PartoMa Study - for saving lives at birth – University of Copenhagen

PartoMa Study - for saving lives at birth

 

Watch the 7-minutes film "PartoMa seminars – Closing the gap between clinical guidelines and reality" by anthropologist and filmmaker Lara Meguid.

The PartoMa study is a collaboration between University of Copenhagen, Denmark, and Mnazi Mmoja Hospital, Zanzibar. Since October 2014, we have worked together on developing and implementing simple and locally achievable guidelines on childbirth care to assist the birth attendants in delivering best possible safe and respectful care to the many women giving birth.

The PartoMa study is an example of how deaths and disabilities can be reduced if health workers have access to basic healthcare information tailored to their reality.

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

We invite for PartoMa PhD Defense and Mini-Symposium:

Invitation to PartoMa PhD defence and mini-symposium

See the full invitation here and summary of the PhD thesis here.

Partoma Pocket Guide and Training

The 2018 updated guidelines and training materials are here available as PDF:

The PartoMa Pocket Guide 2.0
The PartoMa Case Stories for Problem-Based Learning
The PartoMa Background Document – Development, Implementation and Evaluation

Later this year, a more smartphone friendly version of the pocket book will be available online, in both English and Swahili.

Research team

Principal investigator:    

Local supervisor:

Academic supervisors:

Research assistants:

  • Natasha Housseine, MD, intern doctor at Mnazi Mmoja Hospital, Zanzibar

  • Camilla Byskou Andersen, Midwife, Global Health master student at Lund University, Sweden

  • Rashid Saleh Khamis, medical student at Zanzibar Medical School, Zanzibar

  • Ali Gharib Mohamed, medical student at Zanzibar Medical School, Zanzibar

  • Mbweni Makame Ali, medical student at Zanzibar Medical School, Zanzibar

  • Said Mzee Said, medical student at Zanzibar Medical School, Zanzibar

Study aim and objectives

Overall aim of the PhD (PartoMa study)

In the high-volume East African referral hospital of Zanzibar, to co-create locally achievable and partograph-related intrapartum practice guidelines and in-house training, and analyze the pathway to possible effects of this complex intervention on quality of care and, ultimately, survival at birth.

Specific objectives

  1. To analyze baseline quality of intrapartum care by a case-control study of stillbirths.
  2. To co-create locally achievable and agreed partograph-associated labour monitoring-to-action guidelines (the PartoMa Pocket Guide) for strengthening intrapartum decision support, and study its acceptability by skilled birth attendants.
  3. To implement the PartoMa Pocket Guide and in-house training, and study possible related changes in record keeping and quality of intrapartum surveillance and treatment of foetal heart rate abnormalities, slow labour progress, and severe hypertension, and in birth outcomes.
  4. To strengthen the understanding of the causal pathway from implementation of the PartoMa intervention to changes in quality of care, by exploring birth attendants’ perception, reaction, and changes in related knowledge and partograph skills.
  5. To better understand how the birth attendants experience the health system in their clinical work, their agency within the system, and associated coping mechanisms - and how the PartoMa intervention interacted in this.

Project news

14 December 2018
Research grant from Danida, Ministry of Foreign Affairs of Denmark
A team of researchers from University of Copenhagen, Aga Khan University of Dar es Salaam, State University of Zanzibar, Vrije University of Amsterdam and Hvidovre Hospital has been granted 12 million DKK (approximately 1.84 million USD) from Danida Fellowship Centre to conduct a 5-year study based on the intervention developed and successfully pilot tested by Nanna Maaløe as part of her PhD study. The purpose of the Danida supported research project is to examine whether the PartoMa intervention, of tailoring clinical guidance and training to a specific hospital context, can be replicated at scale for improved maternal and perinatal health, and whether the process can serve as pre-service training of health students and as a model for other areas of health care.

