Posted by: blog4globalhealth | 06/29/2011

REVITALIZING THE PARTOGRAPH TO PREVENT FISTULA IN UGANDA

We have a simple existing tool—the partograph—that could easily help prevent needless maternal deaths and injuries.

At 16, Jenny Nalukwago became pregnant and dropped out of school. After learning about the importance of antenatal care at her school in central Uganda, she convinced her mother, who delivered all 10 of her children in the village, to accompany her for check-ups at the nearest health facility. When Jenny went into labor, her mother hired a motorcycle taxi driver to take them to the health center 5 miles away, as the midwife there had instructed.

But despite being at the health center, Jenny did not receive the care she needed. More than 36 hours into Jenny’s labor, the midwife assured them that the baby would come soon. Because Jenny was still young, it just might take her longer to deliver, the midwife said. Forty-eight hours after arriving at the health center, Jenny delivered a dead baby, which had been too big to fit through her birth canal. Immediately after, Jenny began leaking urine. She had developed an obstetric fistula.

Jenny’s story is more common than many people realize. Here in Uganda, for example, 435 women die during or after childbirth for every 100,000 live births. Many more who survive childbirth are left with debilitating injuries like fistula.

If Jenny had given birth in a U.S. hospital, her labor would likely have been closely monitored by clinicians using modern diagnostic tools. Jenny would have had a C-section long before the baby died in utero and Jenny would not have been left with a fistula. While advanced technologies may not be widely available in countries like Uganda, expensive supplies and sophisticated technology are not always needed to save women’s lives. We have a simple existing tool-the partograph-that could easily help prevent needless maternal deaths and injuries.

The partograph is a critical tool for managing the progress of labor, allowing health providers to detect and respond early to potential complications. Developed by the World Health Organization, the partograph is a one-page form that can be used to plot critical changes in the cervix dilation, the descent of the baby, as well as the vital signs of both mother and child. With this detailed information, a health provider can make more informed decisions about whether an intervention is needed to preserve the health and life of the mother and child.

The partograph is safe, affordable, and easy to use. It is a solution that should be used routinely for all laboring women around the world. At Mbarara University Teaching Hospital, Dr. Musa Kayondo has been using the partograph for the past five years. Given how important the tool is for reducing mortality and morbidities, Dr. Kayondo now urges all service providers to ensure the partograph is used for all labors in the facility.

In 2010, as a part of the USAID-funded Fistula Care Project, EngenderHealth set out to learn just how often the partograph was being used in 11 health care facilities in Uganda. In many of the facilities we visited, partograph use was low or even nonexistent for several different reasons. In some places, health care providers did not know how to use the partograph correctly. Some had negative attitudes towards its use, while others wanted to use the partograph but didn’t have access to the forms.

EngenderHealth is working to institutionalize the use of the partograph in Uganda by advocating for increased use of the partograph and training health care providers on its effectiveness in saving lives and preventing avoidable injuries. We are also supplying facilities with an abundance of partograph forms and strengthening supervision over how the partograph is used.

Although these efforts take time, we have begun to see an improvement in the use of the partograph in the 11 Ugandan health facilities where we work. Slowly but surely, these efforts are helping to reduce the number of women who experience avoidable complications during childbirth, as Jenny Nalukwago did.

Written by Joslyn Meier, Program Associate and Peter Mukasa, Senior Medical Associate at EngenderHealth.


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