Local adaption of intrapartum clinical guidelines, United Republic of Tanzania

Nanna Maaløe, Tarek Meguid, Natasha Housseine, Britt Pinkowski Tersbøl, Karoline Kragelund Nielsen, Ib Christian Bygbjerg, Josvan Roosmalen

Research output: Contribution to JournalArticleAcademicpeer-review

Abstract

Problem Gaps exist between internationally derived clinical guidelines on care at the time of birth and realistic best practices in busy, low-resourced maternity units. Approach In 2014-2018, we carried out the PartoMa study at Zanzibar’s tertiary hospital, United Republic of Tanzania. Working with local birth attendants and external experts, we created easy-to-use and locally achievable clinical guidelines and associated in-house training to assist birth attendants in intrapartum care. Local setting Around 11 500 women gave birth annually in the hospital. Of the 35-40 birth attendants employed, each cared simultaneously for 3-6 women in labour. At baseline (1 October 2014 to 31 January 2015), there were 59 stillbirths per 1000 total births and 52 newborns with an Apgar score of 1-5 per 1000 live births. Externally derived clinical guidelines were available, but rarely used. Relevant changes Staff attendance at the repeated trainings was good, despite seminars being outside working hours and without additional remuneration. Many birth attendants appreciated the intervention and were motivated to improve care. Improvements were found in knowledge, partograph skills and quality of care. After 12 intervention months, stillbirths had decreased 34% to 39 per 1000 total births, while newborns with an Apgar score of 1-5 halved to 28 per 1000 live births. Lessons learnt After 4 years, birth attendants still express high demand for the intervention. The development of international, regional and national clinical guidelines targeted at low-resource maternity units needs to be better attuned to input from end-users and the local conditions, and thereby easier to use effectively.

Translated title of the contributionLocal adaption of intrapartum clinical guidelines, United Republic of Tanzania
Original languageSpanish
Pages (from-to)365-370
Number of pages6
JournalBulletin of the World Health Organization
Volume97
Issue number5
DOIs
Publication statusPublished - 1 May 2019

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Tanzania
Parturition
Guidelines
Stillbirth
Apgar Score
Live Birth
Newborn Infant
Remuneration
Quality of Health Care
Practice Guidelines
Tertiary Care Centers

Cite this

Maaløe, Nanna ; Meguid, Tarek ; Housseine, Natasha ; Tersbøl, Britt Pinkowski ; Nielsen, Karoline Kragelund ; Bygbjerg, Ib Christian ; Roosmalen, Josvan. / Adaptación local de las directrices clínicas durante el parto, República Unida de Tanzanía. In: Bulletin of the World Health Organization. 2019 ; Vol. 97, No. 5. pp. 365-370.
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abstract = "Problem Gaps exist between internationally derived clinical guidelines on care at the time of birth and realistic best practices in busy, low-resourced maternity units. Approach In 2014-2018, we carried out the PartoMa study at Zanzibar’s tertiary hospital, United Republic of Tanzania. Working with local birth attendants and external experts, we created easy-to-use and locally achievable clinical guidelines and associated in-house training to assist birth attendants in intrapartum care. Local setting Around 11 500 women gave birth annually in the hospital. Of the 35-40 birth attendants employed, each cared simultaneously for 3-6 women in labour. At baseline (1 October 2014 to 31 January 2015), there were 59 stillbirths per 1000 total births and 52 newborns with an Apgar score of 1-5 per 1000 live births. Externally derived clinical guidelines were available, but rarely used. Relevant changes Staff attendance at the repeated trainings was good, despite seminars being outside working hours and without additional remuneration. Many birth attendants appreciated the intervention and were motivated to improve care. Improvements were found in knowledge, partograph skills and quality of care. After 12 intervention months, stillbirths had decreased 34{\%} to 39 per 1000 total births, while newborns with an Apgar score of 1-5 halved to 28 per 1000 live births. Lessons learnt After 4 years, birth attendants still express high demand for the intervention. The development of international, regional and national clinical guidelines targeted at low-resource maternity units needs to be better attuned to input from end-users and the local conditions, and thereby easier to use effectively.",
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Adaptación local de las directrices clínicas durante el parto, República Unida de Tanzanía. / Maaløe, Nanna; Meguid, Tarek; Housseine, Natasha; Tersbøl, Britt Pinkowski; Nielsen, Karoline Kragelund; Bygbjerg, Ib Christian; Roosmalen, Josvan.

In: Bulletin of the World Health Organization, Vol. 97, No. 5, 01.05.2019, p. 365-370.

Research output: Contribution to JournalArticleAcademicpeer-review

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AU - Housseine, Natasha

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