Clinical Trials Logo

Clinical Trial Details — Status: Completed

Administrative data

NCT number NCT02318420
Other study ID # R164-2013-16038
Secondary ID
Status Completed
Phase N/A
First received
Last updated
Start date October 1, 2014
Est. completion date July 1, 2018

Study information

Verified date September 2019
Source University of Copenhagen
Contact n/a
Is FDA regulated No
Health authority
Study type Interventional

Clinical Trial Summary

OVERALL OBJECTIVE In an East African referral hospital, to develop and analyze the effect of locally agreed and achievable guidelines and a continual in-house training program for strengthening partogram-based monitoring-to-action during labour.

INTERVENTION Paper partograms (WHO), locally developed labour management guidelines (the PartoMa guidelines) and continual in-house education.

OVERALL DESIGN A quasi-experimental pre-post-study (The PartoMa study).

SETTING Department of Obstetrics and Gynaecology, Mnazi Mmoja Hospital, Zanzibar.

POPULATION Labouring women delivering at the study site from October 2014 to January 2016 and their offspring, as well as health providers. Women and their offspring will be enrolled at/after unset of labour and followed until discharge.

ENDPOINTS The primary composite endpoint is stillbirths and birth asphyxia. For further description and secondary outcomes, please see below.

STUDY TIME Data collection from October 2014 to January 2016, supplemented by a post-exit collection of case file data from October 2016 - January 2017.


Description:

SPECIFIC OBJECTIVES

I (a) To analyze in depth current quality of intrapartum care by a mixed methods approach, including exploration of underlying challenges in care delivery and an association between suboptimal labour care and perinatal mortality. (b) To conduct a criterion-based audit of stillbirths investigating direct and indirect causes and related maternal risks.

II. To develop locally achievable and agreed partogram-associated labour monitoring-to-action guidelines (the PartoMa guidelines) for strengthening the partogram use as a decision support tool, and study its acceptability by skilled birth attendants.

III. To implement the PartoMa guidelines and low cost, low dose, high frequency, in-house training for strengthening the use of the partogram as a decision support tool, and study the effect on knowledge, skills, quality of intrapartum care, record keeping, and perinatal outcome.

IV. To conduct a post-exit 2 years evaluation of use and effect of the PartoMa guidelines and recurring training.

V. To develop an electronic smartphone application (the PartoMa app), which includes the PartoMa guidelines.

VI. To estimate the cost-effectiveness of the interventions studied (specific objectives III-V).

SETTING

The East African Mnazi Mmoja Hospital (MMH) in Zanzibar is a governmental referral facility serving the population of Zanzibar. As East Africa in general, the Zanzibarian archipelago struggles with poverty and a resource constraint health system, and half of the population live below the basic needs poverty line.

At the facility's Department of Obstetrics and Gynecology, the yearly number of deliveries is approximately 12,000. Approximately 50 maternal deaths occur annually (420 deaths per 100 000 live births). While the facility-based neonatal death rate is unknown, our baseline study revealed a stillbirth rate of 59 per 1000 total births, of which approximately half were alive at the time of admission.

Prior to this study, maternal and perinatal death audits were not conducted routinely and little is known about direct and indirect causes for the perinatal deaths.

METHODS

This study presents a quality improvement process of intrapartum monitoring, action and triage. The overall study design is here presented in relation to the four specific objectives:

I. The intervention-based study is based on an in-depth baseline quality of care assessment, which includes criterion-based audit of intrapartum management in cases of stillbirths compared to cases with Apgar scores of 7-10, and qualitative exploration of contributing causes to substandard labour management (including participant observations and in depth interviews).

II. Together with local doctors and nurse-midwives, international evidence-based guidelines are adapted to be locally achievable (the PartoMa guidelines). Additionally, they are internationally peer-reviewed with the aim of representing best possible care with the limited resources available at the facility.

III. A concept for reoccurring in-house training in monitoring-to-action during labour is developed, based on the PartoMa guidelines and implemented together with the guidelines. This PartoMa intervention (guidelines and reoccurring in-house training) is evaluated by comparing clinical practice and birth outcome (please see the specific outcome measures below) in the baseline period (October 2014 - January 2015) with the 9th-12th month of the intervention (October 2015 - January 2016).

IV. After the first intervention year (February 2016), a local steering group takes over the continual implementation of the PartoMa guidelines. If the intervention is still running, clinical practice and birth outcome will be analysed during the 21st - 24th month of the intervention (October 2016 - January 2017) and compared with previous assessments.

V. If the PartoMa guidelines show to be accepted among birth attendants and effective in improving quality of care, an electronic smartphone application (the PartoMa app) will be developed, which includes the PartoMa guidelines.

VI. A cost-effectiveness analysis of the intervention steps is carried out.


Recruitment information / eligibility

Status Completed
Enrollment 3087
Est. completion date July 1, 2018
Est. primary completion date March 1, 2016
Accepts healthy volunteers No
Gender All
Age group N/A and older
Eligibility Inclusion Criteria:

- All women in labour delivering at the study site and their outcome, October 2014 - January 2015 and October 2015 - January 2016

- All health care providers at the department during the baseline and intervention period, October 2014 - January 2016

For the different substudies, sub-groups are selected (please see the secondary outcomes for a description).

