Nicole Santos1, Jude Mulowooza2, Nathan Isabirye2, Innocent Inhensiko2, Nancy L Sloan1, Sachita Shah3, Elizabeth Butrick1, Peter Waiswa2,4, Dilys Walker1,5. 1. Institute for Global Health Sciences, University of California San Francisco, San Francisco, CA, USA. 2. School of Public Health, Makerere University, Kampala, Uganda. 3. Department of Emergency Medicine, University of Washington, Seattle, WA, USA. 4. Global Health Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden. 5. Department of Obstetrics, Gynaecology and Reproductive Sciences, University of California San Francisco, San Francisco, CA, USA.
Abstract
OBJECTIVE: To test whether introduction of a midwife-performed triage checklist and focused ultrasound improves diagnosis and referral for obstetric conditions, including multiple gestation, placenta previa, oligohydramnios, preterm birth, malpresentation, and abnormal fetal heart rate. METHODS: We implemented an intake log (Phase 1), a checklist (Phase 2), and a checklist plus ultrasound scan (Phase 3) at three primary health centers in Eastern Uganda for women presenting in labor. Intake diagnoses, referral status, and delivery outcomes were assessed, as well as sensitivity and positive predictive value (PPV). RESULTS: Between February 2018 and July 2019, 1155, 961, and 603 women were enrolled across the three phases (n=2719); 2339 had outcome data. Incidence of any outcome-confirmed condition was 8.8%, 7.9%, and 7.1% (P=0.526) for each phase, respectively. The proportion of referred women with a condition did not change between Phases 1 and 2 (7.8% versus 8.6%, P=0.855), but increased in Phase 3 (48.4%, P<0.001). Sensitivity improved with each intervention; PPV decreased with ultrasound. CONCLUSION: Use of ultrasound plus checklist increased referrals and sensitivity for high-risk conditions, with decreased PPV. The checklist alone improved correct diagnosis, but not referral. Further evaluation of these triage interventions to maximize diagnostic accuracy, referral decisions, and outcomes are warranted.
OBJECTIVE: To test whether introduction of a midwife-performed triage checklist and focused ultrasound improves diagnosis and referral for obstetric conditions, including multiple gestation, placenta previa, oligohydramnios, preterm birth, malpresentation, and abnormal fetal heart rate. METHODS: We implemented an intake log (Phase 1), a checklist (Phase 2), and a checklist plus ultrasound scan (Phase 3) at three primary health centers in Eastern Uganda for women presenting in labor. Intake diagnoses, referral status, and delivery outcomes were assessed, as well as sensitivity and positive predictive value (PPV). RESULTS: Between February 2018 and July 2019, 1155, 961, and 603 women were enrolled across the three phases (n=2719); 2339 had outcome data. Incidence of any outcome-confirmed condition was 8.8%, 7.9%, and 7.1% (P=0.526) for each phase, respectively. The proportion of referred women with a condition did not change between Phases 1 and 2 (7.8% versus 8.6%, P=0.855), but increased in Phase 3 (48.4%, P<0.001). Sensitivity improved with each intervention; PPV decreased with ultrasound. CONCLUSION: Use of ultrasound plus checklist increased referrals and sensitivity for high-risk conditions, with decreased PPV. The checklist alone improved correct diagnosis, but not referral. Further evaluation of these triage interventions to maximize diagnostic accuracy, referral decisions, and outcomes are warranted.
Authors: R L Goldenberg; R O Nathan; D Swanson; S Saleem; W Mirza; F Esamai; D Muyodi; A L Garces; L Figueroa; E Chomba; M Chiwala; M Mwenechanya; A Tshefu; A Lokangako; V L Bolamba; J L Moore; H Franklin; J Swanson; E A Liechty; C L Bose; N F Krebs; K Michael Hambidge; W A Carlo; N Kanaiza; F Naqvi; I S Pineda; W López-Gomez; D Hamsumonde; M S Harrison; M Koso-Thomas; M Miodovnik; D D Wallace; E M McClure Journal: BJOG Date: 2018-06-15 Impact factor: 6.531
Authors: Henrietta Afari; Lisa R Hirschhorn; Annie Michaelis; Pierre Barker; Sodzi Sodzi-Tettey Journal: BMJ Open Date: 2014-05-15 Impact factor: 2.692
Authors: Joy E Lawn; Hannah Blencowe; Peter Waiswa; Agbessi Amouzou; Colin Mathers; Dan Hogan; Vicki Flenady; J Frederik Frøen; Zeshan U Qureshi; Claire Calderwood; Suhail Shiekh; Fiorella Bianchi Jassir; Danzhen You; Elizabeth M McClure; Matthews Mathai; Simon Cousens Journal: Lancet Date: 2016-01-19 Impact factor: 79.321