6 December 2018
Our latest scientific publication is Editor's Pick of the Month in International Journal of Gynecology and Obstetrics
The editor, Dr Richard M Adanu, writes: "The importance of clinical guidelines in obstetric care is very well established. However, one challenge with implementation of guidelines is the fact that the guidelines cannot take every single possible context into consideration. These researchers from Tanzania, Denmark and the Netherlands demonstrate how modifying guidelines to match the local context can result in marked improvement in care and outcome. This paper is a good case study on how to design and implement clinical guidelines specific to a particular context."

Read the publication in full lenght.

11 October 2018
Use of the PartoMa guidelines and seminars appears associated with improved care and perinatal outcome among women with severe hypertensive disorders
These results are now published in International Journal of Gynecology and Obstetrics.

2 July 2018
PartoMa research dissemination and launching event
On Friday 29th June, the Zanzibar Ministry of Health’s continuation of the PartoMa project was celebrated with stakeholders from the ministry, Mnazi Mmoja Hospital and NGOs. With support from UNFPA, the PartoMa seminars will be held quarterly in both Unguja and Pemba, and the PartoMa Pocket Guide will be available for all birth attendants.

7 June 2018
PartoMa Pocket Guide and Training Material Online
The PartoMa Pocket Guide 2.0, case stories for problem-based training, and a background document are now available on the homepage. We are currently working on a more smartphone friendly version of the pocket booklet, which will be available later this year in both English and Swahili.

25 May 2018
Zanzibar Ministry of Health is taking over continuation of PartoMa in Zanzibar
We are happy to announce our new collaboration with Ministry of Health and UNFPA in Zanzibar. From June 2018, they will take over continuation of PartoMa – with distribution of PartoMa pocket booklets and quarterly seminars on Unguja and Pemba. Next round of seminars will be on 27th and 28th June in Unguja and 2nd July in Pemba. On 29th June, this new collaboration and the second version of the PartoMa pocket guide will be celebrated at a launching event in Zanzibar City.

18 April 2018
Donation by Soroptimist International, the Netherlands
We greatly appreciate their donation for printing of 300 PartoMa pocket guides.



14 March 2018
PartoMa seminars – Closing the gap between clinical guidelines and reality
Anthropologist and filmmaker Lara Meguid visited the PartoMa Seminars in December, and we are now excited to launch her 7-minutes "PartoMa seminars – Closing the gap between clinical guidelines and reality":

 


The PartoMa seminars have been conducted for 3 years at Mnazi Mmoja Hospital. By realistic case-stories from the low-resource hospital, the aim is to train use of the locally-tailored PartoMa guidelines for safe and respectful childbirth care. The seminars take place every 3 months, outside working hours and without per diems or allowances. We extend a special thanks to the filmmaker Lara Meguid for this gift – and to the local PartoMa Steering Group at Mnazi Mmoja Hospital for their continual enthusiasm in conducting these seminars.

14 December 2017
Pilot testing of PartoMa guidelines version 2.0 has started
PartoMa guidelines version 2.0 was launched at the 11th round of PartoMa seminars at Mnazi Mmoja Hospital on 13th and 14 December 2017. 70 birth attendants participated voluntarily in their free time and will give their feedback after 1 month use. As the first version, PartoMa guidelines 2.0 is  a locally-tailored pocket booklet of essential childbirth management presented as easy-to-use infographics. In addition to the topics in the first version, PartoMa guidelines 2.0 includes e.g. neonatal resuscitation and bleeding during/after birth.

Photo: Jurre Rompa
Photo: Jurre Rompa

20 October 2017
Use of the PartoMa guidelines are associated with reduction in stillbirths and increased health of the newborns
These results are now published in British Journal of Obstetrics and Gynaecology. The paper also presents an in-depth evaluation of promising changes in quality of care. Read the news story here and find the full study here.

New publication

12 October 2017
PartoMa Guidelines 2.0 under development
First internal review of version 2.0 is now completed, and the draft is ready for external peer-review by specialists in the field. As the first version, PartoMa guidelines 2.0 will be a locally-tailored pocket booklet of essential childbirth management presented as easy-to-use infographics. In addition to the topics in the first version, PartoMa guidelines 2.0 will for instance include neonatal resuscitation, bleeding during and after birth, and labour induction.

