Research

Accessing safe deliveries in Tanzania (ASDIT)

Dr. John LeBlanc led the “Accessing safe deliveries in Tanzania (ASDIT)” project which had an overarching goal to reduce maternal and neonatal morbidity and mortality in Tanzania. The project aimed to identify the requirements of scaling up Comprehensive Emergency Obstetrical and Newborn Care (CEMONC) in Tanzania by studying its implementation in selected health centres. The Dalhousie research team was comprised of Dr. John LeBlanc, Dr. Heather Scott, Dr. Ron George, Dr. Doug McMillan and Shawna O’Hearn.

Tanzanian Training Centre for International Health – TTCIH[SE1]

For more information, contact Dr. John LeBlanc (john.leblanc@dal.ca)

Global women's health education in Canadian obstetrics and gynaecology residency programs: A survey of program directors and senior residents

In the field of obstetrics and gynaecology, little is known about global health education and interest within residency programs. An online survey was administered to program directors and senior residents across Canada to determine 1) current global health teaching and support; 2) the importance of global health to residents and program directors; and 3) the level of interest in a national postgraduate global women's health curriculum. The results show that ObGyn senior residents and program directors feel that global health education is important for all trainees and is currently insufficient. There is a high level of interest in a national postgraduate global women's health curriculum. Our research team consists of Heather Millar (University of Toronto), Elizabeth Randle (Dalhousie University), Heather Scott (Dalhousie University), Dorothy Shaw (University of British Columbia), Nancy Kent (University of British Columbia), Amy Nakajima (University of Ottawa), and Rachel Spitzer (University of Toronto).

You can read the publication here.

A maternal device for the prevention of stillbirth and low birth-weight

Dalhousie medical student Allan Kember was awarded a Grand Challenges Canada Stars in Global Health grant to pursue research into the prevention of stillbirth and low birth weight. Every year, approximately 2.6 million stillbirths (SB) occur and 20 million low birth-weight (LBW) babies are born worldwide. The vast majority of these cases occur in low- and middle-income countries. Sub-Saharan Africa has the highest rate of SB globally and has made the least progress in reducing this number. Similarly, this region has some of the highest rates of LBW in the world. Recently, several studies have identified sleeping on the back during pregnancy as a potential risk factor for having SB or LBW baby. This is a significant correlation, since the majority of 2nd and 3rd trimester pregnant women spend up to 25% of their sleeping time on their back.

Allan and his team from GIRHL, through the support of ICChange, tested a simple, low-cost, and easy-to-implement device that can mitigate this risk factor, which may be one of the keys to enabling an unprecedented reduction in the global burden of SB and LBW. The device, called PrenaBelt, is designed specifically for use by pregnant women while sleeping. The PrenaBelt causes subtle pressure points when a pregnant woman rolls onto her back. These pressure points activate the body’s natural response to spontaneously relieve this pressure by changing position to her side. This approach is known as "positional therapy" and is commonly used in the practice of sleep medicine.  Allan Kember's Dalhousie Research in Medicine project, supervised by Dr. Heather Scott, tested this device in Ghana.

You can read the publication here. 

Research Team: Aditi Sivakumar, Karla Willows, Jocelyn Stairs

Objective: The Newcomer Well Woman Clinic (NWWC) is a specialized clinic that was developed as a partnership between primary care physicians and obstetrics and gynaecology residents to ensure timely provision of sexual and reproductive healthcare for refugee patients in Halifax, Nova Scotia. Since 2015, NWWC has provided monthly clinics offering contraceptive counselling, cervical cancer screening, and intrauterine device insertions with accompanying education sessions. This study aimed to evaluate women’s experiences at the clinic and with interpretation services.

Methods: A sample of patients who attended appointments at the NWWC between January 2015-December 2020 were contacted and invited to participate in a telephone survey facilitated by a translator to evaluate their clinic experience. The survey was adapted from two validated survey measures: the PSQ-18 and CAHPS. Survey results were reported using descriptive statistics. Clinic audit data was used to summarize patient demographics and service delivery during this period. 

