Population Council, Nairobi Kenya. Avenue 5, 3rd Floor, Rose Avenue, PO Box 17643-00500, Nairobi, Kenya.
Jacaranda Health, Nairobi, Kenya.
BMC Womens Health. 2023 Nov 8;23(1):580. doi: 10.1186/s12905-023-02740-2.
Children and women in urban informal settlements have fewer choices to access quality maternal and newborn health care. Many facilities serving these communities are under-resourced and staffed by fewer providers with limited access to skills updates. We sought to increase provider capacity by equipping them with skills to provide general and emergency obstetric and newborn care in 24 facilities serving two informal settlements in Nairobi. We present evidence of the combined effect of mentorship using facility-based mentors who demonstrate skills, support skills drills training, and provide practical feedback to mentees and a self-guided online learning platform with easily accessible EmONC information on providers' smart phones.
We used mixed methods research with before and after cross-sectional provider surveys conducted at baseline and end line. During end line, 18 in-depth interviews were conducted with mentors and mentees who were exposed, and providers not exposed to the intervention to explore effectiveness and experience of the intervention on quality maternal health services.
Results illustrated marked improvement from ability to identify antepartum hemorrhage (APH), postpartum hemorrhage (PPH), manage retained placenta, ability to identify and manage obstructed labour, Pre-Eclampsia and Eclampsia (PE/E), puerperal sepsis, and actions taken to manage conditions when they present. Overall, out of 95 elements examined there were statistically significant improvements of both individual scores and overall scores from 29/95 at baseline (30.5%) to 44.3/95 (46.6%) during end line representing a 16- percentage point increase (p > 0.001). These improvements were evident in public health facilities representing a 17.3% point increase (from 30.9% at baseline to 48.2% at end line, p > 0.001). Similarly, providers working in private facilities exhibited a 15.8% point increase in knowledge from 29.7% at baseline to 45.5% at end line (p = 0.0001).
This study adds to the literature on building capacity of providers delivering Maternal and Newborn Health (MNH) services to women in informal settlements. The complex challenges of delivering MNH services in informal urban settings where communities have limited access require a comprehensive approach including ensuring access to supplies and basic equipment. Nevertheless, the combined effects of the self-guided online platform and mentorship reinforces EmONC knowledge and skills. This combined approach is more likely to improve provider competency, and skills as well as improving maternal and newborn health outcomes.
城市非正规住区的儿童和妇女在获得优质孕产妇和新生儿保健方面选择较少。许多为这些社区服务的设施资源不足，提供服务的提供者较少，获得技能更新的机会有限。我们试图通过培训他们提供一般和紧急产科及新生儿护理的技能，来增强提供者的能力，培训在奈洛比的两个非正规住区的 24 个设施中开展。我们展示了利用基于设施的导师进行指导的综合效果，导师展示技能、支持技能演练培训，并为学员提供实践反馈，以及利用提供者智能手机上易于访问的 EmONC 信息的自我指导在线学习平台。
我们使用混合方法研究，在基线和终线进行前后横断面提供者调查。在终线期间，对暴露于干预措施和未暴露于干预措施的导师和学员进行了 18 次深入访谈，以探讨干预措施对孕产妇保健服务质量的有效性和经验。
结果表明，从识别产前出血（APH）、产后出血（PPH）、处理残留胎盘、识别和处理梗阻性分娩、子痫前期和子痫（PE/E）、产褥期脓毒症以及采取措施处理出现的情况的能力方面，都有明显的改善。总体而言，在检查的 95 个要素中，无论是个人得分还是整体得分都有显著提高，从基线时的 29/95（30.5%）提高到终线时的 44.3/95（46.6%），代表着 16 个百分点的提高（p>0.001）。这些改进在公共卫生设施中显而易见，提高了 17.3 个百分点（从基线时的 30.9%提高到终线时的 48.2%，p>0.001）。同样，在私人设施工作的提供者的知识也提高了 15.8 个百分点，从基线时的 29.7%提高到终线时的 45.5%（p=0.0001）。
本研究为在非正规住区向妇女提供孕产妇和新生儿健康（MNH）服务的提供者能力建设方面的文献增添了内容。在社区获得服务的机会有限的城市非正式住区提供 MNH 服务面临着复杂的挑战，需要采取全面的方法，包括确保获得用品和基本设备。然而，自我指导在线平台和指导的综合作用增强了 EmONC 的知识和技能。这种综合方法更有可能提高提供者的能力和技能，以及改善孕产妇和新生儿的健康结果。