12 June 2017
New scientific publication on the PartoMa study
A paper on the development process of the PartoMa guidelines and birth attendants’ perceptions after 12 months use is now published in BMC Pregnancy and Childbirth. Read more

01 May 2017
First PartoMa seminar on Pemba 
The PartoMa steering group at Mnazi Mmoja Hospital is still conducting the quarterly seminars with high attendance rates, and on 29 April a pilot seminar was conducted for birth attendants in Pemba. It was a success, and we hope to raise funding for additional seminars in Pemba. Thanks very much to the PartoMa steering group and to the birth attendants participating.

11 November 2016
New scientific publication on the PartoMa study
The PartoMa baseline study on Stillbirths and quality of care during labour is now published in BMC Pregnancy and Childbirth. Read more

28 October 2016
Second year of PartoMa seminars is now finalized
The PartoMa steering group at Mnazi Mmoja Hospital conducted the seventh and eighth rounds of quarterly PartoMa seminars with great success. Approximately 50 health providers participated at each round, which were held in July and October 2016. Thanks very much to the PartoMa steering group and to the birth attendants participating.

23 June 2016
Presentation of first results at the RCOG World Congress, Birmingham
Two posters were presented at the RCOG World Congress in Birmingham, 20th-22nd June 2016; baseline findings on quality of intrapartum care and the development process of the PartoMa guidelines.   

22 April 2016
Thanks to all participants at the sixth PartoMa Seminars
On 20th and 21st April, the PartoMa steering group at Mnazi Mmoja Hospital conducted the sixth round of PartoMa seminars on locally achievable labour management. Approximately 50 health providers participated, and their questionnaire evaluations highly positive. Thanks very much to the PartoMa steering group. The next round of seminars will be on 27th and 28th July 2016. Karibuni sana!

14 March 2016
Presentation of the first results of the PartoMa study, Zanzibar
On 11 March 2016, the first results of the PartoMa study was presented for health providers and external stakeholders at Tembo Hotel, Zanzibar. The scientific seminar was arranged and supported by Mnazi Mmoja Hospital, the Kanga Maternity Trust (kmtzanzibar.org) and the PartoMa project. The baseline study on challenges in quality of care during labour and delivery was presented followed by the promising first results from the 1-year evaluation of the PartoMa intervention. 40 health providers from Mnazi Mmoja and Mwembeladu hospitals received certificates for their devoted participation at 3-5 out of the 5 seminar rounds. The event was shared further by Tanzanian media. Pictures from the event are available by following the photo link.

8 March 2016
The new PartoMa steering group at Mnazi Mmoja Hospital is now established
It is with great pleasure that we here present the new PartoMa steering group at Mnazi Mmoja Hospital: Margaret Tayari (head of the steering committee), Dhuria Abdallah Ahmed, Kamilya Aly Omar, Sabra Salum Masoud, Mishi Juma Ali, Lamlat Hassan Nondo, and Tatu Fundi Salum. From April 2016, with support from the PartoMa study, they will take over the full responsibility for conducting the rounds of PartoMa seminars every 3 months. They work on voluntary basis, and they all have high experience with both participating and facilitating at the PartoMa seminars. The Medical Superintendent at Mnazi Mmoja Hospital, Dr. Naufal Kassim, will work as a consultant to support their important work. The scientific evaluation will continue.

16 January 2016
Thanks to all participants at the fifth PartoMa Seminars
On 13th and 14th January, we conducted the fifth round of PartoMa seminars on locally achievable labour management. This time we had the privilege to welcome Professor Jos van Roosmalen as guest facilitator. Again, the number of participants were high, and their questionnaire evaluation positive indeed. In particular, many thanks to Dhuria Abdallah Ahmed, Lamlat Hassan Nondo, Saida Abubakar Mohamed, Natasha Housseine, and Kamilya Aly Omar for participating as local facilitators and planners. The next round of seminars will be in April 2016. Karibuni sana!

