Labour Care Guide implementation as a decision-making tool for monitoring labour among healthcare providers in Uganda: protocol for a mixed-methods study

Abstract

IntroductionThe new WHO Labour Care Guide (LCG), also regarded as the ‘next-generation partograph’, is a core component of 2018 WHO consolidated guidelines on intrapartum care for positive childbirth experience. The Ugandan Ministry of Health is in the process of adopting the new WHO LCG with no local context-specific data to inform this transition. We will explore potential barriers and facilitators to healthcare providers’ (HCPs) sustained engagement in labour monitoring in Mbarara city, Southwestern Uganda, and use the data to refine the new WHO LCG and develop a suitable implementation strategy to effectively integrate LCG into routine maternity care in Uganda. We shall then assess effectiveness, validity and other preliminary implementation outcomes of using the new LCG in detecting prolonged labour.Methods and analysisThe study will use a mixed-methods approach to identify key LCG user perspectives to refine and customise the WHO LCG among 120 HCPs and stakeholders involved in maternity care and labour monitoring within facilities in Southwestern Uganda. The refined prototype will be deployed and used to monitor labour in all 14 basic and comprehensive emergency obstetric and newborn care facilities in the study area. We will review labour outcomes of 520 patients monitored using the new LCG and compare these outcomes with a historical cohort of 520 patients monitored using the partograph. The main effectiveness outcome will be the proportion of women diagnosed with prolonged labour and/or obstructed labour.Ethics and disseminationEthical approval was obtained from the Mbarara University of Science and Technology Research Ethics Committee (MUST-2023-808) and Uganda National Council for Science and Technology (HS2864ES). We shall obtain written informed consent from each participant. The results of this study will be published in international peer-reviewed journals and presented to the Ugandan Ministry of Health as policy briefs and at selected national/international conferences.Trial registration numberNCT05979194.

Customization and acceptability of the WHO labor care guide to improve labor monitoring among health workers in Uganda. An iterative development, mixed method study

“…The enhancement of better quality, evidence based and respectful care during labour and childbirth requires concerted efforts towards better maternal and child health outcomes. This study sought to utilize mixed methods with iterative tool development approaches [ 23 ] to refine, customize and modify the new WHO Labour Care Guide to a locally contextualized acceptable tool that is useable within Ugandan and other similar settings. The simple customized modifications suggested on the new WHO LCG included; 1) adding key socio-demographic data compatible with existing programs to aid better planning and risk management, 2) re-ordering observations to facilitate an easy-to-use interface, flow, familiarization, engagement and clarity, 3) modification of key records and medication dosage to suit local context, for example, modifications to accommodate the oxytocin dose in International Units (IU) administered in a 500mL unit of crystalloids (normal saline or ringers’ lactate) locally available in Uganda, including the lower limit of the normal fetal heart rate from 110 to 120 beats per minute to provide a safety margin for referral since 55% of deliveries occur at BeMONC sites (HCIIs and IIIs) that are unable to conduct caesarean section when required [ 40 ], and 4) inclusion of a section on the LCG reverse side to capture clinical notes, labour outcome data and other key cues to action such as triple elimination codes, Hemoglobin level and others to facilitate auditing, accountability, reference, responsibility, interaction, team work, utilization and immediate care.…”

“…Using mixed methods and iterative development design described by Mugyenyi GR et al 2024 [23], we aimed at customizing, refining and pilot testing a user-centered LCG tool that would be comprehensive and easy-to-use, so as to optimize outcomes and long-term use by HCPs while monitoring labour in Uganda (Fig 2). Using an interview guide, we carried out 30 PLOS GLOBAL PUBLIC HEALTH stakeholder interviews (see stakeholder interview section below for details) to identify facilitators of continuous labour monitoring in Uganda, current user needs, and perceived LCG tool opportunities, complications or challenges (formative phase).…”