Exploring the effectiveness of dialogue in improving health facility deliveries

Abstract

Maternal mortality is a concern worldwide with higher disparities of 1 in 16 in developing compared to 1 in 2800 in developed countries. Kenya's maternal mortality ratio has increased from 414 per 100,000 live births in 2003 to 488 per 100,000 live births in 2009. In 2010 the figure increased to 530 per 100,000 live births. The purpose of the study was to explore the effectiveness of dialogue in improving health facility deliveries in Rachuonyo District. The main objective of the study was to explore the effectiveness of dialogue in improving health facility deliveries. A prospective longitudinal research was conducted collecting baseline and post intervention data. Data was collected using semi structured in depth interview guides based on the causes of maternal deaths. Data collection and analysis were done concurrently to help increase insights and clarify parameters under study till saturation of information. A manual for training CHWs was developed based on gaps identified from baseline data. Community health workers were trained on the community dialogue model addressing gaps identified from baseline phase. Implementation of the dialogue model was conducted by the trained community health workers at the health facility and at the community within households. Baseline findings of study included inadequate equipment and staff at the health facility, late gestation at first visit, limited knowledge on complications, expected date of delivery, frequency of antenatal care (ANC) visits and basic items collected in preparation for arrival of the baby. A post intervention evaluation was done with post natal mothers taken through dialogue to assess effectiveness of dialogue. Findings showed improved knowledge on complications, expected date of delivery, frequency of ANC visits, basic items collected in preparation for arrival of the baby and the role of the husband in relation to the care of the mother. The study concluded that inadequate staffing, supplies and equipment contribute to low uptake of skilled attendant deliveries at the health facility. Mothers had inadequate information on birth preparedness before the intervention and this improved after the intervention. The study recommended facility improvement on provision of adequate staffing, supplies and equipments. There is need for task shifting of health education role from health workers to local community health workers (CHWs) because they were overwhelmed with integration of services and unable to provide adequate birth preparedness information to mothers.