“Quality of prenatal and maternal care: bridging the know-do gap” (QUALMAT study): an electronic clinical decision support system for rural Sub-Saharan Africa
Identifieur interne : 000547 ( Main/Exploration ); précédent : 000546; suivant : 000548“Quality of prenatal and maternal care: bridging the know-do gap” (QUALMAT study): an electronic clinical decision support system for rural Sub-Saharan Africa
Auteurs : Antje Blank [Allemagne] ; Helen Prytherch [Allemagne] ; Jens Kaltschmidt [Allemagne] ; Andreas Krings [Allemagne] ; Felix Sukums [Allemagne, Tanzanie] ; Nathan Mensah [Allemagne, Ghana] ; Alphonse Zakane [Burkina Faso, Suède] ; Svetla Loukanova [Allemagne] ; Lars L. Gustafsson [Suède] ; Rainer Sauerborn [Allemagne] ; Walter E. Haefeli [Allemagne]Source :
- BMC Medical Informatics and Decision Making [ 1472-6947 ] ; 2013.
Abstract
Despite strong efforts to improve maternal care, its quality remains deficient in many countries of Sub-Saharan Africa as persistently high maternal mortality rates testify. The QUALMAT study seeks to improve the performance and motivation of rural health workers and ultimately quality of primary maternal health care services in three African countries Burkina Faso, Ghana, and Tanzania. One major intervention is the introduction of a computerized Clinical Decision Support System (CDSS) for rural primary health care centers to be used by health care workers of different educational levels.
A stand-alone, java-based software, able to run on any standard hardware, was developed based on assessment of the health care situation in the involved countries. The software scope was defined and the final software was programmed under consideration of test experiences. Knowledge for the decision support derived from the World Health Organization (WHO) guideline “Pregnancy, Childbirth, Postpartum and Newborn Care; A Guide for Essential Practice”.
The QUALMAT CDSS provides computerized guidance and clinical decision support for antenatal care, and care during delivery and up to 24 hours post delivery. The decision support is based on WHO guidelines and designed using three principles: (1) Guidance through routine actions in maternal and perinatal care, (2) integration of clinical data to detect situations of concern by algorithms, and (3) electronic tracking of peri- and postnatal activities. In addition, the tool facilitates patient management and is a source of training material. The implementation of the software, which is embedded in a set of interventions comprising the QUALMAT study, is subject to various research projects assessing and quantifying the impact of the CDSS on quality of care, the motivation of health care staff (users) and its health economic aspects. The software will also be assessed for its usability and acceptance, as well as for its influence on workflows in the rural setting of primary health care in the three countries involved.
The development and implementation of a CDSS in rural primary health care centres presents challenges, which may be overcome with careful planning and involvement of future users at an early stage. A tailored software with stable functionality should offer perspectives to improve maternal care in resource-poor settings.
Url:
DOI: 10.1186/1472-6947-13-44
PubMed: 23574764
PubMed Central: 3637082
Affiliations:
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Box 65001, Dar Es Salaam, TZ, Tanzania</nlm:aff><country xml:lang="fr">Tanzanie</country><wicri:regionArea>Muhimbili University of Health and Allied Sciences (MUHAS), Directorate of Information and Communication Technology, P.O. Box 65001, Dar Es Salaam, TZ</wicri:regionArea><wicri:noRegion>TZ</wicri:noRegion></affiliation></author><author><name sortKey="Mensah, Nathan" sort="Mensah, Nathan" uniqKey="Mensah N" first="Nathan" last="Mensah">Nathan Mensah</name><affiliation wicri:level="3"><nlm:aff id="I1">Department of Clinical Pharmacology and Pharmacoepidemiology, Medizinische Klinik (Krehl Klinik), University Hospital of Heidelberg, Im Neuenheimer Feld 410, Heidelberg, D - 69120, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Clinical Pharmacology and Pharmacoepidemiology, Medizinische Klinik (Krehl Klinik), University Hospital of Heidelberg, Im Neuenheimer Feld 410, Heidelberg, D - 69120</wicri:regionArea><placeName><region type="land" nuts="1">Bade-Wurtemberg</region><region type="district" nuts="2">District de Karlsruhe</region><settlement type="city">Heidelberg</settlement></placeName></affiliation><affiliation wicri:level="1"><nlm:aff id="I4">Navrongo Health Research Centre, P.O. Box 114, Navrongo, GH, Ghana</nlm:aff><country xml:lang="fr">Ghana</country><wicri:regionArea>Navrongo Health Research Centre, P.O. 