The majority of maternal deaths in Kenya result from three complications of pregnancy: eclampsia, obstructed labour and post-partum haemorrhage. Medical and surgical interventions exist to treat these conditions, but for these to be successful women must be referred on time to skilled professionals in adequately equipped health facilities. The early and accurate identification of complications during pregnancy and delivery is therefore crucial to reducing maternal deaths.
An essential tool for monitoring and documenting deliveries
Like many counties in Kenya, Vihiga has a high maternal mortality rate. Supportive supervisions carried out in health facilities in the county have revealed considerable gaps in the skills of health workers to fill in partographs during deliveries.
Partographs are a one-page graphic record of the progress of labour (see example below). Key information about the mother and fetus, such as cervical dilation and fetal heart rate, are recorded at regular intervals. When used correctly, partographs can alert health workers that labour is not progressing normally and that a referral may be necessary for augmentation of labour, a Caesarian section or a vacuum extraction. Incorrect or incomplete use of partographs, however, can result in danger signs being missed.
Building confidence in the use of the partograph
To improve health workers’ skills to work with partographs, the Vihiga County Health Management Team (CHMT) and the GIZ Support to the Health Sector program organised supportive supervisions at health facilities in Emuhaya, Hamisi and Sabatia constituencies in mid-January. Fifty-six health workers who attend deliveries participated in these sessions, which were led by the County Reproductive Health Coordinator and the Expanded Programme on Immunization (EPI) Coordinator, using training materials donated by the Liverpool School of Tropical Medicine.
The sessions were divided into two parts: the first part reviewed the basic use of the partograph, while the second part was structured around a series of actual cases. Participants were divided into small groups and practiced filling in the graphs on the basis of information provided about the course of labour. They discussed together and decided whether and when actions should be taken. These practical exercises generated lively interactions and helped health workers become more confident in using the partograph to identify risks and make timely decisions.
August 9, 2018
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