Local adaption of intrapartum clinical guidelines, United Republic of Tanzania

• Published in: Bulletin of the World Health Organization 2019-05, Vol.97 (5), p.365-370
• Main Authors: Maaløe, Nanna, Meguid, Tarek, Housseine, Natasha, Tersbøl, Britt Pinkowski, Nielsen, Karoline Kragelund, Bygbjerg, Ib Christian, van Roosmalen, Jos
• Format: Article
• Language: English
• Subjects: Apgar score; Assistants; Best practice; Birth; Births; Childbirth & labor; Clinical practice guidelines; Compensation; Delivery, Obstetric - education; Experts; Female; Guidelines; Health Knowledge, Attitudes, Practice; Health Personnel - psychology; Humans; Intervention; Lessons from the Field; Local conditions; Maternal child nursing; Maternity units; Midwifery; Midwifery - education; Midwifery - methods; Neonates; Newborn babies; Participation; Practice Guidelines as Topic; Pregnancy; Program Evaluation; Quality of care; Regional development; Seminars; Skills; Stillbirth; Stillbirth - epidemiology; Tanzania - epidemiology; Tertiary Care Centers; Training; Women; Womens health; Working hours
• ISSN: 0042-9686; 1564-0604
• DOI: 10.2471/BLT.18.220830

Gaps exist between internationally derived clinical guidelines on care at the time of birth and realistic best practices in busy, low-resourced maternity units. In 2014-2018, we carried out the PartoMa study at Zanzibar's tertiary hospital, United Republic of Tanzania. Working with local birth attendants and external experts, we created easy-to-use and locally achievable clinical guidelines and associated in-house training to assist birth attendants in intrapartum care. Around 11 500 women gave birth annually in the hospital. Of the 35-40 birth attendants employed, each cared simultaneously for 3-6 women in labour. At baseline (1 October 2014 to 31 January 2015), there were 59 stillbirths per 1000 total births and 52 newborns with an Apgar score of 1-5 per 1000 live births. Externally derived clinical guidelines were available, but rarely used. Staff attendance at the repeated trainings was good, despite seminars being outside working hours and without additional remuneration. Many birth attendants appreciated the intervention and were motivated to improve care. Improvements were found in knowledge, partograph skills and quality of care. After 12 intervention months, stillbirths had decreased 34% to 39 per 1000 total births, while newborns with an Apgar score of 1-5 halved to 28 per 1000 live births. After 4 years, birth attendants still express high demand for the intervention. The development of international, regional and national clinical guidelines targeted at low-resource maternity units needs to be better attuned to input from end-users and the local conditions, and thereby easier to use effectively.