Advertisement

Canadian Journal of Public Health

, Volume 108, Issue 4, pp 448–451 | Cite as

Adapting maternal health practice to co-morbidities and social inequality: A systematic approach

  • Aditi IyerEmail author
  • V. Srinidhi
  • Anuradha Sreevathsa
  • Gita Sen
Commentary

Abstract

The process of adapting universal guidelines to local institutional and cultural settings is recognized as important to their implementation and uptake. However, clarity on what, why and how to adapt in an evidence-based manner is still somewhat elusive. Health providers in low and middle income country contexts often have to deal with widely present co-morbidities and social inequalities among pregnant women. Since neither of these problems finds adequate discussion within the usual guidelines, and given the continual pressures posed by resource scarcity, health providers respond through ad hoc adaptations inimical to maternal safety and equity. We argue for, and describe, a grounded process of systematic adaptation of available guidelines through the example of a handbook on maternal risks for primary care doctors and staff nurses. The systematic adaptation in this practical, action-oriented handbook builds on research for a long-standing community-based project on maternal safety and rights. It takes a case-based problem-solving approach. Reiterating guidelines and best practices in diagnostic decision-making and risk management, it indicates how these can respond to co-morbidities and social inequality via complex clinical cases and new social science information.

Key words

Maternal health best practices guidelines co-morbidity social inequality capacity building 

Mots Clés

santé maternelle pratiques exemplaires directives comorbidité; inégalité sociale; r enforcement des capacités 

Résumé

Il est reconnu que le processus d’adaptation des directives universelles aux milieux institutionnels et culturels locaux importe pour l’application et l’adoption de ces directives. Quoi adapter, pourquoi le faire et comment s’y prendre en se fondant sur les preuves sont toutefois des questions auxquelles il n’existe pas de réponses claires. Les personnels de santé des pays à faible revenu et à revenu intermédiaire doivent souvent composer avec des comorbidités et des inégalités sociales largement répandues chez les femmes enceintes. Comme ces deux problèmes sont insuffisamment abordés dans les directives habituelles, et devant les pressions continuelles exercées par la rareté des ressources, les personnels de santé répondent par des adaptations ponctuelles parfois contraires à la sécurité des mères et à l’équité. Nous promulguons et décrivons un processus bien rodé d’adaptation systématique des directives disponibles en citant l’exemple d’un guide sur les risques maternels rédigé à l’intention des médecins de premier recours et des infirmières de soins généraux. Les adaptations systématiques présentées dans ce guide pratique et pragmatique tirent parti de la recherche effectuée pour un ancien projet communautaire sur la sécurité et les droits des mères. Le guide emploie une méthode de résolution de problèmes au cas par cas. En répétant les directives et les pratiques exemplaires en matière de décisions diagnostiques et de gestion des risques, le guide indique comment elles peuvent répondre aux comorbidités et aux inégalités sociales en les illustrant par des cas cliniques complexes et de nouvelles données de sciences sociales.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    The ADAPTE Collaboration. The ADAPTE Process: The Resource Toolkit for Guideline Adaptation. Version 2, 2009. Available at: http://www.g-i-n.net (Accessed October 22, 2016).Google Scholar
  2. 2.
    Graham ID, Logan J, Harrison MB, Straus SE, Tetroe J, Caswell W, Robinson N. Lost in knowledge translation: Time for a map? J Contin Educ Health Prof2006; 26(1):13–24. PMID: 16557505. doi: 10.1002/chp.47.CrossRefGoogle Scholar
  3. 3.
    World Health Organization. WHO Handbook for Guideline Development, 2nd, ed. Geneva, Switzerland: WHO, 2014.Google Scholar
  4. 4.
    WHO. WHO Handbook for Guideline Development. Geneva, Switzerland: WHO, 2012.Google Scholar
  5. 5.
    Puchalski Ritchie LM, Khan S, Moore JE, Timmings C, van Lettow M, Vogel JP, et al. Low- and middle-income countries face many common barriers to implementation of maternal health evidence products. J Clin Epidemiol 2016; 76:229–37. PMID: 26931284. doi: 10.1016/j.jclinepi.2016.02.017.CrossRefGoogle Scholar
  6. 6.
    Gender and Health Equity Project. Identifying and Addressing Maternal Risks: A Handbook for Healthcare Providers. Bangalore, India: Indian Institute of Management Bangalore, 2015. Available at: https://www.phfi.org/images/pdf/identifying_and_assessing_maternal_risks.pdf (Accessed October 30, 2016).Google Scholar
  7. 7.
    George A, Iyer A, Sen G. Gendered Health Systems Biased Against Maternal Survival: Preliminary Findings from Koppal, Karnataka, India. Brighton, Sussex, UK: Institute of Development Studies; IDS Working Paper 253.Google Scholar
  8. 8.
    Shankar M, Reddy B. Anaemia in pregnancy still a major cause of morbidity and mortality: Insights from Koppal district, Karnataka, India. Reprod Health Matters 2012;20(40):67–68. PMID: 23245410. doi: 10.1016/S0968-8080(12) 40669-3.CrossRefGoogle Scholar
  9. 9.
    Iyer A, Sen G, Sreevathsa A, Varadan V. Verbal autopsies of maternal deaths in Koppal, Karnataka: Lessons from the grave. BMC Proc 2012;6(Suppl 1):P2. doi: 10.1186/1753-6561-6-S1-P2.CrossRefGoogle Scholar
  10. 10.
    Shankar M, Srinidhi V. Deconstructing clinical knowledge of obstetric care at the primary level: Insights from rural Karnataka, India. Paper presented at the Social Science and Medicine Conference Health Systems in Asia 2013: Equity, Governance and Social Impact, December 14, 2013; Singapore: National University of Singapore, 2013.Google Scholar
  11. 11.
    Maternal Health Division. Guidelines for Pregnancy Care and Management of Common Obstetric Complications by Medical Officers. New Delhi, India: Department of Family Welfare, Ministry of Health & Family Welfare, Government of India, 2005.Google Scholar
  12. 12.
    Maternal Health Division. Trainees’ Handbook for Training of Medical Officers in Pregnancy Care and Management ofCommon Obstetric Complications. New Delhi, India: Department of Family Welfare, Ministry of Health & Family Welfare, Government of India, 2009.Google Scholar
  13. 13.
    Maternal Health Division. Workbook for Training ofMedical Officers in Pregnancy Care and Management of Common Obstetric Complications. New Delhi, India: Department of Family Welfare, Ministry of Health & Family Welfare, Government of India, 2009.Google Scholar
  14. 14.
    WHO. Pregnancy, Childbirth, Postpartum and Newborn Care: A Guide for Essential Practice. Geneva, Switzerland: WHO, 2003.Google Scholar
  15. 15.
    WHO, UNFPA, UNICEF, World Bank. Managing Complications in Pregnancy and Child Birth: A Guide for Midwives and Doctors. Geneva, Switzerland: WHO, 2007.Google Scholar

Copyright information

© The Canadian Public Health Association 2017

Authors and Affiliations

  • Aditi Iyer
    • 1
    Email author
  • V. Srinidhi
    • 1
  • Anuradha Sreevathsa
    • 1
  • Gita Sen
    • 1
  1. 1.Ramalingaswami Centre on Equity and Social Determinants of Health, Public Health Foundation of IndiaEpidemic Diseases Hospital CompoundIndiranagarIndia

Personalised recommendations