Implementation of the Risk Factor Identification and the Modified Early Obstetric Warning Signs tools for early detection and management of critically ill Obstetric Patients at 4 District Hospital in Rwanda.

Abstract

Background: The maternal mortality rate remains high in Rwanda and most deaths occur in patients from District Hospitals (DHs) to Referral Hospitals (RHs). Anticipation and timely diagnosis may improve the outcome. The Risk Factor Identification (RI) and Modified Early Obstetric Warning Sign (MEOWS) are easy and effective tools in that regard but have not been evaluated in Rwanda. We evaluated their feasibility in DHs in Rwanda and determined the role of the MEOWS tool in predicting morbidity as defined by RI.

Objectives: 1) To determine the feasibility of RI and MEOWS in DHs in Rwanda. 2) To determine the association between the MEOWS tool and morbidity as defined by RI tool.

Methods: A cross-sectional study was conducted from January to June 2019. Enrolled patients were from 4 district hospitals. For the feasibility we checked the completion rate of the tools. Data was entered into Excel and analyzed with SPSS 23. Prediction for accuracy of MEOWS and RI was calculated.

Results: Among 478 RI and MEOWS forms used, 75.9% forms were fully completed suggesting adequate feasibility. In addition, the MEOWS predicted morbidity with a sensitivity of 28.9%, a specificity of 93.5%, a PPV of 36.1%, a NPV of 91.1%, an accuracy of 86.2%, and a relative risk of 4.1 (95% Confidential Interval (CI), 2.4-7.1). When asked about challenges faced during the use of the RI and MEOWS tool, most of the respondents reported that the tool was long, the staff to patient ratio was low, the English language the forms were printed in was a barrier, and the printed forms were sometimes not available.

Conclusion: The use of the RI and MEOWS tool is feasible in DHs in Rwanda. In addition, having a moderate or high score on the MEOWS tool predicts morbidity. After consideration of the local context, this tool can be adapted and considered for scale up to other DHs in Rwanda or other low-resource settings