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BOLD Project Newsletter
Issue 2 | April 2015
INTRODUCTION
Purpose of BOLD
The Department of Reproductive Health and Research, World Health Organization, initiated the “Better Outcomes in
Labour Difficulty” (BOLD) project to accelerate the reduction of intrapartum-related maternal, fetal and newborn mortality
and morbidity. BOLD seeks to address weaknesses in the process of labour care and bridge the disconnect between the
health systems and the communities in low resource settings. This project, funded by the Bill & Melinda Gates Foundation,
seeks to achieve this goal through a two-pronged approach: (1) by developing a Simplified, Effective, Labour Monitoringto-Action tool (SELMA) to assist healthcare providers to monitor labour and take decisive actions more efficiently; and
(2) by developing innovative tools (“Passport to Safer Birth”), designed together with women, communities and healthcare
providers, to promote access to respectful, quality care during childbirth.
BOLD workflow and analysis plan
This figure depicts the BOLD workflow and analysis plan to demonstrate how
findings from the qualitative research, service design and cohort study activities
will be integrated into the development of SELMA and the Passport to Safer Birth
(the BOLD Strategy).
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BOLD Project Newsletter
Issue 2 | April 2015
PROJECT UPDATES
SELMA UPDATES
Nigeria
Data collection for SELMA effectively commenced middle of
February 2015 after a protracted industrial crisis in the health
sector. Happily, all sites have settled fully into the study and
data collection is progressing well. We have received a total
of 704 forms from all sites.
Data entry onto the database is progressing satisfactorily,
thanks to the meticulous work of Tosin Lawal. All hands
are on deck to ensure successful implementation of BOLD
Project in Nigeria.
Brazil
With data collection ongoing in Uganda and Nigeria, the
BOLD Brazil team has continued to ensure high data quality.
In the last month, new check algorithms were developed
and communication with Uganda and Nigeria teams was
considerably improved.
What is SELMA?
Labour complications are an important cause
of mortality, morbidity and long-term disabilities for both mothers and babies. Given the
current challenges with labour monitoring and
decision-making during labour and childbirth, a
Simplified, Effective, Labour Monitoring-to-Action (SELMA) tool will be developed. To do so, a
prospective cohort study is being conducted in
eight health facilities: four in Nigeria and four in
Uganda. Data from the cohort study will inform
the development of prediction models to identify women at risk of adverse intrapartum outcomes throughout the course of labour. These
prediction models will be used to assemble a
decision-support tool that can identify the best
course of action to avert poor labour outcomes.
Data are exported and checked weekly from RedCap system
in order to find missing values, logical problems and out
of bounds measures. Problems are promptly reported and
corrected in the local databases. Skype meetings are held
biweekly with the data management teams – i.e., Brazil,
Uganda and Nigeria - to clarify problems and find solutions.
Today we have a total of 2,749 records in the system: 2,326
from Uganda and 423 from Nigeria.
Uganda
Data collection in Uganda has been ongoing since December
2014. Uganda now has roughly 4,500 completed forms for
eligible cases.
Meeting with the BOLD research team at Wuse
General Hospital, Abuja
The Uganda data management team is working to enter new
forms into RedCap. They are also in the process of conducting a rapid analysis of the primary end point, to ensure that
the target sample size meets the objectives of the study.
Cross-checking the BOLD logbook with the labor
registry at Maitama District Hospital
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BOLD Project Newsletter
Issue 2 | April 2015
PROJECT UPDATES
PASSPORT TO SAFER BIRTH UPDATES
Nigeria
We are making appreciable progress with BOLD Formative
Study in Nigeria. Our teams of interviewers at all sites
continue to send positive feedback. A total of 95 in-depth
interviews have been conducted out of which 58 had been
transcribed; 22 focus group discussions have also been
conducted, with 6 transcribed thus far.
Uganda
As of 23 March, the BOLD Formative-Uganda team has
conducted a total of 77 in-depth interviews and 16 focus
group discussions across the four Uganda study sites. The
team is wrapping up the final batch of interviews and focus
groups. In the next few weeks, they are focusing on finalising
transcriptions and sharing initial insights with the research
team, led by David Kyaddondo of Makerere University.