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Gustafsson</name><affiliation wicri:level="1"><nlm:aff id="I6">Department of Laboratory Medicine (LABMED), Division of Clinical Pharmacology (C1:68), Karolinska Institutet, Karolinska University Hospital, Stockholm, SE-141 86, Sweden</nlm:aff><country xml:lang="fr">Suède</country><wicri:regionArea>Department of Laboratory Medicine (LABMED), Division of Clinical Pharmacology (C1:68), Karolinska Institutet, Karolinska University Hospital, Stockholm, SE-141 86</wicri:regionArea><wicri:noRegion>SE-141 86</wicri:noRegion></affiliation></author><author><name sortKey="Sauerborn, Rainer" sort="Sauerborn, Rainer" uniqKey="Sauerborn R" first="Rainer" last="Sauerborn">Rainer Sauerborn</name><affiliation wicri:level="3"><nlm:aff id="I2">Department of Public Health, University of Heidelberg, Im Neuenheimer Feld 327, Heidelberg, D - 69120, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Public Health, University of Heidelberg, Im Neuenheimer Feld 327, Heidelberg, D - 69120</wicri:regionArea><placeName><region type="land" nuts="1">Bade-Wurtemberg</region><region type="district" nuts="2">District de Karlsruhe</region><settlement type="city">Heidelberg</settlement></placeName></affiliation></author><author><name sortKey="Haefeli, Walter E" sort="Haefeli, Walter E" uniqKey="Haefeli W" first="Walter E" last="Haefeli">Walter E. Haefeli</name><affiliation wicri:level="3"><nlm:aff id="I1">Department of Clinical Pharmacology and Pharmacoepidemiology, Medizinische Klinik (Krehl Klinik), University Hospital of Heidelberg, Im Neuenheimer Feld 410, Heidelberg, D - 69120, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Clinical Pharmacology and Pharmacoepidemiology, Medizinische Klinik (Krehl Klinik), University Hospital of Heidelberg, Im Neuenheimer Feld 410, Heidelberg, D - 69120</wicri:regionArea><placeName><region type="land" nuts="1">Bade-Wurtemberg</region><region type="district" nuts="2">District de Karlsruhe</region><settlement type="city">Heidelberg</settlement></placeName></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">23574764</idno><idno type="pmc">3637082</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3637082</idno><idno type="RBID">PMC:3637082</idno><idno type="doi">10.1186/1472-6947-13-44</idno><date when="2013">2013</date><idno type="wicri:Area/Pmc/Corpus">000224</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000224</idno><idno type="wicri:Area/Pmc/Curation">000223</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Curation">000223</idno><idno type="wicri:Area/Pmc/Checkpoint">000272</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Checkpoint">000272</idno><idno type="wicri:Area/Ncbi/Merge">000555</idno><idno type="wicri:Area/Ncbi/Curation">000555</idno><idno type="wicri:Area/Ncbi/Checkpoint">000555</idno><idno type="wicri:Area/Main/Merge">000548</idno><idno type="wicri:Area/Main/Curation">000547</idno><idno type="wicri:Area/Main/Exploration">000547</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">“Quality of prenatal and maternal care: bridging the know-do gap” (QUALMAT study): an electronic clinical decision support system for rural Sub-Saharan Africa</title><author><name sortKey="Blank, Antje" sort="Blank, Antje" uniqKey="Blank A" first="Antje" last="Blank">Antje Blank</name><affiliation wicri:level="3"><nlm:aff id="I1">Department of Clinical Pharmacology and Pharmacoepidemiology, Medizinische Klinik (Krehl Klinik), University Hospital of Heidelberg, Im Neuenheimer Feld 410, Heidelberg, D - 