The SMNH implementation framework for districts

The Safe Motherhood Demonstration Project (SMDP) implementation framework was developed as a result of lessons learned and approaches used during SMDP in Western Province, Kenya, 2000–04. All the components require cooperation and support at the provincial and national level. The six components, as outlined in this brief, are: preparation; safe motherhood (SM) rapid appraisal; analysis; intervention planning; implementation; and evaluation. The development of a Safe Motherhood Rapid Appraisal Tool has been an important outcome of the DFID Western Province SMDP. The intervention in Western Province was based on addressing resource and skills gaps in service provision, which were identified by a situation analysis carried out in each district. Through the introduction of training programs tailored to staff needs, ensuring that basic equipment and drugs were available, and ensuring greater community involvement, safe motherhood services have been improved in Western Province. The situation analysis exercise was refined during the project, resulting in the development of the Safe Motherhood Rapid Appraisal Tool

Repositioning post partum care in Kenya

In Kenya, although 45 percent of maternal deaths occur within the first 24 hours after childbirth and 65 percent of maternal deaths occur during the first week postpartum, health-care providers continue to advise on a first check-up six weeks after childbirth. The early postpartum period is also critical to newborn survival, with 50–70 percent of life-threatening newborn illnesses occurring in the first week. Yet most strategies to reduce maternal and perinatal morbidity and mortality have focused on pregnancy and birth. In addition to the heavy workload of providers who do not assess the mother post-delivery when she may bring her infant for immunization, lack of knowledge, poverty, cultural beliefs and practices perpetuate the problem. The only register that exists for mothers post-delivery is for family planning, thus perpetuating the lack of emphasis on the early postpartum period with no standardized register to record care given. To address this gap in service delivery, the Population Council defined the minimal services a mother and baby should receive from a skilled attendant after birth. As stated in this brief, the development of a standardized postpartum register is one step toward advocating for providing early postpartum care among health-service providers

Introducing magnesium sulphate for the management of pregnancy induced hypertension

Global studies have demonstrated that using magnesium sulphate (MgSO4) to manage hypertensive disease in pregnancy reduces morbidity and mortality due to severe pre-eclampsia/eclampsia, one of the five direct causes of maternal death. Many countries have been slow to introduce MgSO4 to the detriment of women’s health. There are also critical gaps in health-care provider knowledge, skills, and practice in management of eclampsia. Although the use of MgSO4 was introduced successfully to the Maternity Unit at Kenyatta National Hospital, Nairobi, in 2001, there has been no systematic introduction of the drug across the country. Generally, the only facilities utilizing MgSO4 are those supported by development partners and some mission hospitals. In response to requests from health-care managers and providers in Western Province to be trained in the use of MgSO4, a two-day practical training program was developed. As noted in this brief, the main objective of the training was to ensure that participants had specific skills for preventing and managing severe pre-eclampsia and eclampsia

Taking maternal services to pregnant women: The community midwifery model

Evidence from a number of studies globally has shown a reduction in maternal and perinatal mortality when women have a skilled attendant present at birth. In Kenya, a skilled attendant assists at only 42 percent of births. In Central Province, over 70 percent deliver with a skilled attendant compared to 28 percent in Western Province. Results from one district in Western Province where midwives were given the necessary equipment and support to assist women during birth at home, showed a significant increase in home births attended by skilled health workers between 2001 and 2003 and a similar decrease in utilization of traditional birth attendants. As noted in this brief, this an indication that skilled attendance in the community is possible and a good alternative for women who are unable to reach a health facility. Building on these results, a Community Midwifery Model was developed that focuses on empowering midwives living in the community to assist women during pregnancy, childbirth, and the postpartum period in their homes, manage minor complications, and facilitate referral when necessary and transfer to the hospital

Relationships between antenatal and postnatal care and post-partum modern contraceptive use: evidence from population surveys in Kenya and Zambia

<p>Abstract</p> <p>Background</p> <p>It is often assumed, with little supportive, empirical evidence, that women who use maternal health care are more likely than those who do not to use modern contraceptives. This study aims to add to the existing literature on associations between the use of antenatal (ANC) and post-natal care (PNC) and post-partum modern contraceptives.</p> <p>Methods</p> <p>Data come from the most recent Demographic and Health Surveys (DHS) in Kenya (2008–09) and Zambia (2007). Study samples include women who had a live birth within five years before the survey (3,667 in Kenya and 3,587 in Zambia). Multivariate proportional hazard models were used to examine the associations between the intensity of ANC and PNC service use and a woman’s adoption of modern contraceptives after a recent live birth.</p> <p>Results</p> <p>Tests of exogeneity confirmed that the intensity of ANC and PNC service use and post-partum modern contraceptive practice were not influenced by common unobserved factors. Cox proportional hazard models showed significant associations between the service intensity of ANC and PNC and post-partum modern contraceptive use in both countries. This relationship is largely due to ANC services; no significant associations were observed between PNC service intensity and post-partum FP practice.</p> <p>Conclusions</p> <p>While the lack of associations between PNC and post-partum FP use may be due to the limited measure of PNC service intensity, the study highlights a window of opportunity to promote the use of modern contraceptives after childbirth through ANC service delivery. Depending on the availability of data, further research should take into account community- and facility-level factors that may influence modern contraceptive use in examining associations between ANC and PNC use and post-partum FP practice.</p