The PartoPen: Using Digital Pen Software to Improve Birth Attendant Training and Maternal Outcomes in Kenya

Problem and Motivation The World Health Organization (WHO) estimates that 300,000 women die every year due to pregnancy-related complications, most of which occur in developing countries [1]. Timely and informed labor monitoring by a skilled attendant can help prevent many of main causes of maternal death – hemorrhage, infection, unsafe abortion, eclampsia, and obstructed labor. Globally, the WHO promotes the paper partograph as an effective and cost-efficient tool for monitoring labor, and preventing obstructed labor and resulting complications. Used correctly, the partograph provides decision support that assists in early detection of maternal and fetal complications during labor. Especially in rural clinics, early detection allows transport decisions to be made in time for a woman to reach a regional facility capable of performing emergency obstetric procedures. Despite the positive reports of improved maternal outcomes resulting from correct partograph use [2], several recent studies in Kenya have reported a significant gap between knowledge and practice. One study from the University of Nairobi showed that while 88.2% of the 1057 evaluated patient records contained a partograph, only 23.8% of the forms had been used correctly [3]. A 1999 study of partograph use in Nigeria found that 94% of doctors thought the partograph was useful, although only 25% used it on a routine basis. In addition, only 35% of participants in this study could correctly explain the purpose of using the partograph [4]. These results are consistent with other partograph studies conducted in developing countries where lack of training and continuing education, exacerbated by limited resources, represent serious barriers to effective partograph use [3,5,6].