The emergency obstetric and neonatal care training; trends of maternal outcomes before and after trainingin the hospitals in Siaya County, Western Kenya

The WHO developed and hasrecommended EmONC training to address the concern with the life-threatening complications during pregnancy, delivery, or postpartum period. Indeed, several countries have implemented the training in sub-Saharan Africa but with unique challenges and barriers. However, very limited evaluations have been carried out to inform improvements or implementation strategies. We therefore conducted retrospective study design to assess the trend of maternal outcomes such as caesarian sections and post-partum hemorrhage before (2 years) and after (2 years) implementation of EmONC training at county referral hospital and 5 sub-county hospitals in Siaya County, Western Kenya. The data on maternal outcomes were extracted from DHIS (District Health Information System) and analyzed with SPSS IBM Version 20 software. The findings showsthat there were 4779 maternal outcomes with 3771 (76.63%) caesarian sections (CSs) and 1028 (23.37%) post-partum hemorrhage (PPH) cases. The PPH cases were 645 (62.74%) and 383(37.26%) after and before the training respectively. Also, the CSs cases were 2177 (35.73%) and 1594 (42.27%) after and before the training respectively. The differences of PPH and CSs cases after and before the training were statistically significant with the P values of 0.0003 and 0.029 respectively. Similar trends of increasing maternal outcomes were observed in six hospitals. The findings suggest that EmONC training has no effect on the selected maternal outcomes possibly because of poor implementation strategy. However, we have a caveat on the interpretation of the findings because the increased outcome could be due to more deliveries as a result of free maternity services. We therefore recommend a similar study in other settings controlling for the effect of free maternity services and also including more maternal and neonatal outcomes as findings are critical improvements of the strategy.