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Posts Tagged ‘‘unbooked case’’

Innovative Solutions for Reducing Maternal Mortality – Nigeria

Saturday, November 13th, 2010

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Imagine the scenario: Sharifah[i] got pregnant and in accordance with the advice from her mother and other women in the village, she went to the local ‘midwife’, the lady who has looked after and delivered all the women in the community. Of course, Sharifah knew there might be problems, she knew of women who had lost their lives or their babies, but she was hopeful…she was young, strong and in love. She did everything the ‘midwife’ told her and she made sure she did not overeat, so her baby would not be too big to deliver. When she was full term and the contractions changed from the passing discomfort to purposeful strong contractions with shortening time intervals, Sharifah moved into the ‘midwife’s’ back room. She labored through the night, into the next day and night. She got exhausted, there was no progress being made. Sharifah’s husband was very worried and finally took a decision to take her to the comprehensive clinic in the next town.

Sharifah arrived at the comprehensive clinic, exhausted, moribund and in obvious distress. The receiving nurse took a history – it was painfully short of details. What was her state of health when she got pregnant? Did anyone know her blood pressure at the time of booking for antenatal care? Had she had any immunizations? Bleeding episodes? Swelling of the feet? Headaches? Fever? Did anyone know anything about her past medical history? Typically, no. Sharifah was the quintessential ‘unbooked case’. Her blood pressure on arrival at the clinic was 130/85; but that was no indication of whether it was high or normal since it could not be compared with her regular BP (which in her case was usually 90/60!). The doctors and nurses battled through the night, with Sharifah and other cases that kept pouring in… patients that the clinic staff clearly prioritized because they were booked.

The outcome? It could all have been so different…if Sharifah had been given a home-based Personal Health Record© [PHR©]. The PHR© is issued to the pregnant mother when she presents for her first visit at the antenatal clinic, it tracks the progress of the pregnancy, delivery, immediate post-natal period and then monitors the growth and development of the child until his/her fifth birthday. As it happened in Sharifah’s case, very often mothers-to-be get antenatal care at a place near their homes, with a person of variable training, but with whom the pregnant mother is very comfortable and in whom she has complete trust. When the delivery becomes complicated, they are then rushed to larger facilities where they are treated as ‘unbooked’ cases. The healthcare workers have little or no prior knowledge of their health status, the mothers, being largely health-illiterate, are unable to offer much accurate credible information and at the end of the day, it becomes a very frustrating time and more likely to produce a poor outcome. They are also more likely to suffer from abusive behaviour during the delivery process. The main purpose of the PHR© is that the holder has his/her medical records to hand at the point of service.

In many LMICs[ii], there is very often poor logistics for handling case notes as well as all the details of lab results, consultation notes, prescriptions, in-patient and out-patient records, ensuring that all the information gets filed in the right case-notes at the right time and can be quickly and easily retrieved when needed. All too often patients get to the facility and their case-notes are misfiled or simply in the wrong place, leaving the poor harassed HCW[iii] with little or no past medical history to review. The Nigerian Integrated MNCH Personal Health Record [PHR©] was developed by the Wellbeing Foundation in collaboration with the Federal Ministry of Health, the Perinatal Institute UK, WHO, relevant agencies and stakeholders to meet the peculiar needs of the country. The PHR© uses pictorial illustrations, have WHO-approved growth charts and use optical character recognition [OCR] for electronic capture of data which is available to health and authorized agencies to collate data. In the case of multiple births, a second (and third) book is simply issued at birth. The book is A5 in size, uses a file format and has a plastic cover. Of course, it is coloured green to denote national ownership and has been nicknamed the “Nigerian health passport”. Though still in the initial roll-out stage, it has so far had a positive response especially among the HCWs who have all the needed information to hand immediately the patient presents.

There are similar concepts in Malaysia, Japan and even the UK ‘red book’. The presence of WHO health information pages at the back of the book assist in teaching mothers easily used home management therapies for common endemic health problems such as infantile diarrhea, malaria and how to prevent infection with HIV/AIDS. The PHR© also permits the dissemination of important health information regarding home and community management of common conditions. For countries that face technological challenges, this simple tool that is not immediately dependant on electrical power (which makes mobile health apps a little less efficient in our present circumstances) but can still be electronically captured for data management offers a way out.

[i] Not her real name
[ii] Low and Middle Income Countries
[iii] Health Care Worker(s)

by
Dr Alero Ann Roberts BSc, MBBS, MPH FMCPH