PTBi-East Africa aims to improve facility-based care during labor, delivery, and the immediate postpartum period. Our efforts center on implementation science: where during this critical period can improvement have the most impact, and what strategies or interventions work best? We also invest in discovery to improve our understanding and better inform development of new interventions to prevent preterm birth.
One solution alone isn’t going to remedy preterm birth. So we are testing a package of existing solutions that can improve the quality of care and reduce neonatal mortality. These solutions focus on labor, delivery, and the immediate postpartum period and are tailored to each location’s needs in order to determine which set of interventions work best to reduce preterm birth. These interventions include data strengthening, introduction of a modified safe childbirth checklist, birth simulation training, and quality improvement.
Good data is an important tool in improving the quality of care because it can demonstrate the need for change and pinpoint gaps and weaknesses in both health care facilities and in care of women and preterm. To capture the true burden of preterm birth in our East Africa locations and to determine where health care facilities need improvement, we are strengthening data systems by training health care workers on both the importance of good data and on how to effectively collect it. We are also introducing new data tools for collecting and analyzing data. By training health care workers, data quality improves and capacity is built to insure good data collection is sustained once the project ends. In addition, this data strengthening project provides important baseline information, which enables us to measure whether our interventions are working.
Modified WHO Safe Childbirth Checklist
We have modified the WHO Safe Childbirth Checklist to focus on five specific time points in labor, delivery and the postpartum period. We are piloting it in health care facilities in Uganda and Kenya to see if it helps improve care and reduce preterm birth.
Birth simulation training
We partner with PRONTO International, an NGO that develops simulation and team training for obstetric and neonatal emergency response in resource-limited settings. Their approach allows healthcare providers to practice skills in high-stress situations to ensure appropriate responses during an actual emergency. With our in-country partners and PRONTO consultants, we work to develop locally relevant, simulation-based curricula for training providers and trainers. Our goal is to improve the performance of the labor and delivery teams.
Improving team performance must be accompanied with improved conditions in healthcare facilities. Another component to our interventions package is continuous Quality Improvement (QI) cycles. Through the team simulation training, opportunities to improve the system will be identified and improved.
In Rwanda, we are designing and implementing a group care model focused on prenatal and postnatal care. With group care, pregnant women meet at the health facility where they receive clinical care and also meet together. We are looking at everything from how many meetings to hold and how long each meeting should be to testing discussion guides for the meetings—all to see if this type of group care leads to reductions in preterm births.
Gestational age dating
Knowing accurate gestational age at birth is critical for proper management of newborns and tracking of developmental progress. Research is underway to develop a metabolic algorithm that can be used to determine the gestational age of newborns using a single drop of blood taken from a newborn's heel.
There are many reasons for preterm birth; for example, infections, pre-eclampsia, or having twins or triplets. Having a more granular understanding of the causes of preterm birth will enable us to better respond and recommend the best interventions based on the cause.
Chorioamnionitis, Group B Streptococcus and preterm birth
Our partners in Uganda are studying whether Group B Streptococcus (GBS) and chorioamnionitis are associated with preterm birth among women in Uganda. The results will help determine whether prenatal testing for GBS and treating with penicillin, which is not currently the standard of care in Uganda, would be effective.
Community and facility barriers to kangaroo care in Uganda
Babies cared for under Kangaroo mother care (KMC) show improved weight gain and growth, mother-infant bonding, and other good outcomes. Yet adoption and use of KMC is low. Our partners seek to explore barriers to uptake and adherence of KMC in different health system contexts (urban/rural and public/private facility settings) and across communities in Eastern Uganda in order to design better interventions to improve uptake.
NoviGuide is a tablet-based training and decision-support tool that translates WHO and country neonatal care guidelines into case-specific clinical instructions. It focuses on respiratory support; glucose, fluid, and feeding; and infection risk and management. Our partners aim to refine the design and implementation process of NoviGuide in a rural hospital setting in eastern Uganda and to determine its feasibility and acceptability.