What is the Passport for Safer Birth?
The Passport to Safer Birth will be an innovative set
of services and tools, designed together with women,
communities and healthcare providers, to promote
access to and awareness of respectful, quality care
during childbirth.
The development of the Passport to Safer Birth will
be an iterative process comprised of two activities:
primary qualitative research and service design.
These activities use innovative methods to explore
and understand needs, expectations and preferences
of women, communities and healthcare providers
regarding childbirth experiences, and the provision of
high quality labour monitoring and timely, safe and
effective interventions during labour and childbirth.
Focus group discussion with women near Akure,
Nigeria [photo credit: Ms. Olalere]
A researcher obtains consent from a woman in Nigeria
[photo credit: Ms. Ojelade]
Meeting with the BOLD research team at Maitama
District Hospital
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BOLD Project Newsletter
Issue 2 | April 2015
PROJECT UPDATES
PASSPORT TO SAFER BIRTH UPDATES
Service design
The design research team of M4ID conducted together with the local partners in Uganda and Nigeria field visits to the
different BOLD facilities and their surrounding communities in November 2014 and February 2014. Over 90 interviews
have been conducted with a diversified set of people ranging from pregnant women, husbands, mother in laws, facility staff
to religious leaders and traditional birth attendants (see all contributors on boldinnovation.org/contributors). In addition
to these, observations have been conducted at different points of the women’s journey through pregnancy and delivery
including Antenatal Care visits, Referral, Admission and Registration as well as Labour, Delivery and Postnatal Ward with
Discharge.
A group discussion with women in Uganda
Sketching ideas and thoughts after a research day
In a several weeklong process, the design team analyzed together with the local teams the observation and interview
experiences as well as the transcribed interviews. The aim was to understand different community member’s perception,
experiences and knowledge with regards to pregnancy and childbirth and identify opportunities to improve the demand
and provision of quality of care at time of birth. During the analysis process themes have been identified that represent a
focus area for the design process. For each of these themes key insights have been summarized as well as inspirations for
design and a set of opportunities. These opportunities will form the base for the co-design workshops in the next phase of
the design process, where different key stakeholders (women, men, midwives) will workshop together to create concrete
ideas for opportunities. The design team will visit Kampala in the second week of April to conduct a first set of co-design
workshops together with women, men and midwives. Participants of the workshops will be tasked with creative exercises
to ideate solutions around improving aspects of the quality of care within the facility. This can be designing an information
poster or a clear visual path for the women through the facility. Check out the next newsletter to get a glimpse on some f the
ideas that will have come up in these workshops.
Mapping of themes and insights
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Identified themes for design
BOLD Project Newsletter
Issue 2 | April 2015
BOLD NEWS
Nigeria design research field visit
BOLD site visit to Abuja
On 5 March 2015, Meghan Bohren (WHO), Bukola Fawole
and Titiloye Musibau (University of Ibadan) conducted site
visits to the three Abuja hospitals (Wuse General Hospital,
Maitama District Hospital and Asokoro District Hospital).
We met with the BOLD research teams (in particular, Dr.
Alu and Dr. Anate at Maitama, Dr. Alabi at Wuse, and Dr.
Adebayo, Dr. Osaze and Mrs. Musa at Asokoro) to review
the data collection process, compare study logbooks to birth
registries and discuss any issues related to the study. We were
pleased to see that the study teams were progressing well
with data collection and capturing all relevant cases.
In February 2015, the M4ID design team (Melanie
Wendland, Damaris Rodriguez, Reima Rönnholm and Maiju
Nöyränen) visited Nigeria to conduct similar design research
activities as in Uganda in November 2014. Dr. Bukola Fawole
hosted the team with so much dedication and effort, thank
you!! The team was accompanied by the two researchers
Mrs. Ojelade Olubunmi and Mrs. OlalereAkinfenwa,
who supported the team with conducting interviews and
observations and providing local insights. The team visited
the Maitama District Hospital in Abuja as well the Mother
& Child hospital in Akure and also spent time in adjacent
communities. After each research day, the team spent time
analysing the impressions and experiences as well as mapping
initial ideas and opportunities for service solutions. The local
team made this week a very insightful and productive visit
for the progress of the PSB activities. Thank you to all of you!