10 October 2015
Thanks to all 83 participants at the fourth PartoMa Seminars
On 7th and 8th October, we conducted the fourth round of PartoMa seminars on locally achievable labour management. This time we had the privilege to welcome an even higher number of health providers from Mnazi Mmoja Hospital than at the previous seminars, which included 67% of the skilled birth attendants from the maternity ward. The participants’ questionnaire evaluations were highly positive. In particular, many thanks to Lamlat Hassan Nondo, Sabra Salum Masoud, Saida Abubakar Mohamed, Natasha Housseine, Margaret Tayari, Kamilya Aly Omar and Haji Machano Haji for participating as local facilitators.

The next round of seminars will be in January 2016. Karibuni sana!

2 July 2015
Thanks to all 86 participants at the third PartoMa Seminars
The third PartoMa seminars on “locally achievable partogram-associated labour management” were carried out at Mnazi Mmoja Hospital on the 15th and 16th June. This time we had the privilege of welcoming 86 enthusiastic health providers from both Mnazi Mmoja Hospital and neighboring facilities.
Furthermore, it was a delight to work with Barbara Kwast and Andrea Solnes Miltenburg, who participated as external facilitators. Additionally, many thanks to Kamilya Aly Omar, Margaret Sylvester Tayari, Tatu Fundi Salum, Mishi Juma Ali, Sabra Salum Masoud, and Lamlat Hassan Nondo. They have all accepted to be enrolled in our facilitators’ program.
We look very much forward to conducting the next seminars in October. KARIBUNI SANA.

8 May 2015
The PartoMa Guidelines were presented at the Day of the Midwife
On 5th May 2015, the Day of the Midwife was celebrated in Zanzibar. Among many good presentations, Midwife in Charge at Mnazi Mmoja Hospital, Tatu Fundi Salum, did a presentation on pre-eclampsia and the PartoMa guidelines. Thanks very much to ZANA and CHaRA for organizing this nice and popular event.

27 March 2015
Thanks to all participants at the second PartoMa Seminars  
The second PartoMa seminars on “locally achievable partogram-associated labour management” were carried out at Mnazi Mmoja Hospital on the 25th and 26th March. Again, we had a high and engaged number of participants: 60 health providers of which 45 are from Mnazi Mmoja Hospital.
Thanks very much to Kamilya Aly Omar, Margaret Sylvester Tayari and Tatu Fundi Salim for being facilitators at the stations – and to Dhuria Abdallah Ahmed for being in charge of the food.
We look very much forward to conducting the next seminars on 15th and 16th June 2015 – KARIBUNI SANA.

25 February 2015
The pilot testing of the PartoMa guidelines is now finalized
All 32 health care providers who were asked to fill in the written evaluation form found the guidelines highly useful in their daily care for women in labour. The guidelines will now be submitted to the 7 international specialists for the second external peer-review. By the end of March 2015, if a final internal approval is granted, we hope to launch version 1 of the PartoMa guidelines.
Thank you to the entire group of skilled birth attendants at Mnazi Mmoja Hospital who helped adjusting the guidelines to reflect real life situations.

23 January 2015
Pilot-testing of the PartoMa guidelines has now commenced
At the first PartoMa seminars, the pilot version of the PartoMa guidelines was launched. Until 20 February 2015, all health care providers at Mnazi Mmoja Hospital have the opportunity to share their thoughts on both content and graphic presentation. Then the guidelines will be modified and a second external review conducted. The final version of the PartoMa guidelines will be presented at the second PartoMa seminars in ultimo March 2015.

22 January 2015
The first PartoMa Seminar was welcomed positively by nurse-midwives and doctors
The first PartoMa seminar on “locally achievable partogram-associated labour management” was carried out twice at Mnazi Mmoja Hospital on the 21st and 22nd of January 2015, 2.30pm-6.00pm. This low-dose in-house seminar is case-based and will be repeated every 3 months. Everyone attends voluntarily in their free-time without payment.
We are happy to announce that 64 participants and 8 facilitators joined these first seminars. The participants included nurse-midwives and doctors from both Mwembeladu and Mnazi Mmoja Hospitals. The oral feedback appeared positive; participants and facilitators found the afternoons enjoyable and useful for their clinical work.

