after introduction of free delivery services. There was also a slight rise in the bad APGAR scores. Despite these compromises, there were no significant changes in terms of adequacy of filling of most of the partograph parameters and intervention characteristics.
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