Our Approach

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.

Implementation

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.

Data strengthening

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.

Quality improvement

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.

Group care

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.

Discovery

PTBi East Africa invests in discovery research that informs the development of interventions to predict, prevent, and manage preterm birth in our settings. We are committed to innovative research that is locally relevant and led by East African investigators. Our areas of interest include estimating gestational age and risk factors for preterm birth, as well as improving care of preterm infants.