ePartogram Effectiveness Study in Kenya

The ePartogram is an electronic version of the WHO Partograph and is developed by Jhpiego. Seventy-eight clinical rules, programmed into the ePartogram, are based on global guidelines in the WHO manual "Managing complications in pregnancy and childbirth: a guide for midwives and doctors" and the expert opinion of Jhpiego physicians and nurse-midwives. The rules underwent a validation process by 65 expert skilled birth attendants (SBAs) (working in maternity wards of health facilities) from a variety of geographic and clinical settings affiliated with Jhpiego. In the ePartogram application ("app") that is put on an Android tablet computer, the clinical rules trigger "reminders" to SBAs to take a routine clinical measurement, such as fetal heart rate (every 30 minutes) or maternal temperature (every 2 hours). The rules also trigger "low-level" alarms indicating a measurement that falls in the abnormal range that could be cause for concern (i.e. meconium-stained liquor), and "high-level" alarms that could indicate need for immediate action (i.e. maternal systolic blood pressure ≥160 mm Hg).

Litwin et al. reported on the feasibility and acceptability of use of an electronic partogram in Zanzibar and concluded that health workers felt the ePartogram improved timeliness of care and supported decision making. Health workers quickly became competent and confident in using the tablet device and ePartogram application. This study in Kenya has an objective to evaluate whether providers' use of the ePartogram improves labor outcomes and labor management in health facilities. The study design is a quasi-experimental design evaluation comparing data collected at 6 intervention sites and 6 comparison sites with similar facility characteristics and in two regions of Kenya.

Inclusion criteria

Facilities:

• In Kisumu or Meru
• BEmONC or CEmONC sites
• At least one SBA on duty in labor ward 24 hours per day
• Facility in-charge or in-charge of L&D ward available physically or remotely 24 hours per day
• Use WHO modified paper partograph
• Adequate supply of paper partographs and maternity registers
• Availability of reliable transportation for referrals (e.g. functional ambulance) 24 hours per day

Providers:

• Providers meeting the WHO definition of Skilled Birth Attendant (SBA) clinical provider working in care for laboring women who will be working at the facility during the study.
• Providers completing the three-day labor management training comprised of training on partograph use and management of normal labors and labor complications, according to WHO and Kenya MOH guidelines
• Intervention sites only: Providers passing the ePartogram post-training test will be asked to use the ePartogram during clinical care.

Exclusion criteria

Facilities:

• Facility not registered with MOH
• No SBA on duty in labor ward at any time during a 24 hour period
• No in-charge available at any time during a 24 hour period
• Dispensary health facilities that do not practice BEmONC

Providers:

• Providers not meeting the WHO definition of SBA
• Providers not completing the labor management training or (intervention sites only) not passing the ePartogram post-training test