title: Clinician attendance and delivery practices at hospital-based vaginal deliveries in Western Kenya.
abstract: OBJECTIVE
  To characterize delivery practices and factors associated with respectful, evidence-based care at a referral hospital in Western Kenya.
  
  
  METHODS
  An exploratory observational study used a standardized birth-observation form to record information on patient characteristics and healthcare practitioner behaviors during uncomplicated vaginal deliveries between June 30, 2014 and July 17, 2014. All deliveries were monitored for whether healthcare staff performed six specific evidence-based practices (three maternal and three neonatal practices).
  
  
  RESULTS
  In total, 75 vaginal deliveries were observed. In 48 (64%) deliveries, nursing students were the only practitioners present. The mean number of evidence-based practices performed at each delivery was 3.58. The number of evidence-based practices performed by junior practitioners was higher when a nurse educator was assessing their performance (4.47 vs 3.36, P<0.001). Lower mean respectful-care scores were recorded when delivery teams comprised three or more practitioners (1.38; 95% confidence interval 0.93-1.84 vs 2.74; 95% confidence interval 2.16-3.31, P=0.002).
  
  
  CONCLUSIONS
  The present study found low rates of evidence-based practice and respectful maternity care; this could serve as a deterrent for women seeking care at the study facility. These findings emphasize the need for a comprehensive approach in increasing the quality of patient care to improve maternal and newborn health outcomes.
authors.affiliation: Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, USA.
authors.forename: Suha J
authors.initials: SJ
authors.lastname: Patel
authors.affiliation: University of Washington School of Medicine, Seattle, USA.
authors.forename: Kelly
authors.initials: K
authors.lastname: Bogaert
authors.affiliation: Department of Obstetrics and Gynaecology, University of Nairobi, Nairobi, Kenya.
authors.forename: Onesmus W
authors.initials: OW
authors.lastname: Gachuno
authors.affiliation: Department of Obstetrics and Gynaecology, University of Nairobi, Nairobi, Kenya.
authors.forename: Minnie W
authors.initials: MW
authors.lastname: Kibore
authors.affiliation: Department of Obstetrics and Gynecology, University of Washington, Seattle, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Unger
authors.affiliation: Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, USA. Electronic address: Dilys.Walker@ucsf.edu.
authors.forename: Dilys M
authors.initials: DM
authors.lastname: Walker
mesh_terms: D000328:Adult; D036861:Delivery, Obstetric / Q000706:statistics & numerical data*; D055317:Evidence-Based Practice / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007630:Kenya; D008427:Maternal Health Services / Q000592:standards*; D009773:Obstetric Nursing / Q000706:statistics & numerical data; D009774:Obstetrics / Q000193:education*; D009775:Obstetrics and Gynecology Department, Hospital / Q000706:statistics & numerical data; D011247:Pregnancy; D055815:Young Adult
keywords: Birth attendants; Delivery practices; Respectful care; Training; Vaginal delivery