Maternal health project in Guinea
The Safe Delivery App was implemented and tested through a pilot project in Guinea, West Africa, in joint implementation with Danish Red Cross and Guinea Red Cross. The App was launched in November 2016 as a component of a wider reproductive health program. The impact of the Safe Delivery App in Guinea was assessed through an endline data collection carried out in November 2017.
The objective of the pilot was to assess the impact of Safe Delivery App in strengthening knowledge and confidence in basic emergency care among the midwives in the program. This was done by collecting quantitative data on knowledge and confidence as well as carrying out qualitative data collection to account for perceptions, experiences and attitudes around the Safe Delivery App.
Maternal and neonatal mortality remains staggering high in Guinea representing one of the highest maternal mortality rates worldwide. Scarce access to quality care and health information represent just a few of the challenges pregnant women face in a country in lack of skilled birth attendants.
In partnership with Danish and Guinea Red Cross, 51 midwives and health workers from 34 rural health facilities received clinical training in Basic Emergency Obstetric and Newborn Care (BEmONC). They were then introduced to and trained in using the Safe Delivery App as a job-aid to strengthen knowledge and skills to improve care to pregnant and delivering women. 50% of the midwives in the project work at health post level in rural communities and are on their own when complications arise.
The purpose of the pilot project was to provide midwives in Guinea with direct and instant access to evidence-based and up-to-date clinical guidelines on BEmONC. The aim was to impact health outcomes positively in terms of reduction of maternal and perinatal mortality/morbidity in the project zone.
The endline data (12 months) provided overall positive results in the target group.
- Positive increases in clinical knowledge and in self-confidence managing basic complications related to child birth
- Reported faster management of references due to earlier identification of danger signs
- Reported increased management of minor complications in local health centres
The Safe Delivery App was implemented through Guinea Red Cross’ large reproductive health programme within clinical capacity building and community work which support the positive results we see on the App’s impact.
Level of clinical knowledge in Basic Emergency Obstetric and Newborn Care (BEmONC)
Knowledge is a strong indicator for midwives’ ability to prevent and identify signs of danger and act accordingly in an emergency. The Key Feature Questionnaire (KFQ) tests skilled birth attendants’ clinical knowledge assessed through 55 questions in 15 clinical cases. The questions are asked in a way that make midwives reflect on how they would act in a real situation.
The results showed a clear impact on the midwives’ clinical knowledge. The average increase was almost 10%-points from Baseline to the end of the project after using the Safe Delivery App for 12 months. In addition, in 6 out of 8 clinical topics we see that knowledge increases over time during the project period while the midwives had the App.
Level of confidence in managing complications
Confidence is an important indicator to emergency care as it is proven to impact the efficiency and rapidity of management. The midwives’ confidence in managing basic complications was assessed through noting their sentiments towards different complications on a scale from 1-5 (1 = I panic and 5= I am confident) before and after the Safe Delivery App.
Self-confidence across management of all basic complications increased in average 1,9 points on a scale from 1-5 and confidence especially increased in managing post-partum hemorrhage – the most frequent cause of maternal deaths. The increased confidence should be understood as an effect not only of the Safe Delivery App but of the combined effort of clinical training and the Safe Delivery App.