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Scale-Up of Doppler to Improve Intrapartum Fetal Heart Rate Monitoring in Tanzania: A Qualitative Assessment of National and Regional/District Level Implementation Factors

Citation

Plotkin, Marya; George, John; Bundala, Felix; Tibaijuka, Gaudiosa; Njonge, Lusekelo; Lemwayi, Ruth; Drake, Mary; Bishanga, Dunstan; Rawlins, Barbara; & Ramaswamy, Rohit, et al. (2020). Scale-Up of Doppler to Improve Intrapartum Fetal Heart Rate Monitoring in Tanzania: A Qualitative Assessment of National and Regional/District Level Implementation Factors. International Journal of Environmental Research and Public Health, 17(6), 1931. PMCID: PMC7142453

Abstract

High-quality intrapartum care, including intermittent monitoring of fetal heart rates (FHR) to detect and manage abnormalities, is recommended by WHO and the Government of Tanzania (GoT) and creates potential to save newborn lives in Tanzania. Handheld Doppler devices have been investigated in several low-resource countries as an alternative to Pinard stethoscope and are more sensitive to detecting accelerations and decelerations of the fetal heart as compared to Pinard. This study assessed perspectives of high-level Tanzanian policymakers on facilitators and barriers to scaling up use of the hand-held Doppler for assessing FHR during labor and delivery. From November 2018-August 2019, nine high-level policymakers and subject matter experts were interviewed using a semi-structured questionnaire, with theoretical domains drawn from Proctor's implementation outcomes framework. Interviewees largely saw use of Doppler to improve intrapartum FHR monitoring as aligning with national priorities, though they noted competing demands for resources. They felt that GoT should fund Doppler, but prioritization and budgeting should be driven from district level. Recommended ways forward included learning from scale up of Helping Babies Breathe rollout, making training approaches effective, using clinical mentoring, and establishing systematic monitoring of outcomes. To be most effective, introduction of Doppler must be concurrent with improving case management practices for abnormal intrapartum FHR. WHO's guidance on scale-up, as well as implementation science frameworks, should be considered to guide implementation and evaluation.

URL

http://dx.doi.org/10.3390/ijerph17061931

Reference Type

Journal Article

Journal Title

International Journal of Environmental Research and Public Health

Author(s)

Plotkin, Marya
George, John
Bundala, Felix
Tibaijuka, Gaudiosa
Njonge, Lusekelo
Lemwayi, Ruth
Drake, Mary
Bishanga, Dunstan
Rawlins, Barbara
Ramaswamy, Rohit
Singh, Kavita
Wheeler, Stephanie B.

Year Published

2020

Volume Number

17

Issue Number

6

Pages

1931

PMCID

PMC7142453

Reference ID

13050