The PartoMa Project: Assisting birth attendants to save lives in Tanzania

Photo: Dan Meyrowitsch

Since 2014, the PartoMa project has developed and implemented simple and locally achievable clinical guidelines and associated training. We aim to assist birth attendants in busy low-resource maternity units in delivering best possible safe and respectful care at birth.

Our finalized 4-years study in Zanzibar’s tertiary hospital from 2014-2018 revealed how simple,locally-tailored guidelines and training could assist birth attendants in delivering more timely and safe care to women giving birth. The results were encouraging, and concurrently survival during birth improved significantly.

In 2019, the PartoMa team began a new 5-year research project in Tanzania. The project aims to investigate whether the PartoMa pilot intervention from Zanzibar can be modified and scaled to other low-resource maternity units.

Watch this 7-minutes video of the PartoMa intervention in action!

 

 

 

 

Globally, 300,000 women and 5 million children die each year in relation to childbirth. Most would have survived with proper care during birth.

Clinical guidelines have been developed to improve maternity care in low-resource settings, however these guidelines are often incompatible with the contextual realities. Maternity units in low-resource settings often deal with limited capacity, high turnover of staff, and an overwhelming ratio of labouring women per birth attendant. These clinical realities make it practically impossible to adhere to international clinical guidelines. For example, spending ten minutes half-hourly with each labouring woman counting foetal heart rate and contractions is mathematically impossible when simultaneously caring for three or more women.

The disparity between low resource realities and international clinical guidelines highlights the importance of research on effective development, implementation, and upscaling of achievable clinical guidelines for low-resource settings.

The PartoMa project’s focus on generating evidence-based and respectful childbirth care is a key priority to reach the Sustainable Development Goals – particularly on birth-related survival and gender equality, but also more broadly in regards to health system strengthening, societal development and the reduction of poverty.

Photo: Rune Maaløe Andersen

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

The PartoMa study in Zanzibar from 2014-2018 forms the pilot study for ongoing PartoMa research. The study was a collaboration between University of Copenhagen and Zanzibar’s tertiary Mnazi Mmoja Hospital, led by Nanna Maaløe as primary investigator.

During the study years, the research team and birth attendants at Mnazi Mmoja Hospital worked together to develop and implement a pocket booklet with simple and locally achievable clinical guidance for safe and respectful care at birth. The initial version was completed in 2015 and has since been further adjusted to match the needs expressed by staff and the resource-constrained reality. Quarterly, the birth attendants were offered training in the use of the booklet in 3-hour case-based seminars. On average 60-70% of the staff from the maternity unit participated together with staff from other Zanzibari maternity units.

One year after implementation, the study found multiple improvements in quality of care, and a concurrent 33 % decrease of stillbirths and a 46% decrease in newborns with immediate poor state of health compared to baseline.

In June 2018, Zanzibars Ministry of Health officially took over the up-scale and continuous support of the PartoMa intervention in Zanzibar. The seminars are now being held every three months in both of Zanzibar’s main islands, with financial support from UNFPA.

The current version of PartoMa clinical guidelines and training materials are available in the dropdown menu labeled “PartoMa guidelines and training material”.

For more information, please see a summary of Nanna Maaløe’s PhD thesis and our lessons from the field paper in the WHO Bulletin.

Primary investigator: Nanna Maaløe

Research advisors: Ib Christian Bygbjerg, Jos van Roosmalen, Tarek Meguid, Britt Pinkowski Tersbøl and Birgitte Bruun Nielsen.

Research assistants: Natasha Housseine, Rashid Saleh Khamis, Ali Gharib Mohamed, Mbweni Makame Ali, Said Mzee Said, Camilla Byskou Andersen and Camilla Thomsen.

