1. 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

2. 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.

3. 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

4. Context

5. 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

6. 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

7. 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

8. 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.

9. 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?

10. 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

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