Evaluating the impact of a longitudinal mentorship intervention on the documentation of maternal vital signs in Blantyre district, Malawi

Staff shortages, insufficient training and support, and high patient caseloads limit maternal quality of care (QoC) and influence poor documentation of vital signs and labor progress in Malawi. Aware that this limits providers’ ability to anticipate or manage complications, we explored the impact of a longitudinal multipronged intervention on the documentation of maternal vital signs at key clinical times during childbirth to identify targeted opportunities for improvement. We conducted a retrospective quantitative analysis of maternal charts from two primary health centres in Blantyre district in Malawi to assess for differences in the documentation of vital signs established in the WHO Safe Childbirth Checklist (SCC). The intervention consisted of short course training followed by 12 months of bedside mentorship. Bivariate and multivariate analyses assessed differences in the recording of each vital sign both pre- and post-intervention as well as according to availability of the appropriate device for that vital sign. A total of 271 maternal charts—96 from the pre-intervention period and 175 from the post-intervention period—were analyzed and found to have recorded between 2% and 52% of key maternal vital signs at the SCC-designated times. Post-intervention charts showed a statistically significant (p < 0.05) increase in the documentation of heart rate/pulse and blood pressure both upon admission and immediately postpartum, though not at the time of active childbirth. Additionally, while few maternal charts included all vital signs, there was a significant increase in the number of vital signs recorded between the pre- and post-intervention periods. A sub-analysis explored the impact of the availability of key medical devices on documentation during the post-intervention period and found that the recorded availability of thermometers and blood pressure cuffs were not significantly associated with whether temperature or blood pressure was recorded, respectively. However, at admission, significantly more vital signs were recorded when all a centre’s medical devices were consistently available. A deeper exploration into which strategies are most effective for vital sign measurement and how it affects QoC indicators is warranted. Meanwhile, continuing and expanding training followed by supportive mentorship will be key to making sustainable maternal QoC improvement.