A stillbirth is a baby born dead after 24 completed weeks of pregnancy. Stillbirth is more common than many people think. Worldwide, more than three million children die each year on the day they are born - either during birth or shortly afterwards. If their mothers had received acceptable care during childbirth, almost all of these children would be alive, fit and healthy. This is particularly a problem in low-income countries in Africa, where there is alarming pressure on the stretched healthcare systems. For example, in Zanzibar's main hospital, Mnazi Mmoja Hospital, each doctor or midwife assists an average of four to six women in labour simultaneously.
‘Due of advances in technology, prenatal care has improved, which has dramatically reduced the number of late and term stillbirth. However, the rate of early stillbirth has remained about the same over time.’
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However, researchers from the University of Copenhagen in cooperation with local health staff at Mnazi Mmoja Hospital have conducted an inexpensive project, which holds considerable promise. They have developed a brief and easy-to-understand childbirth guide tailored to the local reality, the PartoMa guidelines. After the guide was introduced, the number of stillbirths has fallen by 33 percent, and the number of newborns in obvious poor health has almost been halved. The findings have just been published in the British Journal of Obstetrics and Gynaecology. "The international guidelines available were often too complicated, time-consuming and resource-demanding for the health staff at Mnazi Mmoja Hospital - they gathered dust on the shelves in the hectic maternity ward, where the staff desperately need knowledge, yet barely knew that the guidelines existed. Therefore, we developed the simple PartoMa childbirth guide, where the dogma is that our recommendations should be possible to follow under the conditions which are found at this overstretched hospital where resources are in short supply," says the main author of the study, Nanna Maaløe, a PhD student at the Global Health Section at the Department of Public Health, University of Copenhagen.
Eight-pages of hands-on advice
The guide comprises an eight-page pocket booklet, and it was developed in cooperation with the local doctors and midwives at Mnazi Mmoja Hospital. In addition, it was approved by seven international experts in obstetric care in order to quality-assure the content. Much of the work has involved making international recommendations more specific, simple and practical. And it looks as though it is saving human lives.
The researchers measured the number of stillbirths over a four-month period prior to phasing in the guidelines. Next, the guidelines were implemented through reoccurring quarterly afternoon seminars where the staff practiced on it's use. Then, the number of stillbirths was measured for four months after introduction. Other factors may have had an impact on the fall in the number of stillbirths, but the researchers also demonstrated improvements in the quality of childbirth care in accordance with the guidelines in the pocket booklet and found a halving of numbers of newborns with immediate signs of poor health. This indicates also that the childbirth guidelines had a significant effect.
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Pocket booklet still in use
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"We're still using the guide after more than two and a half years. Our employees, particularly the younger doctors, tell us that it helps them provide better health care. Other health facilities in Zanzibar are also showing an interest in the guidelines," says Tarek Meguid, a consultant obstetrician at Mnazi Mmoja Hospital, who also advised on and co-authored the study.
The study was supported by the Lundbeck Foundation, the Laerdal Foundation and the Augustinus Foundation.
Source-Eurekalert