Newborn Morbidity Clinical Trial
Official title:
ePartogram Effectiveness Study: A Mixed Methods Quasi-experimental Study in Kisumu and Meru, Kenya.
Quasi-experimental study to evaluate whether clinical care offered to clients was more appropriate and in line with WHO recommendations for care in normally progressing labor and in labor with complications, among providers using the novel intervention, ePartogram (an electronic version of the WHO paper partograph) vs. providers who offered care using the standard paper partograph, and whether fetal/newborn outcomes were improved among cases where partograph was used.
The ePartogram is an electronic version of the WHO Partograph and is developed by Jhpiego.
Seventy-eight clinical rules, programmed into the ePartogram, are based on global guidelines
in the WHO manual "Managing complications in pregnancy and childbirth: a guide for midwives
and doctors" and the expert opinion of Jhpiego physicians and nurse-midwives. The rules
underwent a validation process by 65 expert skilled birth attendants (SBAs) (working in
maternity wards of health facilities) from a variety of geographic and clinical settings
affiliated with Jhpiego. In the ePartogram application ("app") that is put on an Android
tablet computer, the clinical rules trigger "reminders" to SBAs to take a routine clinical
measurement, such as fetal heart rate (every 30 minutes) or maternal temperature (every 2
hours). The rules also trigger "low-level" alarms indicating a measurement that falls in the
abnormal range that could be cause for concern (i.e. meconium-stained liquor), and
"high-level" alarms that could indicate need for immediate action (i.e. maternal systolic
blood pressure ≥160 mm Hg).
Litwin et al. reported on the feasibility and acceptability of use of an electronic partogram
in Zanzibar and concluded that health workers felt the ePartogram improved timeliness of care
and supported decision making. Health workers quickly became competent and confident in using
the tablet device and ePartogram application. This study in Kenya has an objective to
evaluate whether providers' use of the ePartogram improves labor outcomes and labor
management in health facilities. The study design is a quasi-experimental design evaluation
comparing data collected at 6 intervention sites and 6 comparison sites with similar facility
characteristics and in two regions of Kenya.
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