Labour management guidelines for a Tanzanian referral hospital: The participatory development process and birth attendants’ perceptions

BMC Pregnancy and Childbirth

Research Article

Jos van Roosmalen¹  Rashid Saleh Khamis²  Natasha Housseine³  Tarek Meguid⁴  Birgitte Bruun Nielsen⁵  Ib Christian Bygbjerg⁶  Britt Pinkowski Tersbøl⁶  Nanna Maaløe⁶ 

[1] Athena Institute, VU University of Amsterdam, De Boelelaan 1105, 1081 HV, Amsterdam, the Netherlands;Department of Obstetrics and Gynaecology, Mnazi Mmoja Hospital, Zanzibar, Tanzania;Department of Obstetrics and Gynaecology, Mnazi Mmoja Hospital, Zanzibar, Tanzania;Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Universiteitsweg 100, 3584 CG, Utrecht, the Netherlands;Department of Obstetrics and Gynaecology, Mnazi Mmoja Hospital, Zanzibar, Tanzania;School of Health & Medical Sciences, State University of Zanzibar, P.O.Box:146, Zanzibar, Tanzania;Department of Obstetrics, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100, København Ø, Denmark;Global Health Section, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, Building 9, 1353, Copenhagen K, Denmark;

关键词: Guidelines;    Labour;    Partograph;    Quality of care;    Tanzania;    PartoMa;   

DOI  :  10.1186/s12884-017-1360-2

 received in 2017-01-24, accepted in 2017-05-26,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundWhile international guidelines for intrapartum care appear to have increased rapidly since 2000, literature suggests that it has only in few instances been matched with reviews of local modifications, use, and impact at the targeted low resource facilities. At a Tanzanian referral hospital, this paper describes the development process of locally achievable, partograph-associated, and peer-reviewed labour management guidelines, and it presents an assessment of professional birth attendants’ perceptions.MethodsPart 1: Modification of evidence-based international guidelines through repeated evaluation cycles by local staff and seven external specialists in midwifery/obstetrics. Part 2: Questionnaire evaluation 12 months post-implementation of perceptions and use among professional birth attendants.ResultsPart 1: After the development process, including three rounds of evaluation by staff and two external peer-review cycles, there were no major concerns with the guidelines internally nor externally. Thereby, international recommendations were condensed to the eight-paged ‘PartoMa guidelines ©’. This pocket booklet includes routine assessments, supportive care, and management of common abnormalities in foetal heart rate, labour progress, and maternal condition. It uses colour codes indicating urgency. Compared to international guidelines, reductions were made in frequency of assessments, information load, and ambiguity. Part 2: Response rate of 84% (n = 84). The majority of staff (93%) agreed that the guidelines helped to improve care. They found the guidelines achievable (89%), and the graphics worked well (90%). Doctors more often than nurse-midwives (89% versus 74%) responded to use the guidelines daily.ConclusionsThe PartoMa guidelines ensure readily available, locally achievable, and acceptable support for intrapartum surveillance, triage, and management. This is a crucial example of adapting evidence-based international recommendations to local reality.Trial registrationThis paper describes the intervention of the PartoMa trial, which is registered on ClinicalTrials.org (NCT02318420, 4th November 2014).

【 授权许可】

CC BY   
© The Author(s). 2017