Population Council Projects | Improving Delivery and Postpartum Practices for Normal Labor in Cairo, Egypt: An Intervention Study

PROJECT
Improving Delivery and Postpartum Practices for Normal Labor in Cairo, Egypt: An Intervention Study

Substandard care has been identified by the Egyptian Ministry of Health and Population as the leading avoidable factor contributing to maternal deaths in Egypt. Understandably, most studies have focused on the management of obstetric emergencies, with the result that there is very little information on common facility practices for normal labor that can have serious consequences for mothers in labor and their babies. In 2001, Council researchers conducted a study that for the first time comprehensively documented practices for normal labor in a busy teaching hospital in Egypt (see "An Observational Study of Facility Practices for Normal Labor in Egypt"). A multifaceted observational methodology was used to observe 176 women from admission to discharge. Both quantitative and qualitative data were collected.

The findings from the study were worrying, with implications for the quality of obstetric care provided and its divergence from evidence-based practice and what is known of the factors contributing to maternal and neonatal mortality and morbidity in Egypt. The site of the study—El Galaa Teaching Hospital—is Egypt’s most influential teaching hospital. It trains over 200 obstetricians annually, and providers there face challenges that are not unique to the facility but are shared by many professionals in similar developing-country situations. It was felt that an intervention exploring approaches to encourage appropriate obstetric management in the service-delivery context would contribute valuable lessons for providers and policymakers within as well as beyond Egypt who face similar service-delivery obstacles.

To improve selected delivery and postpartum practices of obstetric providers at El Galaa in line with evidence-based best practice, Council researchers aimed to design, implement, and evaluate a training approach to decrease specific harmful delivery and postpartum practices for normal labor. Providers in training in the hospital’s nonpaying delivery and postpartum wards were trained in collaboration with the facility’s service providers and administrators.

The specific goal of this research is to decrease the frequency of practices known to contribute directly to maternal and neonatal mortality and morbidity by 60 percent and to decrease the frequency of all other harmful practices related to information-sharing and behavioral attitudes by 40 percent, (as compared to earlier findings) by the intervention’s end.

The intervention has been completed, and data are currently being analyzed.

Location

El Galaa Teaching Hospital, Cairo, Egypt

Duration

January 2004–December 2004

Population Council researcher

Miral Breebaart

Non-Council collaborators

Mohamed Cherine, consultant (El Galaa Teaching Hospital)

Nevine Hassanein, consultant (John Snow Inc.)

Amr Elnoury (National Laser Institute, Cairo University)

Donors