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Innovations

Addressing Labor Complications: A Low-Cost Solution for a Persistent Global Health Challenge
Device Features: Indicator lights for reminders and alerts Telemedicine/SMS module for remote support Easy data entry for simplified plotting Capability to manage multiple patients for busy labor wards Collaborators: Johns Hopkins University Center for Bioengineering Innovation and Design, the United States Agency for International Development, and GE Foundation Contact: For more information on this project, contact Brinnon Mandel at bmandel@jhpiego.net

Global Health Need


Obstructed labor is a major direct cause of maternal and infant mortality and morbidityup to 9.5% in some African countries. Additional deaths due to sepsis and hemorrhage occur during prolonged or obstructed labor. The partogram serves as an early warning system that assists in monitoring the progress of labor and the condition of the mother and baby. It increases the quality and regularity of important observations on the progress of labor and early detection of problems, which can lead to better decision-making and earlier referrals. Despite the benefits, use of the paper partogram in developing countries is low and inconsistent. 1 Factors contributing to low use of the partogram include: lack of availability of partograms, negative perceptions and attitudes toward the partogram, high client volume, low staffing at facilities, and little supervision related to partogram use.

Low-Cost Technology Solution


Jhpiego and the Johns Hopkins Center for Bioengineering Innovation and Design (JHU-CBID) have developed the ePartogram, a handheld device and software platform based on the current partogram recommended by the World Health Organization. The device, which incorporates traditional best practices and clinical algorithms from the paper partogram, facilitates broader use and expands the benefits of the paper-based version through the following improvements: Features efficient data entry, automatic plotting of observations Provides instant graphing of data Reminds providers when to measure and record critical observations Stores multiple patient data in one device Provides indicators when complications arise Limits retroactive data entry after delivery (a current practice that reduces the current paper partogram into a mere recording tool) Transmits data to off-site experts who can provide guidance and support

Current Status and Future of the ePartogram


Jhpiego and JHU-CBID engineers are working with end-users to refine the device interface and gather data about user needs and preferences for device improvements, manufacturing, and additional field studies.

1 Ogwang S, Karyabakabo Z, Rutebemberwa E. Assessment of partogram use during labour in Rujumbura Health Sub District, Rukungiri District, Uganda. Afr Health Sci 2009; 9(S1): S27S34. c_m