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Fetal heart rate monitoring practices at a public hospital in Northern Uganda – what health workers document, do and say

Background: In Uganda, perinatal mortality is 38 per 1000 pregnancies. One-third of these deaths are due to birth asphyxia. Adequate fetal heart rate (FHR) monitoring during labor may detect birth asphyxia but little is known about monitoring practices in low resource settings. Objective: To explore...

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Autores principales: Ayebare, Elizabeth, Jonas, Wibke, Ndeezi, Grace, Nankunda, Jolly, Hanson, Claudia, Tumwine, James K., Hjelmstedt, Anna
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Taylor & Francis 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7006641/
https://www.ncbi.nlm.nih.gov/pubmed/31955672
http://dx.doi.org/10.1080/16549716.2020.1711618
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author Ayebare, Elizabeth
Jonas, Wibke
Ndeezi, Grace
Nankunda, Jolly
Hanson, Claudia
Tumwine, James K.
Hjelmstedt, Anna
author_facet Ayebare, Elizabeth
Jonas, Wibke
Ndeezi, Grace
Nankunda, Jolly
Hanson, Claudia
Tumwine, James K.
Hjelmstedt, Anna
author_sort Ayebare, Elizabeth
collection PubMed
description Background: In Uganda, perinatal mortality is 38 per 1000 pregnancies. One-third of these deaths are due to birth asphyxia. Adequate fetal heart rate (FHR) monitoring during labor may detect birth asphyxia but little is known about monitoring practices in low resource settings. Objective: To explore FHR monitoring practices among health workers at a public hospital in Northern Uganda. Methods: A sequential explanatory mixed methods study was conducted by reviewing 251 maternal records and conducting 11 interviews and two focus group discussions with health workers complemented by observations of 42 women in labor until delivery. Quantitative data were summarized using frequencies and percentages. Content analysis was used for qualitative data. Results: FHR was assessed in 235/251 (93.6%) of records at admission. Health workers documented the FHR at least once in 175/228 (76.8%) of cases during the first stage of labor compared to observed 17/25 (68.0%) cases. Median intervals between FHR monitoring were 30 (IQR 30–120) minutes in patients’ records versus 139 (IQR 87–662) minutes according to observations. Observations suggested no monitoring of FHR during the second stage of labor but records indicated monitoring in 3.2% of cases. Reported barriers to adequate FHR monitoring were inadequate number of staff and monitoring devices, institutional challenges such as few beds, documentation problems and perceived non-compliant women not reporting for repeated checks during the first stage of labor. Health workers demonstrated knowledge of national FHR monitoring guidelines and acknowledged that practice was different. Conclusions: When compared to national and international guidelines, FHR monitoring is sub-optimal in the studied setting. Approximately one in four women was not monitored during the first stage of labor. Barriers to appropriate FHR monitoring included shortage of staff and devices, institutional challenges and mother’s negative attitudes. These barriers need to be addressed in order to reduce neonatal mortality.
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spelling pubmed-70066412020-02-20 Fetal heart rate monitoring practices at a public hospital in Northern Uganda – what health workers document, do and say Ayebare, Elizabeth Jonas, Wibke Ndeezi, Grace Nankunda, Jolly Hanson, Claudia Tumwine, James K. Hjelmstedt, Anna Glob Health Action Research Article Background: In Uganda, perinatal mortality is 38 per 1000 pregnancies. One-third of these deaths are due to birth asphyxia. Adequate fetal heart rate (FHR) monitoring during labor may detect birth asphyxia but little is known about monitoring practices in low resource settings. Objective: To explore FHR monitoring practices among health workers at a public hospital in Northern Uganda. Methods: A sequential explanatory mixed methods study was conducted by reviewing 251 maternal records and conducting 11 interviews and two focus group discussions with health workers complemented by observations of 42 women in labor until delivery. Quantitative data were summarized using frequencies and percentages. Content analysis was used for qualitative data. Results: FHR was assessed in 235/251 (93.6%) of records at admission. Health workers documented the FHR at least once in 175/228 (76.8%) of cases during the first stage of labor compared to observed 17/25 (68.0%) cases. Median intervals between FHR monitoring were 30 (IQR 30–120) minutes in patients’ records versus 139 (IQR 87–662) minutes according to observations. Observations suggested no monitoring of FHR during the second stage of labor but records indicated monitoring in 3.2% of cases. Reported barriers to adequate FHR monitoring were inadequate number of staff and monitoring devices, institutional challenges such as few beds, documentation problems and perceived non-compliant women not reporting for repeated checks during the first stage of labor. Health workers demonstrated knowledge of national FHR monitoring guidelines and acknowledged that practice was different. Conclusions: When compared to national and international guidelines, FHR monitoring is sub-optimal in the studied setting. Approximately one in four women was not monitored during the first stage of labor. Barriers to appropriate FHR monitoring included shortage of staff and devices, institutional challenges and mother’s negative attitudes. These barriers need to be addressed in order to reduce neonatal mortality. Taylor & Francis 2020-01-20 /pmc/articles/PMC7006641/ /pubmed/31955672 http://dx.doi.org/10.1080/16549716.2020.1711618 Text en © 2020 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group. https://creativecommons.org/licenses/by/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research Article
Ayebare, Elizabeth
Jonas, Wibke
Ndeezi, Grace
Nankunda, Jolly
Hanson, Claudia
Tumwine, James K.
Hjelmstedt, Anna
Fetal heart rate monitoring practices at a public hospital in Northern Uganda – what health workers document, do and say
title Fetal heart rate monitoring practices at a public hospital in Northern Uganda – what health workers document, do and say
title_full Fetal heart rate monitoring practices at a public hospital in Northern Uganda – what health workers document, do and say
title_fullStr Fetal heart rate monitoring practices at a public hospital in Northern Uganda – what health workers document, do and say
title_full_unstemmed Fetal heart rate monitoring practices at a public hospital in Northern Uganda – what health workers document, do and say
title_short Fetal heart rate monitoring practices at a public hospital in Northern Uganda – what health workers document, do and say
title_sort fetal heart rate monitoring practices at a public hospital in northern uganda – what health workers document, do and say
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7006641/
https://www.ncbi.nlm.nih.gov/pubmed/31955672
http://dx.doi.org/10.1080/16549716.2020.1711618
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