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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; 

ABSTRACT

Background:

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

Objective:

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.

Methods:

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.

Results:

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.

Conclusions:

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.


 Citation

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

URL: https://preprints.jmir.org/preprint/17056


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