Low- and middle-income countries face many common barriers to implementation of maternal health evidence products

Ritchie, Lisa M Puchalski; Khan, Sobia; Moore, Julia E.; Timmings, Caitlyn; Lettow, Monique van; Vogel, Joshua P.; Khan, Dina N.; Mbaruku, Godfrey; Mrisho, Mwifadhi; Mugerwa, Kidza; Uka, Sami; Gülmezoglu, A. Metin; Straus, Sharon E.

doi:10.1016/j.jclinepi.2016.02.017

Cited by 135 publications

(94 citation statements)

References 10 publications

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“…The majority of deaths occur in the poorest countries . Though the global proportion of facility births is increasing, it has not been matched with improvements in the quality of intra‐facility labour care . This is a key priority in the post‐2015 era .…”

Section: Introductionmentioning

confidence: 99%

Effect of locally tailored labour management guidelines on intrahospital stillbirths and birth asphyxia at the referral hospital of Zanzibar: a quasi‐experimental pre‐post study (The PartoMa study)

Maaløe

Housseine

Meguid

et al. 2017

BJOG

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Objective To evaluate effect of locally tailored labour management guidelines (PartoMa guidelines) on intrahospital stillbirths and birth asphyxia. Design Quasi‐experimental pre‐post study investigating the causal pathway through changes in clinical practice. Setting Tanzanian low‐resource referral hospital, Mnazi Mmoja Hospital. Population Facility deliveries during baseline (1 October 2014 until 31 January 2015) and the 9th to 12th intervention month (1 October 2014 until 31 January 2015). Methods Birth outcome was extracted from all cases of labouring women during baseline (n = 3690) and intervention months (n = 3087). Background characteristics and quality of care were assessed in quasi‐randomly selected subgroups (n = 283 and n = 264, respectively). Main outcome measures Stillbirths and neonates with 5‐minute Apgar score ≤5. Results Stillbirth rate fell from 59 to 39 per 1000 total births (RR 0.66, 95% CI 0.53–0.82), and subanalyses suggest that this was primarily due to reduction in intrahospital stillbirths. Apgar scores between 1 and 5 fell from 52 to 28 per 1000 live births (RR 0.53, 95% CI 0.41–0.69). Median time from last fetal heart assessment till delivery (or fetal death diagnosis) fell from 120 minutes (IQR 60–240) to 74 minutes (IQR 30‐130) (Mann–Whitney test for difference, P < 0.01). Oxytocin augmentation declined from 22% to 12% (RR 0.54, 95% CI 0.37–0.81) and timely use improved. Conclusion Although low human resources and substandard care remain major challenges, PartoMa guidelines were associated with improvements in care, leading to reductions in stillbirths and birth asphyxia. Findings furthermore emphasise the central role of improved fetal surveillance and restricted intrapartum oxytocin use in safety at birth. Tweetable abstract #PartoMa guidelines aided in reducing stillbirths and birth asphyxia at a Tanzanian low‐resource hospital Plain Language Summary PartoMa guidelines help birth attendants in Tanzania to save livesEvery year, 3 million babies die on the day of birth. The vast majority of these deaths occur in the poorest countries. If their mothers had received better care during birth, most babies would have survived.At Mnazi Mmoja Hospital, an East African referral hospital, the PartoMa study shows that use of locally developed guidelines helps birth attendants to deliver better quality of care, which has led to improved survival at birth.At the hospital studied, resources are scarce. Each birth attendant assists four to six birthing women simultaneously, and many have less than 1 year of professional experience. International guidelines are available, but they are often unachievable and seldom applied.The PartoMa guidelines were developed in close collaboration with the birth attendants and approved by seven international experts. The result is an 8‐page pocket booklet providing locally achievable and simple decision support for care during birth.Use of the PartoMa guidelines began in February 2015. As the staff group frequently changes, quarterly seminars are conducted where b...

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Section: Introductionmentioning

confidence: 99%

Effect of locally tailored labour management guidelines on intrahospital stillbirths and birth asphyxia at the referral hospital of Zanzibar: a quasi‐experimental pre‐post study (The PartoMa study)

Maaløe

Housseine

Meguid

et al. 2017

BJOG

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“…The lack of emphasis on EBM in training limits the uptake of evidence-based practices in LMICs, and limits investment in EMCRs 12. Many healthcare professionals, thus, lack the core competencies of critical appraisal, question formulation, study design and the skills to translate evidence into practice 13 14.…”

Section: Problem 2: Lack Of Training In Ebmmentioning

confidence: 99%

Building capacity in evidence-based medicine in low-income and middle-income countries: problems and potential solutions

Gill¹,

Ali²,

Elsobky³

et al. 2019

BMJ EBM

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“…Barriers, such as limited capacity to collect and use data or accountability for performance, can severely limit the ability of health workers to integrate local epidemiology and real-time data on diseases. 4 Although systems are moving toward digital transfer and collation of data centrally, processes that feed back to influence management are often cumbersome and restricted by rigid policies and guidelines. These barriers, which within the context of an already inefficient paper-based system, reduce the benefit patients might gain from data on current conditions (such as seasonal prevalence, disease outbreaks, and drifts in pathogen prevalence and drug susceptibility).…”

Section: The Digital Revolution and Public Health In Low-income Countmentioning

confidence: 99%

Dynamic Clinical Algorithms: Digital Technology Can Transform Health Care Decision-Making

Bell

Gachuhi

Assefi

2018

The American Journal of Tropical Medicine and Hygiene

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Abstract.Most health care in low-income countries is delivered at a primary care level by health workers who lack quality training and supervision, often distant from more experienced support. Lack of knowledge and poor communication result in a poor quality of care and inefficient delivery of health services. Although bringing great benefits in sectors such as finance and telecommunication in recent years, the Digital Revolution has lightly and inconsistently affected the health sector. These advances offer an opportunity to dramatically transform health care by increasing the availability and timeliness of information to augment clinical decision-making, based on improved access to patient histories, current information on disease epidemiology, and improved incorporation of data from point-of-care and centralized diagnostic testing. A comprehensive approach is needed to more effectively incorporate current digital technologies into health systems, bringing external and patient-derived data into the clinical decision-making process in real time, irrespective of health worker training or location. Such dynamic clinical algorithms could provide a more effective framework within which to design and integrate new digital health technologies and deliver improved patient care by primary care health workers.

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Low- and middle-income countries face many common barriers to implementation of maternal health evidence products

Cited by 135 publications

References 10 publications

Effect of locally tailored labour management guidelines on intrahospital stillbirths and birth asphyxia at the referral hospital of Zanzibar: a quasi‐experimental pre‐post study (The PartoMa study)

Effect of locally tailored labour management guidelines on intrahospital stillbirths and birth asphyxia at the referral hospital of Zanzibar: a quasi‐experimental pre‐post study (The PartoMa study)

Building capacity in evidence-based medicine in low-income and middle-income countries: problems and potential solutions

Dynamic Clinical Algorithms: Digital Technology Can Transform Health Care Decision-Making

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