O84 Impact of decision–operation interval on pregnancy outcomes among mothers who undergo emergency caesarean section at Mulago Hospital

Balikuddembe, Michael

doi:10.1016/s0020-7292(09)60456-2

Cited by 5 publications

(10 citation statements)

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“…This has included audits on, for example, triage and early warning scoring systems, anti-biotic use and C-section rates. Building on detailed audit conducted by a Ugandan doctor on the causes and impact of delays or ‘decision-operation-intervals’ in the National Referral Hospital ( Balikuddembe et al 2009 ), a number of clinical volunteers have developed similar small scale studies focused on referring health centres. One of these studies conducted by a volunteer obstetrician is discussed in some detail in this paper.…”

Section: Methodsmentioning

confidence: 99%

“…Research conducted by three Ugandan specialists ( Balikuddembe et al 2009 ) assessed the length, impacts and causes of delays in conducting emergency caesareans in Mulago National Referral Hospital. Although the lack of theatre space was listed as a factor contributing to delay in nearly all cases, the study highlighted major problems in human resources and the presence of staff (see table 1 ):…”

Section: Understanding the Underlying Causes Of Maternal And Neonatalmentioning

confidence: 99%

“… Source: Balikuddembe et al (2009 ). a Assume all 351 participants’ DOI could be affected by all the factors.…”

Section: Understanding the Underlying Causes Of Maternal And Neonatalmentioning

confidence: 99%

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The impact of delays on maternal and neonatal outcomes in Ugandan public health facilities: the role of absenteeism

Ackers

Ioannou

Ackers-Johnson

2016

Health Policy Plan.

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Maternal mortality in low- and middle-income countries continues to remain high. The Ugandan Ministry of Health’s Strategic Plan suggests that little, if any, progress has been made in Uganda in terms of improvements in Maternal Health [Millennium Development Goal (MDG) 5] and, more specifically, in reducing maternal mortality. Furthermore, the UNDP report on the MDGs describes Uganda’s progress as ‘stagnant’. The importance of understanding the impact of delays on maternal and neonatal outcomes in low resource settings has been established for some time. Indeed, the ‘3-delays’ model has exposed the need for holistic multi-disciplinary approaches focused on systems change as much as clinical input. The model exposes the contribution of social factors shaping individual agency and care-seeking behaviour. It also identifies complex access issues which, when combined with the lack of timely and adequate care at referral facilities, contributes to extensive and damaging delays. It would be hard to find a piece of research on this topic that does not reference human resource factors or ‘staff shortages’ as a key component of this ‘puzzle’. Having said that, it is rare indeed to see these human resource factors explored in any detail. In the absence of detailed critique (implicit) ‘common sense’ presumptions prevail: namely that the economic conditions at national level lead to inadequacies in the supply of suitably qualified health professionals exacerbated by losses to international emigration. Eight years’ experience of action-research interventions in Uganda combining a range of methods has lead us to a rather stark conclusion: the single most important factor contributing to delays and associated adverse outcomes for mothers and babies in Uganda is the failure of doctors to be present at work during contracted hours. Failure to acknowledge and respond to this sensitive problem will ultimately undermine all other interventions including professional voluntarism which relies on local ‘co-presence’ to be effective. Important steps forward could be achieved within the current resource framework, if the political will existed. International NGOs have exacerbated this problem encouraging forms of internal ‘brain drain’ particularly among doctors. Arguably the system as it is rewards doctors for non-compliance resulting in massive resource inefficiencies.

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Section: Methodsmentioning

confidence: 99%

Section: Understanding the Underlying Causes Of Maternal And Neonatalmentioning

confidence: 99%

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The impact of delays on maternal and neonatal outcomes in Ugandan public health facilities: the role of absenteeism

Ackers

Ioannou

Ackers-Johnson

2016

Health Policy Plan.