69120, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Clinical Pharmacology and Pharmacoepidemiology, Medizinische Klinik (Krehl Klinik), University Hospital of Heidelberg, Im Neuenheimer Feld 410, Heidelberg, D - 69120</wicri:regionArea><placeName><region type="land" nuts="1">Bade-Wurtemberg</region><region type="district" nuts="2">District de Karlsruhe</region><settlement type="city">Heidelberg</settlement></placeName></affiliation></author><author><name sortKey="Prytherch, Helen" sort="Prytherch, Helen" uniqKey="Prytherch H" first="Helen" last="Prytherch">Helen Prytherch</name><affiliation wicri:level="3"><nlm:aff id="I2">Department of Public Health, University of Heidelberg, Im Neuenheimer Feld 327, Heidelberg, D - 69120, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Public Health, University of Heidelberg, Im Neuenheimer Feld 327, Heidelberg, D - 69120</wicri:regionArea><placeName><region type="land" nuts="1">Bade-Wurtemberg</region><region type="district" nuts="2">District de Karlsruhe</region><settlement type="city">Heidelberg</settlement></placeName></affiliation></author><author><name sortKey="Kaltschmidt, Jens" sort="Kaltschmidt, Jens" uniqKey="Kaltschmidt J" first="Jens" last="Kaltschmidt">Jens Kaltschmidt</name><affiliation wicri:level="3"><nlm:aff id="I1">Department of Clinical Pharmacology and Pharmacoepidemiology, Medizinische Klinik (Krehl Klinik), University Hospital of Heidelberg, Im Neuenheimer Feld 410, Heidelberg, D - 69120, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Clinical Pharmacology and Pharmacoepidemiology, Medizinische Klinik (Krehl Klinik), University Hospital of Heidelberg, Im Neuenheimer Feld 410, Heidelberg, D - 69120</wicri:regionArea><placeName><region type="land" nuts="1">Bade-Wurtemberg</region><region type="district" nuts="2">District de Karlsruhe</region><settlement type="city">Heidelberg</settlement></placeName></affiliation></author><author><name sortKey="Krings, Andreas" sort="Krings, Andreas" uniqKey="Krings A" first="Andreas" last="Krings">Andreas Krings</name><affiliation wicri:level="3"><nlm:aff id="I1">Department of Clinical Pharmacology and Pharmacoepidemiology, Medizinische Klinik (Krehl Klinik), University Hospital of Heidelberg, Im Neuenheimer Feld 410, Heidelberg, D - 69120, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Clinical Pharmacology and Pharmacoepidemiology, Medizinische Klinik (Krehl Klinik), University Hospital of Heidelberg, Im Neuenheimer Feld 410, Heidelberg, D - 69120</wicri:regionArea><placeName><region type="land" nuts="1">Bade-Wurtemberg</region><region type="district" nuts="2">District de Karlsruhe</region><settlement type="city">Heidelberg</settlement></placeName></affiliation></author><author><name sortKey="Sukums, Felix" sort="Sukums, Felix" uniqKey="Sukums F" first="Felix" last="Sukums">Felix Sukums</name><affiliation wicri:level="3"><nlm:aff id="I1">Department of Clinical Pharmacology and Pharmacoepidemiology, Medizinische Klinik (Krehl Klinik), University Hospital of Heidelberg, Im Neuenheimer Feld 410, Heidelberg, D - 69120, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Clinical Pharmacology and Pharmacoepidemiology, Medizinische Klinik (Krehl Klinik), University Hospital of Heidelberg, Im Neuenheimer Feld 410, Heidelberg, D - 69120</wicri:regionArea><placeName><region type="land" nuts="1">Bade-Wurtemberg</region><region type="district" nuts="2">District de Karlsruhe</region><settlement type="city">Heidelberg</settlement></placeName></affiliation><affiliation wicri:level="1"><nlm:aff id="I3">Muhimbili University of Health and Allied Sciences (MUHAS), Directorate of Information and Communication Technology, P.O. Box 65001, Dar Es Salaam, TZ, Tanzania</nlm:aff><country xml:lang="fr">Tanzanie</country><wicri:regionArea>Muhimbili University of Health and Allied Sciences (MUHAS), Directorate of Information and Communication Technology, P.O. Box 65001, Dar Es Salaam, TZ</wicri:regionArea><wicri:noRegion>TZ</wicri:noRegion></affiliation></author><author><name sortKey="Mensah, Nathan" sort="Mensah, Nathan" uniqKey="Mensah N" first="Nathan" last="Mensah">Nathan Mensah</name><affiliation