Use of the electronic partogram, a digital labor-support application, is associated with improved fetal outcomes and greater use of interventions to maintain normal labor compared to the paper partograph.

BackgroundThe ePartogram is a tablet-based application developed to improve care for women in labor by addressing documented challenges in partograph use. The application is designed to provide real-time decision support, improve data entry, and increase access to information for appropriate labor management. This study’s primary objective was to evaluate the feasibility and acceptability of ePartogram use in resource-constrained clinical settings.MethodsThe ePartogram was introduced at three facilities in Zanzibar, Tanzania. Following 3 days of training, skilled birth attendants (SBAs) were observed for 2 weeks using the ePartogram to monitor laboring women. During each observed shift, data collectors used a structured observation form to document SBA comfort, confidence, and ability to use the ePartogram. Results were analyzed by shift. Short interviews, conducted with SBAs (n = 82) after each of their first five ePartogram-monitored labors, detected differences over time. After the observation period, in-depth interviews were conducted (n = 15). A thematic analysis of interview transcripts was completed.ResultsObservations of 23 SBAs using the ePartogram to monitor 103 women over 84 shifts showed that the majority of SBAs (87–91%) completed each of four fundamental ePartogram tasks—registering a client, entering first and subsequent measurements, and navigating between screens—with ease or increasing ease on their first shift; this increased to 100% by the fifth shift. Nearly all SBAs (93%) demonstrated confidence and all SBAs demonstrated comfort in using the ePartogram by the fifth shift. SBAs expressed positive impressions of the ePartogram and found it efficient and easy to use, beginning with first client use. SBAs noted the helpfulness of auditory reminders (indicating that measurements were due) and visual alerts (signaling abnormal measurements). SBAs expressed confidence in their ability to interpret and act on these reminders and alerts.ConclusionsIt is feasible and acceptable for SBAs to use the ePartogram to support labor management and care. With structured training and support during initial use, SBAs quickly became competent and confident in ePartogram use. Qualitative findings revealed that SBAs felt the ePartogram improved timeliness of care and supported decision-making. These findings point to the ePartogram’s potential to improve quality of care in resource-constrained labor and delivery settings.Electronic supplementary materialThe online version of this article (10.1186/s12884-018-1760-y) contains supplementary material, which is available to authorized users.

Objective To assess fertility desires by availability and use of ART/PMTCT services in Rakai, Uganda. Design Retrospective analyses of longitudinal data from the Rakai Community Cohort Study. Methods Study participants were retrospectively identified and categorized by HIV status. Availability of antiretroviral therapy and prevention of mother-to-child transmission (ART/PMTCT) services in Rakai was defined in three periods: 1) Pre-ART/PMTCT (<2005), 2) ART/PMTCT rollout (2005-06), and 3) universal ART/PMTCT (>2006); and use of ART/PMTCT was coded as yes if the woman received services. Trends in fertility desires were assessed by chi-square. “Modified” Poisson regression was performed using generalized linear models with a log link and Poisson family to estimate prevalence rate ratios (PRR) and 95% confidence intervals of desire for another child among previously and currently pregnant women; PRR were adjusted for demographic and behavioral factors. Results 4,227 sexually active women in Rakai, including 436 HIV+ women, contributed 13,970 observations over 5 survey rounds. Fertility desires increased in the population in the ART/PMTCT rollout (adjusted PRR: 1.08, CI: 1.04-1.13) and the universal availability periods (adj. PRR: 1.11, CI: 1.08-1.14) compared to pre-ART/PMTCT period. A total of 862 woman observations used ART/PMTCT services. Fertility desires were similar among ART/PMTCT service users and non-users in cross-sectional analysis (adj. PRR: 0.84, CI: 0.62-1.14) and one year after ART/PMTCT use (adj. PRR: 1.27, CI: 0.83-1.94). Conclusion Availability of ART/PMTCT may increase fertility desires of previously pregnant women in Rakai, Uganda. Use of ART/PMTCT services was not correlated with fertility desires of previously or current pregnant women.

Background: During the 2014-2016 Ebola virus epidemic, more than 500 health care workers (HCWs) died in spite of the use of personal protective equipment (PPE). The Johns Hopkins University Center for Bioengineering Innovation and Design (CBID) and Jhpiego, an international nongovernmental organization affiliate of Johns Hopkins, collaborated to create new PPE to improve the ease of the doffing process. Methods: HCWs in Liberia and a US biocontainment unit compared standard M edecins Sans Fronti ere PPE (PPE A) with the new PPE (PPE B). Participants wore each PPE ensemble while performing simulated patient care activities. Range of motion, time to doff, comfort, and perceived risk were measured. Results: Overall, 100% of participants preferred PPE B over PPE A (P < .0001); 98.1% of respondents would recommend PPE B for their home clinical unit (P < .0001). There was a trend towards greater comfort in PPE B. HCWs at both sites felt more at risk in PPE A than PPE B (71.9% vs 25% in Liberia, P < .0001; 100% vs 40% in the US biocontainment unit, P < .0001). Conclusions: HCWs preferred a new PPE ensemble to M edecins Sans Fronti ere PPE for high-consequence pathogens. Further studies on the safety of this new PPE need to be conducted.