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“…The obstructed labor complex directly contributes to 6-10% of the maternal deaths, in addition to contributing to other diseases for the mother and the baby [3,4]. …”

Section: Introductionmentioning

confidence: 99%

Computerized Childbirth Monitoring Tools for Health Care Providers Managing Labor: A Scoping Review

Balikuddembe¹,

Tumwesigye²,

Wakholi³

et al. 2017

JMIR Med Inform

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BackgroundProper monitoring of labor and childbirth prevents many pregnancy-related complications. However, monitoring is still poor in many places partly due to the usability concerns of support tools such as the partograph. In 2011, the World Health Organization (WHO) called for the development and evaluation of context-adaptable electronic health solutions to health challenges. Computerized tools have penetrated many areas of health care, but their influence in supporting health staff with childbirth seems limited.ObjectiveThe objective of this scoping review was to determine the scope and trends of research on computerized labor monitoring tools that could be used by health care providers in childbirth management.MethodsWe used key terms to search the Web for eligible peer-reviewed and gray literature. Eligibility criteria were a computerized labor monitoring tool for maternity service providers and dated 2006 to mid-2016. Retrieved papers were screened to eliminate ineligible papers, and consensus was reached on the papers included in the final analysis.ResultsWe started with about 380,000 papers, of which 14 papers qualified for the final analysis. Most tools were at the design and implementation stages of development. Three papers addressed post-implementation evaluations of two tools. No documentation on clinical outcome studies was retrieved. The parameters targeted with the tools varied, but they included fetal heart (10 of 11 tools), labor progress (8 of 11), and maternal status (7 of 11). Most tools were designed for use in personal computers in low-resource settings and could be customized for different user needs.ConclusionsResearch on computerized labor monitoring tools is inadequate. Compared with other labor parameters, there was preponderance to fetal heart monitoring and hardly any summative evaluation of the available tools. More research, including clinical outcomes evaluation of computerized childbirth monitoring tools, is needed.

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“…About 303,000 women and a higher number of babies died in 2015 from pregnancy-related causes [1] like obstructed labour. Obstructed labour directly contributes 6–8% maternal deaths but it plays a role in other causes of death and morbidity for mother and baby [2, 3]. Over 95% of this morbidity and mortality occurs in low- and middle-income countries (LMIC), with over 35% found in East and Southern Africa [1, 4].…”

Section: Introductionmentioning

confidence: 99%

Expert perspectives on essential parameters to monitor during childbirth in low resource settings: a Delphi study in sub-Saharan Africa

et al. 2019

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Objective There is no consensus on the essential parameters to monitor during childbirth, when to start, and the rate of monitoring them. User disagreement contributes to inconsistent use of the twelve-item modified World Health Organization partograph that is started when the cervix is at least 4 cm dilated. The inconsistent use is associated with poor outcomes at birth. Our objective was to identify the perspectives of childbirth experts on what and when to routinely monitor during childbirth in low resource settings as we develop a more acceptable childbirth clinical decision support tool. Method We carried out a Delphi study with two survey rounds in early 2018. The online questionnaire covered the partograph items like foetal heart, cervical dilation, and blood pressure, and their monitoring rates. We invited panellists with experience of childbirth care in sub-Saharan Africa. Consensus was pre-set at 70% panellists rating a parameter and we gathered some qualitative reasons for choices. Results We analysed responses of 76 experts from 13 countries. There was consensus on six important parameters including foetal heart rate, amniotic fluid clearness, cervical dilation, strength of uterine contractions, maternal pulse, and blood pressure. Two in three experts expressed support for changing the monitoring intervals for some parameters in the partograph. 63% experts would raise the partograph starting point while 58% would remove some items from it. Consensus was reached on monitoring the cervical dilation at 4-hourly intervals and there was agreement on monitoring the foetal heart rate one-hourly. However, other parameters only showed majority intervals and without reaching agreement scores. The suggested intervals were two-hourly for strength of uterine contractions, and four-hourly for amniotic fluid thickness, maternal pulse and blood pressure. The commonest reason for their opinions was the more demanding working conditions. Conclusion There was agreement on six partograph items being essential for routine monitoring at birth, but the frequency of monitoring could be changed. To increase acceptability, revisions to birth monitoring guidelines have to be made in consideration of opinions and working conditions of several childbirth experts in low resource settings. Electronic supplementary material The online version of this article (10.1186/s12978-019-0786-6) contains supplementary material, which is available to authorized users.

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O84 Impact of decision–operation interval on pregnancy outcomes among mothers who undergo emergency caesarean section at Mulago Hospital

Cited by 5 publications

References 0 publications

The impact of delays on maternal and neonatal outcomes in Ugandan public health facilities: the role of absenteeism

The impact of delays on maternal and neonatal outcomes in Ugandan public health facilities: the role of absenteeism

Computerized Childbirth Monitoring Tools for Health Care Providers Managing Labor: A Scoping Review

Expert perspectives on essential parameters to monitor during childbirth in low resource settings: a Delphi study in sub-Saharan Africa

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