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Researchers recommend digital labor care guide for maternity care providers

Kampala, Uganda | THE INDEPENDENT | Researchers have urged the government to fast-track the use of the electronic partograph, a digital tool that helps in monitoring the progress of labor in expectant mothers. This will help to improve health outcomes in maternity care.

The Makerere University-based scientists who were releasing results of the study in which they compared outcomes of using the traditional and widely used partograph and a digital device fitted with an alarm system say they found midwives miss a lot of key steps using traditional means which can grossly affect delivery outcomes. In the traditional system, a health worker is supposed to periodically plot vital trends on a piece of paper as they monitor a woman about to deliver.

Dr Justine Bukenya, a principal investigator of the study told URN in an interview that for mothers, they monitored five variables including contractions, fetal heart rate, blood pressure and temperature in addition to doing a urine sample examination.

While they were using a computerized e-partograph, all the four were captured, and when it comes to the paper partograph, three mothers were not monitored for the heart rate of unborn, seven missed blood pressure measurements and six mothers missed temperature recordings. 50 percent of all the women in the study didn’t do urine examinations according to Bukenya.

The study which was done in the West Nile district of Adjumani involved 382 mothers monitored between the month of March and September last year. 201 of the mothers were monitored using a paper partograph and 181 with an e-partograph where health workers were given computer tabs and trained on how to monitor electronically.

Apart from the mothers, the researchers also assessed outcomes for the babies. They tested them for heart rate, respiratory effort, muscle tone, colour and reflex irritability. Bukenya who is also a lecturer in the School of Public Health says 11 of the babies had an apgar score of below 7 requiring to be immediately rushed to the Neonatal intensive care unit(NICU), those that used the e-device, only two needed NICU services.

An Apgar score is a scoring system doctors and nurses use to assess babies one minute and five minutes after they’re born.

According to researchers, regular and timely monitoring of maternal and the unborn parameters during labour is critical to assessing maternal and unborn well-being, supporting normal labour, identifying complications and spurring clinical decision-making to address them in a timely manner.

In Uganda, 27 babies in every 1000 die in the first 28 days of life according to the Uganda Demographic Health Survey, 2016. Statistics also show that 375 women in every 100,000 die from health problems related to pregnancy. For the last four decades, the WHO has recommended that during labour, skilled birth attendants use the partograph as a tool to improve documentation of intrapartum maternal and the unborn measurements, identify abnormalities, and inform appropriate labour management.

Dr Richard Mangwi Ayiasi, a research fellow in the Department of Community Health and Behavioural Sciences at the School of Public Health told URN that health workers revealed to them experiencing stock-outs of partograph papers.

Mangwi who was also a co-investigator on the study said they also found a number of health workers computer illiterate but with the coaching they quickly grasped how the technology works.

Joshua Businge Muleesi, a computer scientist who helped in designing the e-tool says it was made in a way that it enables sharing of patient data among health workers which makes referral easy especially in remote communities. He says they have tested this system in Ayilo, Pagirinya, Dzaipi health centres which all refer their patients to the main Adjumani Hospital.

But the researcher said to adopt the lifesaving e-system, the government needs to address the sustainability issues, internet data and airtime, the security of the gadgets, maintenance of the tablets as well as ensuring the availability of resident IT staff to rectify issues as they arise.



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