wicri:level="3"><nlm:aff id="I1">Department of Clinical Pharmacology and Pharmacoepidemiology, Medizinische Klinik (Krehl Klinik), University Hospital of Heidelberg, Im Neuenheimer Feld 410, Heidelberg, D - 69120, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Clinical Pharmacology and Pharmacoepidemiology, Medizinische Klinik (Krehl Klinik), University Hospital of Heidelberg, Im Neuenheimer Feld 410, Heidelberg, D - 69120</wicri:regionArea><placeName><region type="land" nuts="1">Bade-Wurtemberg</region><region type="district" nuts="2">District de Karlsruhe</region><settlement type="city">Heidelberg</settlement></placeName></affiliation><affiliation wicri:level="1"><nlm:aff id="I4">Navrongo Health Research Centre, P.O. Box 114, Navrongo, GH, Ghana</nlm:aff><country xml:lang="fr">Ghana</country><wicri:regionArea>Navrongo Health Research Centre, P.O. Box 114, Navrongo, GH</wicri:regionArea><wicri:noRegion>GH</wicri:noRegion></affiliation></author><author><name sortKey="Zakane, Alphonse" sort="Zakane, Alphonse" uniqKey="Zakane A" first="Alphonse" last="Zakane">Alphonse Zakane</name><affiliation wicri:level="1"><nlm:aff id="I5">Centre de Recherche en Santé de Nouna (CRSN), Nouna, BF, BP 02, Burkina Faso</nlm:aff><country xml:lang="fr">Burkina Faso</country><wicri:regionArea>Centre de Recherche en Santé de Nouna (CRSN), Nouna, BF, BP 02</wicri:regionArea><wicri:noRegion>BP 02</wicri:noRegion></affiliation><affiliation wicri:level="1"><nlm:aff id="I6">Department of Laboratory Medicine (LABMED), Division of Clinical Pharmacology (C1:68), Karolinska Institutet, Karolinska University Hospital, Stockholm, SE-141 86, Sweden</nlm:aff><country xml:lang="fr">Suède</country><wicri:regionArea>Department of Laboratory Medicine (LABMED), Division of Clinical Pharmacology (C1:68), Karolinska Institutet, Karolinska University Hospital, Stockholm, SE-141 86</wicri:regionArea><wicri:noRegion>SE-141 86</wicri:noRegion></affiliation></author><author><name sortKey="Loukanova, Svetla" sort="Loukanova, Svetla" uniqKey="Loukanova S" first="Svetla" last="Loukanova">Svetla Loukanova</name><affiliation wicri:level="3"><nlm:aff id="I2">Department of Public Health, University of Heidelberg, Im Neuenheimer Feld 327, Heidelberg, D - 69120, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Public Health, University of Heidelberg, Im Neuenheimer Feld 327, Heidelberg, D - 69120</wicri:regionArea><placeName><region type="land" nuts="1">Bade-Wurtemberg</region><region type="district" nuts="2">District de Karlsruhe</region><settlement type="city">Heidelberg</settlement></placeName></affiliation></author><author><name sortKey="Gustafsson, Lars L" sort="Gustafsson, Lars L" uniqKey="Gustafsson L" first="Lars L" last="Gustafsson">Lars L. Gustafsson</name><affiliation wicri:level="1"><nlm:aff id="I6">Department of Laboratory Medicine (LABMED), Division of Clinical Pharmacology (C1:68), Karolinska Institutet, Karolinska University Hospital, Stockholm, SE-141 86, Sweden</nlm:aff><country xml:lang="fr">Suède</country><wicri:regionArea>Department of Laboratory Medicine (LABMED), Division of Clinical Pharmacology (C1:68), Karolinska Institutet, Karolinska University Hospital, Stockholm, SE-141 86</wicri:regionArea><wicri:noRegion>SE-141 86</wicri:noRegion></affiliation></author><author><name sortKey="Sauerborn, Rainer" sort="Sauerborn, Rainer" uniqKey="Sauerborn R" first="Rainer" last="Sauerborn">Rainer Sauerborn</name><affiliation wicri:level="3"><nlm:aff id="I2">Department of Public Health, University of Heidelberg, Im Neuenheimer Feld 327, Heidelberg, D - 69120, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Public Health, University of Heidelberg, Im Neuenheimer Feld 327, Heidelberg, D - 69120</wicri:regionArea><placeName><region type="land" nuts="1">Bade-Wurtemberg</region><region type="district" nuts="2">District de Karlsruhe</region><settlement type="city">Heidelberg</settlement></placeName></affiliation></author><author><name sortKey="Haefeli, Walter E" sort="Haefeli, Walter E" uniqKey="Haefeli W" first="Walter E" last="Haefeli">Walter E. Haefeli</name><affiliation wicri:level="3"><nlm:aff id="I1">Department of