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Preventing Fistula : Through Facility-Based Interventions :

Resources & Tools

Evaluation and Research Studies

Use of the Partograph: A Literature Review on Effectiveness, Training, Modifications, and Barriers
The purpose of the review was to identify and summarize the available literature on the use and efficacy of the partograph (including information on the attitudes of health care providers toward the partograph) and to identify and evaluate training strategies and barriers to its use.
Files: English (PDF, 342KB) and French (PDF, 236KB)

Key Findings and Recommendations: A Multi-Center Retrospective Review of Data Collection Procedures and Data Quality of Indications for Cesarean Deliveries
To determine if cesarean indications could easily be extracted from patient records for periodic review and whether a simple indication classification system such as the one proposed by the Immpact/International Federation of Obstetrics and Gynecology (FIGO) group to track trends would be useful for hospitals we support, Fistula Care carried out a retrospective record review study. The objectives of the study were to: 1. Identify the indications for a sample of cesareans, specifically to determine if obstructed labor and other related indications were recorded in client files 2. Identify other key details about the cesarean delivery (e.g., timing of cesarean, use of the partograph, cadre of provider who performed the cesarean), using a standard data collection tool, to identify areas for improvement 3. Review data reporting procedures to identify any challenges to recording and reporting quality data on cesarean indications at facilities 4. Assess providers’ perspectives about the organization of cesarean services and data management.
Files: English (PDF, 833KB) and French (PDF, 315KB)

Journal Articles

Striving For Excellence: Nurturing Midwives' Skills in Freetown, Sierra Leone
Midwives provide critical, lifesaving care to women and babies. Effective midwives must be clinically competent, with the required knowledge, skills, and attitudes to provide quality care. Their success depends on an environment of supportive supervision, continuing education, enabling policies, and access to equipment and referral facilities. In Freetown, Sierra Leone, the Aberdeen Women’s Centre launched a maternity unit with an emphasis on striving for excellence and providing ongoing professional development to its staff midwives. This paper describes how they successfully fostered a sense of responsibility and teamwork, providing necessary resources, conforming to evidence-based standards, and building partnerships. An explicit philosophy of care was crucial for guiding clinical decision making. In its first two years of operation, the Aberdeen Women’s Centre assisted 2,076 births, with two maternal deaths and 92 perinatal deaths. In-service education and supportive supervision facilitated the midwives’ professional growth, leading to capable future leaders who are providing exemplary care to delivering mothers and their newborns in Freetown.
Link: English
Abstract: French (PDF, 228KB)

Project and Meeting Reports

Revitalizing the Partograph: Does the Evidence Support a Global Call to Action
EngenderHealth’s Fistula Care project and the Maternal Health Task Force brought together international experts in November 2011 to review evidence and make recommendations about the partograph, a decision-making tool for preventing and managing prolonged or obstructed labor. Correct use of the partograph can prevent serious complications, including ruptured uterus, obstetric fistula, and stillbirth. Yet after more than 50 years of training and investment in the partograph in low-resource settings, the partograph is used infrequently, and few health care workers understand how to complete it properly. This report explores the major health system challenges to partograph implementation and the evidence in favor of revitalizing its use, not only to manage labor effectively, but also to improve the overall quality of care offered to women and their babies during childbirth.
Files: English (PDF, 370KB) and French (PDF, 242KB)

Urinary Catheterization for Primary and Secondary Prevention of Obstetric Fistula: A Consultative Meeting to Review and Standardize Current Guidelines and Practice
Evidence from the work of Dr. Kees Waaldijk in northern Nigeria suggests that women with obstetric fistula who present soon after the injury may heal spontaneously if the bladder is drained with a catheter. It is estimated that early management with a catheter could lead to closure of the fistula in 25% of cases. This important finding has the potential to allow some women to avoid the need for surgical repair of their fistula, which is both traumatic for women as well as a huge drain on scarce resources. Thus, the concept of treating fistula conservatively, and perhaps even preventing it by catheterization during or immediately after prolonged or obstructed labor, offers a promising alternative approach. This consultative meeting brought together a group of experienced Nigerian and international fistula surgeons, representatives of national and international professional nursing and midwifery associations, relevant officials from the Federal Ministry of Health, as well as national and international staff from the EngenderHealth-led Fistula Care project. The goal was to review current guidelines and practices, to discuss knowledge gaps, and to develop recommendations for standardized approaches to urinary catheterization for prevention and nonsurgical treatment of fistula. In preparation, Fistula Care conducted a review of literature pertinent to this topic and conducted an informal survey of current practices among Nigerian fistula service providers. Participants agreed on a simplified approach to catheterization for early management of fistula. The resulting recommendations will be disseminated to the Nigerian Ministry of Health and other relevant stakeholders, to facilitate the development and implementation of standardized national (and global) guidelines.
Files: English (PDF, 1.1MB) and French (PDF, 517KB)

Technical Briefs

Increasing Access to Maternity Services in Rural Bangladesh: Sustainable Facility-Community Links
The Ad-din Hospital for Women and Children and the LAMB Project in Bangladesh have established community-level services for women in rural, underserved communities. This technical brief describes their noteworthy programs, which ensure community ownership and sustainability. One program is integrated into a microfinance program to enable financial independence; the other empowers community members to truly own and manage its services.
Files: English (PDF, 1.1MB) and French (PDF, 1.2MB)

Low-Cost Ambulance Network to Provide Access to Maternity Services in Dhaka, Bangladesh
Transportation to skilled maternity care is critical. In 2008, the Ad-din Hospital recognized that many women in Dhaka were unable to access emergency obstetric care and established a low-cost ambulance service. This technical brief describes how Ad-din uses mobile phones and global positioning system (GPS) tracking to manage a fleet of ambulances stationed throughout the city.
Files: English (PDF, 736KB) and French (PDF, 781KB)

Integrating Fistula Treatment and Prevention: The Launch of a Maternity Unit in Sierra Leone
The Aberdeen Women's Centre maternity unit began offering delivery services in May 2010. Its dedicated staff provide hundreds of women with high-quality maternity services each year. This brief details the challenges of opening a maternity center and the factors that have led to the success of the clinic.
Files: English (PDF, 2.26MB) and French (PDF, 1.6MB)

Improving Partograph Use in Uganda through Coaching and Mentoring
Fistula Care promotes correct and consistent use of the partograph as one of its key fistula prevention interventions. Since 2010, Fistula Care has collaborated with the Reproductive Health Department of the Ugandan Ministry of Health to strengthen partograph use. This technical brief describes the challenges and achievements of developing and implementing a new approach to support partograph use in five facilities across three districts and makes recommendations for future partograph programming at the national, district, and facility levels.
Files: English (PDF, 2.2MB)


Guinea Partograph Poster
This job aid was developed in Guinea and provides guidance on the proper use of the partograph during labor.
Files: French (PDF, 787KB)

Monitoring Tool for Partograph Review
This tool facilitates review of partographs for monitoring and research purposes by facility managers or researchers. It includes detailed instructions, a data collection tool, and a summary sheet for recording data.
Files: English (XLS, 409KB) and French (XLS, 414KB)


© 2013 EngenderHealth.

This resource was made possible by the generous support of the American people through the U.S. Agency for International Development (USAID), under the terms of the cooperative agreement GHS-A-00-07-00021-00. The information provided on this resource is not official U.S. Government information and does not represent the views or positions of the USAID or the U.S. Government.