19 January 2015
Welcome to new research assistants
We are happy to welcome two new research assistants to the PartoMa study team: Mbweni Makame Ali & Said Mzee Said. They will particularly be involved in the on-going data collection based on case files and registers.

4 January 2015
First internal review of the PartoMa guidelines completed
Thanks to Mathew Oswald Zacharia, Tatu Fundi Salim, Fatma Ali Khatib, Kamilya Aly Omar and Sanura Abdalla, the first internal review of the partogram-associated labour management guidelines has now been completed.
This is the first important step in developing locally achievable, easy to use, evidence-based guidelines booklet for the staff at Mnazi Mmoja Hospital.
The guidelines will now be send to eight external international specialists in obstetrics and midwifery for their comments, and on the first PartoMa seminar in the end of January, the pilot version will be launched.

13 October 2014
The PartoMa study has now officially started
The research team met at the Department of Obstetrics and Gynaecology, Mnazi Mmoja Hospital, and the three research assistants – Natasha Housseine, Rashid Saleh Khamis and Ali Gharib Mohamed – were enrolled in the team. The study has now officially started and data collection has begun. 

7 October 2014
Ethical clearance received

The Zanzibar Medical and Research Ethics Committee has completed their review of the PartoMa project, and we have received ethical clearance to commence the study. 

28 May 2014
Additional funding received

Additional project funding has been received from the Laerdal Foundation and the Augustinus Foundation.

15 April 2014
Research grant from the Lundbeck Foundation
Professor Ib Bygbjerg and Medical Doctor Nanna Maaløe at University of Copenhagen have been granted USD 225 000 from the Lundbeck Foundation to investigate the effect of new solutions to strengthen monitoring to action during labour in resource limited referral hospitals

Scientific publications

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).

We are currently working on additional papers related to study objectives c-e.

Funding and partners

Contact

For inquiries regarding this research project, please contact the principal investigator:

Nanna Maaløe
E-mail: nannam@sund.ku.dk
Phone: +45 35 33 72 91

Mailing address

Att. Nanna Maaløe
Department of Public Health
University of Copenhagen
Øster Farimagsgade 5, bldg. 9
PO Box 2099
DK-1014 Copenhagen K
Denmark

Ekstra information / Sidebar

Contact Nanna Maaløe

Nanna Maaløe
MD, PhD student
nannam@sund.ku.dk

Photos

Project photos available in our Flickr gallery

Latest news

14 December 2018
Research grant from Danida, Ministry of Foreign Affairs of Denmark
A team of researchers from University of Copenhagen, Aga Khan University of Dar es Salaam, State University of Zanzibar, Vrije University of Amsterdam and Hvidovre Hospital has been granted 12 million DKK (approximately 1.84 million USD) from Danida Fellowship Centre to conduct a 5-year study based on the intervention developed and successfully pilot tested by Nanna Maaløe as part of her PhD study. The purpose of the Danida supported research project is to examine whether the PartoMa intervention, of tailoring clinical guidance and training to a specific hospital context, can be replicated at scale for improved maternal and perinatal health, and whether the process can serve as pre-service training of health students and as a model for other areas of health care.

6 December 2018
Our latest scientific publication is Editor's Pick of the Month in International Journal of Gynecology and Obstetrics
The editor, Dr Richard M Adanu, writes: "The importance of clinical guidelines in obstetric care is very well established. However, one challenge with implementation of guidelines is the fact that the guidelines cannot take every single possible context into consideration. These researchers from Tanzania, Denmark and the Netherlands demonstrate how modifying guidelines to match the local context can result in marked improvement in care and outcome. This paper is a good case study on how to design and implement clinical guidelines specific to a particular context."

Read the publication in full lenght.