Bottom-up development of national obstetric guidelines in middle-income country Suriname

Obstetric guidelines are useful to improve the quality of care. Availability of international guidelines has rapidly increased, however the contextualization to enhance feasibility of implementation in health facilities in low and middle-income settings has only been described in literature in a few...

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Bibliographic Details
Published in:	BMC health services research Vol. 19; no. 1; p. 651
Main Authors:	Verschueren, Kim J C, Kodan, Lachmi R, Brinkman, Tom K, Paidin, Raez R, Henar, Sheran S, Kanhai, Humphrey H H, Browne, Joyce L, Rijken, Marcus J, Bloemenkamp, Kitty W M
Format:	Journal Article
Language:	English
Published:	England BioMed Central Ltd 09-09-2019 BioMed Central BMC
Subjects:	Analysis Childbirth & labor Clinical guidelines Clinical medicine Clinical practice guidelines Contextually-tailored guidelines Control Female Health aspects Health care industry Health Care Surveys Health services Hemorrhage Hospitals Human subjects Humans Hypertension Hypertensive disorders of pregnancy International organizations Locally adapted guidelines Low income groups Maternal Health Services - statistics & numerical data Maternal mortality Maternal Mortality - trends Medical care Medical care quality Medical diagnosis Medical students Middle-income country Midwifery Obstetric Labor Complications - mortality Obstetrics Patient care Post partum hemorrhage Practice Practice guidelines (Medicine) Practice Guidelines as Topic Pregnancy Pregnancy Complications - mortality Quality Quality management Questionnaires Suriname Suriname - epidemiology Womens health Suriname Contextually-tailored guidelines Clinical guidelines Locally adapted guidelines Suriname Post partum hemorrhage Hypertensive disorders of pregnancy Middle-income country
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Summary:	Obstetric guidelines are useful to improve the quality of care. Availability of international guidelines has rapidly increased, however the contextualization to enhance feasibility of implementation in health facilities in low and middle-income settings has only been described in literature in a few instances. This study describes the approach and lessons learned from the 'bottom-up' development process of context-tailored national obstetric guidelines in middle-income country Suriname. Local obstetric health care providers initiated the guideline development process in Suriname in August 2016 for two common obstetric conditions: hypertensive disorders of pregnancy (HDP) and post partum haemorrhage (PPH). The process consisted of six steps: (1) determination of how and why women died, (2) interviews and observations of local clinical practice, (3) review of international guidelines, (4) development of a primary set of guidelines, (5) initiation of a national discussion on the guidelines content and (6) establishment of the final guidelines based on consensus. Maternal enquiry of HDP- and PPH-related maternal deaths revealed substandard care in 90 and 95% of cases, respectively. An assessment of the management through interviews and labour observations identified gaps in quality of the provided care and large discrepancies in the management of HDP and PPH between the hospitals. International recommendations were considered unfeasible and were inconsistent when compared to each other. Local health care providers and stakeholders convened to create national context-tailored guidelines based on adapted international recommendations. The guidelines were developed within four months and locally implemented. Development of national context-tailored guidelines is achievable in a middle-income country when using a 'bottom-up' approach that involves all obstetric health care providers and stakeholders in the earliest phase. We hope the descriptive process of guideline development is helpful for other countries in need of nationwide guidelines.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1472-6963 1472-6963
DOI:	10.1186/s12913-019-4377-6