Abstract
BackgroundDespite reaching Millennium Development Goal (MDG) 3, the maternal mortality rate (MMR) is still high in Rwanda. Most deaths occur after transfer of patients with obstetric complications from district hospitals (DHs) to referral hospitals; timely detection and management may improve these outcomes. The RI and MEOWS tool has been designed to predict morbidity and decrease delay of transfer. Our study aimed: 1) to determine if the use of the RI and MEOWS tool is feasible in DHs in Rwanda and 2) to determine the role of the RI and MEOWS tool in predicting morbidity.MethodsA cross-sectional study enrolled parturient admitted to 4 district hospitals during the study period from April to July 2019. Data was collected on completeness rate (feasibility) to RI and MEOWS tool, and prediction of morbidity (hemorrhage, infection, and pre-eclampsia).ResultsAmong 478 RI and MEOWS forms used, 75.9% forms were fully completed suggesting adequate feasibility. In addition, the RI and MEOWS tool showed to predict morbidity with a sensitivity of 28.9%, a specificity of 93.5%, a PPV of 36.1%, a NPV of 91.1%, an accuracy of 86.2%, and a relative risk of 4.1 (95% Confidential Interval (CI), 2.4–7.1). When asked about challenges faced during use of the RI and MEOWS tool, most of the respondents reported that the tool was long, the staff to patient ratio was low, the English language was a barrier, and the printed forms were sometimes unavailable.ConclusionThe RI and MEOWS tool is a feasible in the DHs of Rwanda. In addition, having moderate or high scores on the RI and MEOWS tool predict morbidity. After consideration of local context, this tool can be considered for scale up to other DHs in Rwanda or other low resources settings.Trial registrationThis is not a clinical trial rather a quality improvement project. It will be registered retrospectively.
Highlights
Despite reaching Millennium Development Goal (MDG) 3, the maternal mortality rate (MMR) is still high in Rwanda
In 2015, PostPartum Hemorrhage (PPH) and sepsis accounted for 46% of maternal deaths in Rwanda; more than 70% of deaths occurred in teaching and district hospitals, and 64% of deaths occurred during the postpartum period [3]
Studies done in Ireland and Zimbabwe reported an improvement in the time interval between trigger and antibiotic administration, and preoperative stabilization of women undergoing caesarean section following the implementation of the Early Warning Signs (EWS) tool [4, 5]
Summary
Despite reaching Millennium Development Goal (MDG) 3, the maternal mortality rate (MMR) is still high in Rwanda. Most deaths occur after transfer of patients with obstetric complications from district hospitals (DHs) to referral hospitals; timely detection and management may improve these outcomes. Rwanda reached Millennium Development Goal (MDG) 3 (Promote gender equality and empower women), the maternal mortality rate (MMR) in the country is still high. 75% of maternal deaths are caused by the following 5 complications: hemorrhage, infections, preeclampsia and eclampsia, obstructed labor, and abortions [2] This is similar to the situation of Rwanda where these 5 common causes of maternal mortality in Rwanda have remained the same for the last decade [1]. Most maternal deaths occur after transfer of patients with obstetric complications from a DH to a RH [3] This referral system is associated with delays at each level (DH and RH). Studies done in Ireland and Zimbabwe reported an improvement in the time interval between trigger and antibiotic administration, and preoperative stabilization of women undergoing caesarean section following the implementation of the Early Warning Signs (EWS) tool [4, 5]
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