Effectiveness of an Electronic Partogram: A Mixed-Method, Quasi-Experimental Study Among Skilled Birth Attendants in Kenya

Sanghvi, Harshad; Mohan, Diwakar; Litwin, Lindsay; Bazant, Eva; Gomez, Patricia; MacDowell, Tara; Onsase, Levis; Wabwile, Valentino; Waka, Charles; Qureshi, Zahida; Omanga, Eunice; Gichangi, Anthony; Muia, Ruth Wayua

doi:10.9745/ghsp-d-19-00195

Cited by 20 publications

(32 citation statements)

References 21 publications

(28 reference statements)

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“…In Ethiopia, health care providers recognized that the e-partograph could reduce maternal and neonatal mortality, but staff shortages, lack of skills/competence, and lack of motivation were mentioned as barriers for partograph utilization [ 55 ]. Studies from Kenya and Tanzania found that even where e-partograph is acceptable and has high perceived ease of use, its feasibility in settings with high delivery load, staff shortages, and lack of infrastructure is limited [ 56 , 57 ].…”

Section: Discussionmentioning

confidence: 99%

Acceptability and Barriers to Use of the ASMAN Provider-Facing Electronic Platform for Peripartum Care in Public Facilities in Madhya Pradesh and Rajasthan, India: A Qualitative Study Using the Technology Acceptance Model-3

Usmanova

Gresh

Cohen

et al. 2020

IJERPH

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The evolving field of mobile health (mHealth) is revolutionizing collection, management, and quality of clinical data in health systems. Particularly in low- and middle-income countries (LMICs), mHealth approaches for clinical decision support and record-keeping offer numerous potential advantages over paper records and in-person training and supervision. We conducted a content analysis of qualitative in-depth interviews using the Technology Acceptance Model 3 (TAM-3) to explore perspectives of providers and health managers in Madhya Pradesh and Rajasthan, India who were using the ASMAN (Alliance for Saving Mothers and Newborns) platform, a package of mHealth technologies to support management during the peripartum period. Respondents uniformly found ASMAN easy to use and felt it improved quality of care, reduced referral rates, ensured timely referral when needed, and aided reporting requirements. The TAM-3 model captured many determinants of reported respondent use behavior, including shifting workflow and job performance. However, some barriers to ASMAN digital platform use were structural and reported more often in facilities where ASMAN use was less consistent; these affect long-term impact, sustainability, and scalability of ASMAN and similar mHealth interventions. The transitioning of the program to the government, ensuring availability of dedicated funds, human resource support, and training and integration with government health information systems will ensure the sustainability of ASMAN.

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Section: Discussionmentioning

confidence: 99%

Acceptability and Barriers to Use of the ASMAN Provider-Facing Electronic Platform for Peripartum Care in Public Facilities in Madhya Pradesh and Rajasthan, India: A Qualitative Study Using the Technology Acceptance Model-3

Usmanova

Gresh

Cohen

et al. 2020

IJERPH

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“…The user rate of e-partogram showed three-fold increase (OR 3.31; 95 % CI, 2.04–5.38; p < 0.001) compared to the user rate with paper partogram. Similarly, a study from Kenya comparing 842 women monitored with e-partogram and 1042 women with paper partogram showed usage of e-partogram associated with a 56 % (95%CI, 27 %–73 %) lower likelihood of adverse fetal outcomes as compared to monitoring with paper partogram [ 34 ].…”

Section: Introductionmentioning

confidence: 99%

Need for more evidence in the prevention and management of perinatal asphyxia and neonatal encephalopathy in low and middle-income countries: A call for action

Krishnan

Kumar

Variane³

et al. 2021

Seminars in Fetal and Neonatal Medicine

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Although low- and middle-income countries (LMICs) shoulder 90 % of the neonatal encephalopathy (NE) burden, there is very little evidence base for prevention or management of this condition in these settings. A variety of antenatal factors including socio-economic deprivation, undernutrition and sub optimal antenatal and intrapartum care increase the risk of NE, although little is known about the underlying mechanisms. Implementing interventions based on the evidence from high-income countries to LMICs, may cause more harm than benefit as shown by the increased mortality and lack of neuroprotection with cooling therapy in the hypothermia for moderate or severe NE in low and middle-income countries (HELIX) trial. Pooled data from pilot trials suggest that erythropoietin monotherapy reduces death and disability in LMICs, but this needs further evaluation in clinical trials. Careful attention to supportive care, including avoiding hyperoxia, hypocarbia, hypoglycemia, and hyperthermia, are likely to improve outcomes until specific neuroprotective or neurorestorative therapies available.

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“…The electronic partograph releases audible reminders when clinical measurements are due, but the intervention developers and evaluators have not assessed contextual feasibility of WHO's recommendations for labour surveillance, which were adopted directly into the intervention. 29…”

Section: At the Global Levelmentioning

confidence: 99%

The injustice of unfit clinical practice guidelines in low-resource realities

Maaløe

Ørtved

Sørensen

et al. 2021

The Lancet Global Health

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To end the international crisis of preventable deaths in low-income and middle-income countries, evidence-informed and cost-efficient health care is urgently needed, and contextualised clinical practice guidelines are pivotal. However, as exposed by indirect consequences of poorly adapted COVID-19 guidelines, fundamental gaps continue to be reported between international recommendations and realistic best practice. To address this long-standing injustice of leaving health providers without useful guidance, we draw on examples from maternal health and the COVID-19 pandemic. We propose a framework for how global guideline developers can more effectively stratify recommendations for low-resource settings and account for predictable contextual barriers of implementation (eg, human resources) as well as gains and losses (eg, cost-efficiency). Such development of more realistic clinical practice guidelines at the global level will pave the way for simpler and achievable adaptation at local levels. We also urge the development and adaptation of high-quality clinical practice guidelines at national and subnational levels in low-income and middleincome countries through co-creation with end-users, and we encourage global sharing of these experiences.

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Effectiveness of an Electronic Partogram: A Mixed-Method, Quasi-Experimental Study Among Skilled Birth Attendants in Kenya

Abstract: Use of the electronic partogram, a digital labor-support application, is associated with improved fetal outcomes and greater use of interventions to maintain normal labor compared to the paper partograph.

Cited by 20 publications

References 21 publications

Acceptability and Barriers to Use of the ASMAN Provider-Facing Electronic Platform for Peripartum Care in Public Facilities in Madhya Pradesh and Rajasthan, India: A Qualitative Study Using the Technology Acceptance Model-3

Acceptability and Barriers to Use of the ASMAN Provider-Facing Electronic Platform for Peripartum Care in Public Facilities in Madhya Pradesh and Rajasthan, India: A Qualitative Study Using the Technology Acceptance Model-3

Need for more evidence in the prevention and management of perinatal asphyxia and neonatal encephalopathy in low and middle-income countries: A call for action

The injustice of unfit clinical practice guidelines in low-resource realities

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