The 7th EAHSC Developing and testing a synchronized e-partograph to improve management of intrapartum care and support the referral system for emergency obstetric care among refugee hosting communities in Adjumani district, Uganda Richard Mangwi Ayiasi/MD, MPH, PhD Makerere University School of Public Health

Rarely used leading to: Introduction The paper-based partograph - standard tool for monitoring intra-partum care Rarely used leading to: Delayed decision for action in case of danger Delayed access to emergency obstetric care Especially in distant health facilities.

Objectives Develop an electronic-partograph Based at the health facility Synchronized to a referral hospital Provide iterative decision-making for health facility workers Theory of change: availability of real-time technical backstop Reduce delay in decision-making in case of danger

Context

Materials and Methods An electronic partograph application designed on a tablet (December 2017-March 2018) Pretested March – June 2018 Piloted in a busy health facility and linked to the referral hospital through internet Three senior midwifes each at health facility and at referral hospital were trained in application use. Progress was monitored remotely through cloud-based server and monthly field visits

Results 120 intra-partum patients have been monitored using e- partograph Seven were referred based on iterative process between health facility and hospital The average time for decision for evacuation was 20 minutes, ranging 10 to 30 minutes APGAR score for all seven babies was 6/10 and above after one minute

Results #e-partographs filled APGAR Scores Frequencies (%) #referrals (%) Average time for evacuation (Minutes) 120 7 & above 113 (91.2) 6 (5.0) 20 5-6 06 (5.0) 1 (0.8) 30 Below 5 01 (0.8) 0 (0.0) N/A

Discussion This was a proof of concept with small numbers However, results demonstrate that with: Real-time evidence and Timely backstop from senior colleagues Decision-time for referral is minimized.

Implication In the context of Adjumani, a refugee hosting with additional human and transport resources enabled urgent evacuation of emergency cases Implying that the e-partograph per se cannot reduce the delay in accessing care, rather the presence of other support systems is equally important Enthusiasm among health workers to use electronic partograph – sustained interest?

Conclusion This proof of concept demonstrates the potential to reduce delay in accessing care once the patient has reached the health care system – The third delay A larger study is needed to demonstrate its effect compared to the paper-based partograph

Acknowledgement Grand Challenges Canada Makerere University, School of Public Health Colleagues, IT specialist