Project Lead(s): Stella Luk
In 2010, 56,000 women in India died during or shortly after their pregnancies, accounting for 20% of maternal deaths globally.
The World Health Organization (WHO) promotes use of the partograph, a paper labour management tool that can halve the rate of prolonged labour and postpartum infection, and prevent obstructed labour. Despite the partograph’s value, many healthcare providers find this paper tool to be complex, requiring unrealistic amounts of training.
Efforts to update the partograph have been limited.
The team developed an electronic mobile partograph that addresses the challenges of healthcare workers who find conventional partographs to be complex and to require unrealistic amounts of training. ‘mLabour’ provides decision support, automatic graphing and reminders, prompting clinicians to conduct patient exams.
Over the course of 18 months, formative research, wireframe testing, prototype testing, scenario testing and a usability study were conducted, in efforts to create mLabour to help intrapartum care providers track labour progress and identify obstructed labour.
The tool’s information architecture requires the same data as paper forms but without duplicate data entry, and presents the data in a succinct fashion that is quick to interpret.
In March 2015, 12 nurses used the initial prototype of the mLabour application for one month at the Abdul Hakeem Centenary Hospital at Jamia Hamdard University (New Delhi, India). During this period, 104 births were conducted and the team monitored the use of the tool, along with conducting qualitative research on its usability through focus group discussions and structured observations by a neutral observer.
In focus group discussions, nurses stated that ‘patient neglect decreased’ thanks to mLabour.
The physical size of the tablet made it easy for nurses to carry the app with them between beds, a significant improvement over the large, heavy, paper registries. This gave nurses more time for direct patient care, enabling them to take better care of the women in labour.
The automatic graphing function also saved them the time it would have taken to plot by hand, which also led to partographs being filled out more completely.
Indian law and hospital protocol dictate that, for every child born, a paper partograph should be filled out, yet only 13 out of 104 births in this study had complete paper partographs, while 100% were recorded through mLabour.
On average, nurses took 6 minutes and 51 seconds to register a patient with mLabour and 1 minute and 37 seconds to update patient indicators and measurements – a significant drop in time spent.
The nurses said they felt timely follow-ups with patients improved, since the application prompted them to conduct visits.
A generic version of mLabour has been created to publish on the CommCare Exchange for anyone to download and use. Building off the initial mLabour prototype, the team will work to validate the tool across multiple contexts in India, focusing primarily on rural and public healthcare facilities.
Funding is being sought to scale up the project and the team can produce letters of support from many organizations stating their interest in deploying mLabour, including John Snow International, Save the Children, EngenderHealth, Pathfinder, FHI360, AIPH and Shifa University.
As the tool scales in other countries, the team will work to leverage existing partnerships in-country to align the tool with national standards.