Browsing by Author "Lissauer, David"

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    Exploring how to sustain and scale ultrasound scanning during early pregnancy to improve the quality of antenatal care in Malawi and Zambia
    (Kamuzu University of Health Sciences, 19-01-22) Lissauer, David
    Type of study A mixed methods study design applying qualitative and quantitative methods. The problem The over-arching rationale for DIPLOMATIC is to improve pregnancy care in Malawi and reduce preterm birth, stillbirth and other adverse pregnancy outcomes. The work described here support these aims. First, the Ministry of Health (MoH) of Malawi is committed to the implementation of routine ultrasound dating in early pregnancy to reduce preterm birth and stillbirth. The DIPLOMATIC USS pilot study trained health staff in USS to establish gestational age, the number of foetuses, and Fetal viability. Because staff training will be rolled out widely across Malawi, standardized training tools are paramount. Through participatory workshops, we will develop standardised ultrasound training manuals and identify health systems-related facilitators and barriers to USS in early pregnancy. Second, there is a high prevalence of adolescent pregnancy and associated adverse birth outcomes in Malawi. Through interviews and focus groups with adolescent mothers, their male partners and stakeholders, we will explore provision of USS to adolescents and whether it encourages first trimester attendance. Third, Malawi has committed to halving rates of neonatal mortality and stillbirth by 2030 and adopted World Health Organisation (WHO) guidance on antenatal care. We will use the DIPLOMATIC dataset to describe the quality of antenatal and pregnancy care being delivered against selected WHO guidance. Researchers will co-create a quality improvement (QI) tool to to improve the compliance with WHO recommendations and to empower midwives and pregnant women. Research question DIPLOMATIC in Malawi introduced ultrasound scanning (USS) during early pregnancy. We now seek to understand how scanning can be sustained and scaled up. We will assess the impact of USS on adolescent mothers as an important group who require improved pregnancy services. We will also work with health professionals and policy makers to improve the quality of antenatal care. Broad objective: To exploring approaches to sustain and scale Ultrasound Scanning during early pregnancy to improve antenatal care Specific objectives: Work package 1 1. Assess perceptions of health care workers on the effect of introducing USS service in routine care 2. Identify challenges that implementers and consumers experience with the services 3. Assess facilitators to effective implementation of USS in routine care 4. Explore strategies that enhance uptake, utilization, and availability of the USS services 5. Co-create manuals for successful implementation and scale of USS in routine care. Work package 2 1. Assess the social and contextual factors affecting early Antenatal care attendance for adolescent mothers (aged 10-19) in Malawi 2. Determine effective strategies for promoting early pregnancy dating and correct/appropriate ANC use among adolescent mothers 3. Evaluate impact of adolescence on utilization of USS and correct pregnancy dating Work package 3 1. Assess the quality of pregnancy care being delivered against WHO standards using the DIPLOMATIC dataset and health records 2. Collaborate with providers, patient representatives and policy makers to co-create quality improvement (QI) approaches and tools to improve compliance with WHO guidance 3. Field test the developed tools to enable optimisation prior to evaluation at scale Methodology A mixed-methods research study with qualitative and quantitative methodologies. Qualitative methods include participatory workshops and interviews. Quantitative methods include records review, quantitative survey, and health economics cost consequence analysis. Expected findings This study will identify barriers and facilitators to sustainable implementation of USS during antenatal care. We will develop a clinical training manual, gain insight into the concerns of adolescent pregnant women and construct protocols to ensure clinical practice incorporates key components of WHO guidance.