Coadaptation and implementation of intrapartum clinical guidelines to save lives during childbirth: Protocol for an...

BACKGROUND: Although several clinical practice guidelines (CPGs) exist to improve maternity care, their relevance in low- and middle-income countries is often debated. Despite calls for local adaptation, gaps remain between CPG recommendations and on-the-ground realities, hampering their use. In Zanzibar, cocreated, context-specific PartoMa CPGs coupled with low-dose high-frequency training were associated with improved quality of intrapartum care and perinatal survival. In Ethiopia, where maternal and perinatal deaths remain high, we aim to adapt the PartoMa CPG from Tanzania to the context of thirteen government hospitals networked in the Ethiopian Obstetric Surveillance System (EthOSS) in the eastern region. In addition, we introduce the MOYO device into the CPGs to enable continuous monitoring of the fetal heart rate during childbirth. METHODS: This study has four phases: (I) a mixed-methods baseline situational analysis of current intrapartum practice and birth outcomes, clinical challenges and current CPG use; (II) cocreation of context-specific CPGs, which is based on (a) the Tanzanian PartoMa CPGs, (b) the situational analysis, and (c) focus group discussions with birth attendants, local health managers and women; (III) pilot implementation combined with a mixed-method evaluation of the adapted PartoMa intervention in two of the hospitals; and (IV) analysis of lessons learned from intercountry adaptation of the PartoMa intervention. The overall study design will be a quasi-experimental study with embedded qualitative analysis. Women with a positive fetal heart rate on admission will be evaluated for the quality of care provided and experienced birth outcomes. In addition, further analysis will be performed on the perceptions of birth attendants toward the use of interventions and other associated learning. DISCUSSION: The lessons learned from this cocreation of CPGs and implementation of other PartoMa interventions provide insight into how to adapt clinical decision support interventions between resource-constrained settings to enhance the competencies and quality of care provided by frontline health workers. TRIAL REGISTRATION NUMBER: The trial has been registered at ClinicalTrials.gov. Number of registration (NCT06273007). Date of registration: 15.02.2024.