Clinical Pharmacology and Pharmacoepidemiology, Medizinische Klinik (Krehl Klinik), University Hospital of Heidelberg, Im Neuenheimer Feld 410, Heidelberg, D - 69120, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Clinical Pharmacology and Pharmacoepidemiology, Medizinische Klinik (Krehl Klinik), University Hospital of Heidelberg, Im Neuenheimer Feld 410, Heidelberg, D - 69120</wicri:regionArea><placeName><region type="land" nuts="1">Bade-Wurtemberg</region><region type="district" nuts="2">District de Karlsruhe</region><settlement type="city">Heidelberg</settlement></placeName></affiliation></author></analytic><series><title level="j">BMC Medical Informatics and Decision Making</title><idno type="eISSN">1472-6947</idno><imprint><date when="2013">2013</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background</title><p>Despite strong efforts to improve maternal care, its quality remains deficient in many countries of Sub-Saharan Africa as persistently high maternal mortality rates testify. The QUALMAT study seeks to improve the performance and motivation of rural health workers and ultimately quality of primary maternal health care services in three African countries Burkina Faso, Ghana, and Tanzania. One major intervention is the introduction of a computerized Clinical Decision Support System (CDSS) for rural primary health care centers to be used by health care workers of different educational levels.</p></sec><sec><title>Methods</title><p>A stand-alone, java-based software, able to run on any standard hardware, was developed based on assessment of the health care situation in the involved countries. The software scope was defined and the final software was programmed under consideration of test experiences. Knowledge for the decision support derived from the World Health Organization (WHO) guideline “Pregnancy, Childbirth, Postpartum and Newborn Care; A Guide for Essential Practice”.</p></sec><sec><title>Results</title><p>The QUALMAT CDSS provides computerized guidance and clinical decision support for antenatal care, and care during delivery and up to 24 hours post delivery. The decision support is based on WHO guidelines and designed using three principles: (1) Guidance through routine actions in maternal and perinatal care, (2) integration of clinical data to detect situations of concern by algorithms, and (3) electronic tracking of peri- and postnatal activities. In addition, the tool facilitates patient management and is a source of training material. The implementation of the software, which is embedded in a set of interventions comprising the QUALMAT study, is subject to various research projects assessing and quantifying the impact of the CDSS on quality of care, the motivation of health care staff (users) and its health economic aspects. The software will also be assessed for its usability and acceptance, as well as for its influence on workflows in the rural setting of primary health care in the three countries involved.</p></sec><sec><title>Conclusion</title><p>The development and implementation of a CDSS in rural primary health care centres presents challenges, which may be overcome with careful planning and involvement of future users at an early stage. A tailored software with stable functionality should offer perspectives to improve maternal care in resource-poor settings.</p></sec><sec><title>Trial registration</title><p><ext-link ext-link-type="uri" xlink:href="http://www.clinicaltrials.gov/NCT01409824">http://www.clinicaltrials.gov/NCT01409824</ext-link>.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Hogan, Mc" uniqKey="Hogan M">MC Hogan</name></author><author><name sortKey="Foreman, Kj" uniqKey="Foreman K">KJ Foreman</name></author><author><name sortKey="Naghavi, M" uniqKey="Naghavi M">M Naghavi</name></author><author><name sortKey="Ahn, Sy" uniqKey="Ahn S">SY Ahn</name></author><author><name sortKey="Wang, M" uniqKey="Wang M">M Wang</name></author><author><name sortKey="Makela, Sm" uniqKey="Makela S">SM Makela</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Ten Hoope Bender, P" 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