TY - JOUR

T1 - Labour management guidelines for a Tanzanian referral hospital

T2 - The participatory development process and birth attendants' perceptions

AU - Maaløe, Nanna

AU - Housseine, Natasha

AU - van Roosmalen, Jos

AU - Bygbjerg, Ib Christian

AU - Tersbøl, Britt Pinkowski

AU - Khamis, Rashid Saleh

AU - Nielsen, Birgitte Bruun

AU - Meguid, Tarek

N1 - Her er referencen: BMC Pregnancy Childbirth. 2017 Jun 7;17(1):175. doi: 10.1186/s12884-017-1360-2. Labour management guidelines for a Tanzanian referral hospital: The participatory development process and birth attendants' perceptions. Maaløe N1, Housseine N2,3, van Roosmalen J4, Bygbjerg IC5, Tersbøl BP5, Khamis RS2, Nielsen BB6, Meguid T2,7.

PY - 2017/6/7

Y1 - 2017/6/7

N2 - Background: While 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.Methods: Part 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.Results: Part 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.Conclusions:The 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 registration: This paper describes the intervention of the PartoMa trial, which is registered on ClinicalTrials.org (NCT02318420, 4th November 2014).

AB - Background: While 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.Methods: Part 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.Results: Part 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.Conclusions:The 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 registration: This paper describes the intervention of the PartoMa trial, which is registered on ClinicalTrials.org (NCT02318420, 4th November 2014).

U2 - 10.1186/s12884-017-1360-2

DO - 10.1186/s12884-017-1360-2

M3 - Journal article

C2 - 28592237

VL - 17

SP - 1

EP - 11

JO - B M C Pregnancy and Childbirth

JF - B M C Pregnancy and Childbirth

SN - 1471-2393

M1 - 175

ER -