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Currently submitted to: JMIR Public Health and Surveillance

Date Submitted: Nov 18, 2019
Open Peer Review Period: Nov 14, 2019 - Jan 9, 2020
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An algorithm for monitoring childbirth in settings where tracking all parameters in the WHO partograph is not feasible: design and expert validation

  • Michael S. Balikuddembe; 
  • Peter K. Wakholi; 
  • Nazarius M. Tumwesigye; 
  • Thorkild Tylleskär; 



After determining the key childbirth monitoring items from experts in childbirth, we designed an algorithm to represent the experts’ suggestions and we validated it.


In this paper we describe the abridged algorithm for labour and delivery (LaD) management and use theoretical case to compare its performance to human childbirth experts.


The LaD algorithm encompasses the tracking of six of the 12 childbirth parameters monitored using the World Health Organisation partograph. It has recommendations on how to manage a patient when parameters are outside the normal ranges. We validated the algorithm with purposively selected experts selecting actions for a stratified sample of patient case scenarios. The experts’ selections were compared to get pairwise sensitivity and false positive rates (FPR) between them and the algorithm.


The mean weighted pairwise sensitivity among experts was 68.2% (StD. 6.95; CI. 59.6, 76.8) while that between the experts and LaD algorithm was 69.4% (StD. 17.95; CI. 47.1, 91.7). The pairwise FPR amongst the experts ranged from 12% to 33% with a mean of 23.9% (CI. 12.6, 35.2) and that between the experts and the algorithm ranged from 18% to 43% (mean 26.3%; CI. 13.3, 39.3). The was a correlation (mean of 0.67) in the actions selected by the expert pairs for the different patient cases with a reliability coefficient 0.91.


The LaD algorithm was more sensitive but with a higher FPR than the childbirth experts, although the differences were not statistically significant. An electronic tool for childbirth monitoring with fewer than WHO-recommended parameters may not be inferior to human experts in labour and delivery clinical decision support.


Please cite as:

Balikuddembe MS, Wakholi PK, Tumwesigye NM, Tylleskär T

An algorithm for monitoring childbirth in settings where tracking all parameters in the WHO partograph is not feasible: design and expert validation

JMIR Preprints. 18/11/2019:17056

DOI: 10.2196/preprints.17056


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