Study Design


Related Conditions & MeSH terms


Intervention

Other:
The PartoMa intervention
WHO partogram, locally developed and achievable labour management guidelines (PartoMa guidelines), continual in-house training

Locations

Country Name City State
Tanzania Dept. Obstetrics and Gynaecology, Mnazi Mmoja Hospital Zanzibar City Zanzibar

Sponsors (7)

Lead Sponsor Collaborator
Ib Christian Bygbjerg Free University Medical Center, Laerdal Foundation, Lundbeck Foundation, Mnazi Mmoja Hospital, Rigshospitalet, Denmark, University of Copenhagen

Country where clinical trial is conducted

Tanzania, 

Outcome

Type Measure Description Time frame Safety issue
Primary Composite outcome of stillbirths and birth asphyxia Stillbirths (=late foetal deaths >=1000g), subdivided into pre- and intra-hospital stillbirths (with/without positive foetal heart rate on admission). Birth asphyxia was defined as newborns with a 5-minutes Apgar score < 6. A comparison of the baseline (Oct. 14 - Jan. '15) with 9th-12th month of the intervention (Oct. '15 - Jan. '16).
Secondary Maternal death Deaths of women at the study site while pregnant or within 42 days postpartum, from any cause related to or aggravated by pregnancy or its management. A comparison of the baseline (Oct. 14 - Jan. '15) with 9th-12th month of the intervention (Oct. '15 - Jan. '16).
Secondary Cesarean sections and vacuum extractions A comparison of the baseline (Oct. 14 - Jan. '15) with 9th-12th month of the intervention (Oct. '15 - Jan. '16).
Secondary Process indicators of quality of intrapartum labour care This includes partogram use, timely surveillance (of foetal heart rate, labour progress, and maternal vital signs), and oxytocin use for labour augmentation. Management is compared to pre-selected audit criteria. A comparison of the baseline (Oct. 14 - Jan. '15) with 9th-12th month of the intervention (Oct. '15 - Jan. '16).
Secondary Health providers' perception of their work situation in the labour and delivery rooms Participant observations and in-depth interviews. This is assessed at multiple time points throughout the study period and more in-depth after 2 years of the intervention.
Secondary The women's experience of care received during delivery. By focus group discussions. This is assessed through community visits in January - March 2016.
Secondary HALE Cost of healthy life years gained /1,000 population /year This will be evaluated economically after finalizing the study period.
See also
  Status Clinical Trial Phase
Recruiting NCT03605511 - TTP and aHUS in Complicated Pregnancies
Completed NCT02379728 - Ghana PrenaBelt Trial: A Positional Therapy Device to Reduce Still-Birth N/A
Not yet recruiting NCT01664546 - Study of the Best Blastocyst Post Transfer by aCGH N/A
Completed NCT02218931 - ESTEEM - Effect of Simple, Targeted Diet in Pregnant Women With Metabolic Risk Factors on Pregnancy Outcomes N/A
Recruiting NCT03662178 - Investigating the Structured Use of Ultrasound Scanning for Fetal Growth
Completed NCT03290924 - Accelerating Newborn Survival in Ghana Through a Low-dose, High-frequency Health Worker Training Approach N/A
Recruiting NCT05901688 - Umbilical Cord Abnormalities in the Prediction of Adverse Pregnancy Outcomes
Completed NCT02339077 - Group B Streptococcus (GBS) Associated Stillbirths in a High Burden Setting
Completed NCT03112018 - Strengthening Facility-based Intrapartum/Immediate Newborn Care to Reduce Mortality of Preterm Infants in Migori County, Kenya and Busoga Region, Uganda N/A
Completed NCT02862925 - Introducing Fetal Scalp Stimulation as an Adjunct to Intermittent Auscultation in Low-Resource Settings. N/A
Recruiting NCT05757167 - Improving Neonatal Health Through Rapid Malaria Testing in Early Pregnancy With High-Sensitivity Diagnostics Phase 4
Completed NCT02148952 - BetterBirth: A Trial of the WHO Safe Childbirth Checklist Program N/A
Active, not recruiting NCT01995968 - Antenatal Detection of Fetal Growth Restriction and Stillbirths Rate. N/A
Completed NCT00270530 - Intermittent Preventive Treatment of Malaria in HIV-Seropositive Pregnant Women in Zambia Phase 4
Completed NCT04600076 - MOMSonLINE2 ; A Pilot Study Testing Recruitment and Retention of Women of Color to an Online Support Group for Bereaved Mothers N/A
Completed NCT03363308 - Effects of a Health Workforce Capacity Building and Quality Improvement Intervention in Kinshasa N/A
Completed NCT03722615 - Epidemiology of Congenital Cytomegalovirus in a High HIV Prevalence Setting, South Africa
Completed NCT02907242 - Revealed Versus Concealed Cerebroplacental Ratio N/A
Recruiting NCT02336243 - A Randomized Trial of Docosahexaenoic Acid Supplementation During Pregnancy to Prevent Deep Placentation Disorders Phase 3
Completed NCT00133744 - Impact of Prenatal Vitamin/Mineral Supplements on Perinatal Mortality Phase 3