We also met with representatives of the BOLD-Abuja
formative research team at the FCT Primary Health Care
Development Board. We discussed the Abuja team’s progress
to date and developed a plan to finish data collection.
Kudos to the hard work of the Abuja BOLD teams!
The design research team with Maitama Hospital staff
Meeting to share and prioritise insights from
M4ID design research field visits
On 13 March 2015, Melanie Wendland and Mari Tikkanen
from M4ID visited Geneva to meet with the WHO study
coordinating team to share their insights and opportunities
for design from the initial design research trips to Uganda
and Nigeria. The group worked together to integrate initial
findings from the BOLD qualitative research into the design
research plan. The meeting resulted in a set of thirteen
prioritized themes to increase demand for and provision
of quality of care during childbirth, for further exploration
during the co-design phase.
Meeting with the BOLD research team at Asokoro
District Hospital
RECENT BOLD ACTIVITIES
UPCOMING BOLD ACTIVITIES
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Nigeria initial design trip to Abuja and Akure: 23-27
February 2015
Site visit to Abuja hospitals – 5 March 2015
Site visit to Abuja BOLD formative team – 5 March 2015
M4ID insight sharing meeting in Geneva – 13 March 2015
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Co-design visit in Uganda – April 2015
Exploring SELMA models through data simulation in Brazil
– April 2015
Site visit to Uganda – May 2015
Midterm project review meeting in Geneva – June 2015
BOLD Project Newsletter
Issue 2 | April 2015
MEET THE BOLD TEAM
Damaris Rodriguez, Senior Service Designer
at M4ID, working with design research and
concept design for the Passport to Safer Birth
objective.
What is the most fascinating aspect of the BOLD
project?
“The BOLD project brings a unique opportunity to link different challenges in maternal health
that haven´t been connected and tackled before
as a whole, e.g. bringing together all the people involved directly or indirectly in the pregnancy and
delivery process. It has been very inspiring to speak
with men, birth companions, Community Health
Workers, Church leaders and family members to
understand and identify the opportunities for the
Passport to Safer Birth objective. In essence BOLD
is going beyond the women´s or health practicioners perspective to join forces so everyone will
be part of future solutions.”
This newsletter is designed for all those involved or
interested in the BOLD project. We hope that this
publication will keep you up-to-date on current and
upcoming activities, accomplishments by the team,
and important project changes. The newsletter
will be distributed bi-monthly, with the next issue
scheduled for June 2015. We welcome submissions
of project updates by any team member for inclusion
in the newsletter. Please submit material by 22 May
2015 to Meghan Bohren ([email protected]) for
the next newsletter.
Visit us on the web at www.boldinnovation.org
Thank you to all BOLD members for contributing
content.
Project partners
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BOLD study sites:
Maitama District Hospital, Abuja, Nigeria (Dr. Frank E. ALU, Coordinator)
Asokoro District Hospital, Abuja, Nigeria (Dr. Amos A. ADEBAYO, Coordinator)
Wuse II District Hospital, Abuja, Nigeria (Dr. Olubunmi Abraham ALABI,
Coordinator)
Mother and Child Hospital, Akure, Nigeria (Dr. Adesina AKINTAN, Coordinator)
Mulago Hospital, Kampala, Uganda (Dr. Miriam Nakalembe, Coordinator)
St. Francis Hospital Nsambya, Kampala, Uganda (Dr. Othiniel Musana, Coordinator)
Mengo Hospital, Kampala, Uganda (Dr. Michael Bukenya, Coordinator)
Lubaga Hospital, Kampala, Uganda (Dr. Salim Bataale, Coordinator)