Results: Since 2015, 288 patients attended the clinic. Despite the pandemic, the number of appointments increased annually. 76% (50/66) of eligible invitees consented to participate. Most patients were satisfied (10%) or highly satisfied (74%) with their care and found the education sessions helpful (80%). Frequently requested education topics included cervical cancer prevention (54%) and contraception (36%). 80% of patients used an interpreter at the clinic and 78% felt that their concerns were always or usually conveyed appropriately to the physician.

Conclusion: Refugee patients were highly satisfied by the sexual and reproductive healthcare provided by the NWWC and with interpretation services. To meet the needs of refugees, innovative care models such as the NWWC could be adopted by healthcare providers.     

Research Team: Adolph L, Pinkrah R, Walawah D, Amewadzi, Merson A, Ofori P, Slaunwhite J, Anane-Fenin B, Agbeno E, George RB, Scott H

Background: This study assesses the ability of a system of standardized obstetric emergency triage assessment and treatment (ETAT) to improve documentation of triage assessment – a proxy measure for triage quality – at the obstetrical unit at Cape Coast Teaching Hospital (CCTH). 

Methods: We conducted a pre/interim/post study of women presenting to CCTH obstetrical unit. Data were collected via chart reviews of consecutive women presenting at three discrete intervals: prior to ETAT training (PRE); after ETAT training (INT); and after ETAT re-training (PST). At each interval, documentation rates for ten key triage history elements were recorded. The mean documentation rate of all history elements combined at each interval was compared using a one-way ANOVA.

Documentation rates of each element at each interval were compared using a Chi-squared test. The analysis was stratified by pregnancy/postpartum status because some history elements were not applicable to the postpartum patient.

Findings: Charts of pregnant (118 PRE, 121 INT, 133 PST) and postpartum (8 PRE, 8 INT, 8 PST) patients were included. In the pregnant group, the documentation rate of all elements increased over the two training periods (χ²ps<0.05). The mean number of elements documented increased between the PRE and INT periods (p<0.001), decreased between the INT and PST periods (p=0.047), but did not significantly differ between the PRE and PST period (p=0.349). In the postpartum group, the rates of documentation of per-vaginal loss, vitals and care plan increased over the two training periods (χ² p<0.05), while this was non-significant or inconclusive for the remaining elements.

Interpretation: These data support the efficacy of the ETAT training system implemented at CCTH, with the greatest improvement in documentation seen after its first implementation. Our results therefore suggest that there may be some benefit to more regular, and potentially earlier, retraining given the drop-off in documentation rates between the INT and the PST periods.

Triage System graphic

Research Team: Emma Sumner, Heather Scott, Catherine Craig, Jerry Coleman, Henry Kumi

Objective: We evaluated low-fidelity simulation as a feasible and effective method of improving resident knowledge and confidence in managing postpartum hemorrhage (PPH) in a low-resource setting.

Methods: We conducted a pre/post study of a PPH simulation exercise at Korle Bu Hospital in Accra, using a low-fidelity birthing simulator and questionnaires. Confidence and knowledge in PPH management were measured before and after using 5-point Likert scales and multiple- choice questions. A feedback survey was administered. Descriptive statistics were calculated to summarize demographics, confidence, and knowledge, with frequencies, percentages, means and standard deviations reported. Statistical significance of the change in scores was assessed using paired t tests.

Results: 35 residents participated. Mean confidence scores across all items increased from 3.5 before the intervention to 4.6 after, for a mean increase of 1.0 (95% CI, 0.9 – 1.2). Mean knowledge scores increased from 8.1 to 9.4 for a mean increase of 1.3 (95% CI, 0.9 – 1.6). All 35 participants agreed the simulation was educational, relevant and realistic, and 94% felt simulation could be incorporated into their training.

Conclusion: Immediate improvements in knowledge and confidence in managing PPH were evident following a simulation exercise. It was well received and was considered an effective training method by participants.

The Department of Obstetrics and Gynaecology and the Department of Anesthesia at Dalhousie University are partnering with Western University (London, Ontario) on a project funded by Global Affairs Canada : “Training, Support and Access Model for MNCH in Rwanda and Burundi”.  This project seeks to strengthen systems to improve access to health services and improve health care delivery through training and support of health care workers.  As part of this project, the Department of Obstetrics and Gynaecology and the Department of Anesthesia at Dalhousie have proposed a collaboration to develop and implement mentorship programs to support the implementation of the Safe Childbirth Checklist in Rwanda.