 

 

 

 

 

Sørensen JB, Housseine N, Maaløe N, Bygbjerg IC , Tersbøl BP and Konradsen F. Scaling up Locally Adapted Clinical Practice Guidelines for Improving Childbirth Care in Tanzania: A Protocol for Programme Theory and Qualitative Methods of the PartoMa Scale-up Study, Global Health Action vol. 15, 2022, issue 1

Maaløe N, Housseine N, Sørensen JB, Obel J, DMello BS and Kujabi ML. Scaling up context-tailored clinical guidelines and training to improve childbirth care in urban, low-resource maternity units in Tanzania: A protocol for a stepped-wedged cluster randomized trial with embedded qualitative and economic analyses (The PartoMa Scale-Up Study), Global Health Action vol. 15, 2022, issue 1

Maaløe N, van Roosmalen J, Dmello BS, Kwast B, van den Akker T, Housseine N, Kujabi ML, Meguid T, Kidanto H. WHO next-generation partograph: revolutionary steps towards individualised labour care?,  BJOG 2021

Maaløe N, Marie A, Ørtved R, Sørensen JB, Dmello BS, van ven Akker T, Kujabi ML, Kidanto HL, Meguid T, Bygbjerg IC, van Roosmalen J, Meyrowitsch DW, Housseine N.  The injustice of unfit clinical practice guidelines in low-resource realities. Lancet Global Health 2021

Sequeira Dmello B, Sellah Z, Magembe G, Housseine N, Maaløe N, Van Den Akker T, Meyrowitsch DW, Mushi T, Masweko M, Jidayi D, van Roosmalen J, Kidanto HL.Learning from changes concurrent with implementing a complex and dynamic intervention to improve urban maternal and perinatal health in Dar es Salaam, Tanzania, 2011-2019. BMJ Global Health 2020

Housseine N, Punt MC, Mohamed AG, Said SM, Maaløe N, Zuithoff NP, Meguid T, Franx A, Grobbee DE, Browne JL, Rijken MJ. Quality of intrapartum care: direct observations in a low-resource tertiary hospital. Reprod Health 2020.

Dmello BS, Housseine N, van den Akker T, van Roosmalen J, Maaløe N. Impact of COVID-19 on maternal and child health. Lancet Global Health 2020.

Housseine N, Punt MC, Browne JL, Van J, Maaløe N, Meguid T, Theron GB, Franx A, Grobbee DE, Visser GHA, Rijken MJ. Delphi consensus statement on intrapartum fetal monitoring in resource settings. Int J Gynaecol Obstet. 2019. 146(1):8-16.

Maaløe N, Meguid T, Housseine N, Tersbøl BP, Nielsen KK, Bygbjerg IC, van Roosmalen J. Local adaption of intrapartum clinical guidelines, United Republic of Tanzania. Bull World Health Organ 2019; 97:365–370.

Housseine N, Punt MC, Browne JL, Meguid T, Klipstein-Grobusch K, Kwast BE, Franx A, Grobbee DE, Rijken MJ. Strategies for intrapartum foetal surveillance in low- and middle-income countries: A systematic review. PLoS One 2018; 13: e0206295.

Maaløe N, Andersen CB, Housseine N, Meguid T, Bygbjerg IC, van Roosmalen JJM. Effect of locally-tailored clinical guidelines on intrapartum management of severe hypertensive disorders at Zanzibar’s tertiary hospital (The PartoMa study). Int J Gynecol Obstet 2018. DOI:10.1002/ijgo.12692.

Maaløe N, Housseine N, Meguid T, Nielsen BB, Jensen AKG, Khamis RS, et al. Effect of locally-tailored labour management guidelines on intrahospital stillbirths and birth asphyxia at the referral hospital of Zanzibar: A quasi-experimental pre-post-study (The PartoMa study). BJOG. 2017;125(2):235–45.

Maaløe N, Housseine N, van Roosmalen J, Bygbjerg IC, Tersbøl BP, Khamis RS, et al. Labour management guidelines for a Tanzanian referral hospital: The participatory development process and birth attendants’ perceptions. BMC Pregnancy Childbirth. 2017;17(175).

Maaløe N, Housseine N, Bygbjerg IC, Meguid T, Khamis RS, Mohamed AG, et al. Stillbirths and quality of care during labour at the low resource referral hospital of Zanzibar: a case-control study. BMC Pregnancy Childbirth. 2016;16 (351).

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

All identifiable people appearing on this website in photos or text have given their oral consent.