Implementation and Evaluation of Two Community-Based Interventions to Reduce Maternal Morbidity and Mortality in Rural Rwanda
With research support provided by the US Fulbright African Regional Research Program and a pilot research grant awarded by the Einstein Global Health Center, a prospective cohort study was begun to access the impact of a Mobile Reproductive Health Team in rural communities neighboring Kibogora, Rwanda.
A total of 50 villages are included in this study. In the control community, all reproductive health services are provided as per the protocols of the Rwandan Ministry of Health, via a single community health post, providing ambulatory care only. In the first intervention community, we have augmented this care model by adding a Birthing Center, which is located in close proximity to the existing community health post. In the second intervention community, we have augmented the care through the establishment of a Mobile Reproductive Health Team that provides antenatal and postnatal care, family planning, and VCT/PMTCT. In addition, for all pregnant women, team members are instructed to provide detailed birth planning assistance.
The primary goal of this study is to assess the extent to which these new interventions can increase the rate of attended deliveries and improve maternal and newborn outcomes.
Teaching Obstetric Emergency Management: A Global Health Training of the Trainers Program
As detailed on the Rwandan Programs page, a site-specific “Training of Trainers” emergency obstetric simulation training program has been implemented a the district hospital in Kibogora, Rwanda. Our primary research objectives with this program are to compare knowledge, skill and confidence of the Trainers before and after participation in the Training of Trainers program. Additional secondary objectives include:
- Assessment of the ability of the new Trainers to implement a site-specific emergency obstetric simulation-training program at Kibogora District Hospital for their fellow physicians, nurses, and midwives on the maternity ward
- Comparison of knowledge, skill and confidence of the physicians and nurses, and midwives before and after participation in the site-specific emergency obstetric simulation-training program
Implementation of Obstetrical Checklists in a Rural African Hospital
In the field of Obstetrics, very few studies have been conducted to examine the effectiveness of checklist utilization in a hospital maternity department. No studies have looked exclusively at implementing checklists for obstetric care on maternity wards in resource-poor settings. We are thus implementing the following checklists at Kibogora District Hospital: Obstetric hemorrhage; Pre-eclampsia/Eclampsia; Oxytocin utilization; and Cesarean section. Our objectives are to determine the impact on maternal and neonatal outcomes after checklist implementation. In addition, implementation research will be conducted to evaluate proper use and adherence to the checklists.
Engaging Youth in the Design of an Adolescent Sexual Health Program: Implementation and Evaluation of Knowledge and Behavior
In March 2011, we conducted a reproductive health needs assessment at two neighboring secondary schools in Kibogora, Rwanda. Our goal was to determine the perceived reproductive health education and service needs of the students and utilize the results in the design and implementation of a youth-friendly adolescent sexual health program. After analyzing the results, the final elements of the program are the following:
- Didactic – lecture and question and answer-style sessions with students, teachers, parents
- Hands-on/Practical - field trips to local health care facilities, demonstrations
- Anonymous – question drop boxes and email
- Youth Friendly reproductive health services - on-site services at the schools and on field-trip days, students can opt to stay and receive services
In an effort to maximize sustainability of the program and utilization of services, we specifically focused on two key aspects of this program:
- Training of teachers at the two secondary schools to implement and incorporate the sexual health program into their current school curriculum
- Creation of an adolescent friendly atmosphere at the health center so students feel comfortable accessing reproductive health care
We are currently in the implementation phase of this program. The following outcomes will be evaluated upon completion: Sexual health knowledge; utilization of reproductive health services; and utilization of available methods of contraception.