Web based application
Using a Perinatal Registry to screen for NCD’s in Ukraine
Von Martin Raab & Natalia Riabtseva, Goncalo Castro and Grigory Naumovets / Schweizerisches Tropen- und Public-Health Institut (Swiss TPH)
Maternal mortality ranks among the highest in Europe. The Perinatal Registry is a web based application recording data related to all pregnancies in a given region. It enables improved monitoring of the course of pregnancies and the analysis of risk factors. Ukrainian health authorities in partnership with the Swiss Tropical and Public Health Institute developed and introduced the Registry in 2011 to combat high mortality figures. The Ukraine Swiss Mother and Child Health Programme, financed by the Swiss Development Cooperation (SDC) is currently expanding the Registry in Ukraine.
Ukraine has been placing increasing emphasis on improving Reproductive Health and Perinatal Health over the past decade. Especially Maternal Mortality is of concern as Ukraine has relatively high Maternal Mortality rates ( 32/100’000; Poland: 5, Hungary: 21; Sweden:4, Switzerland: 6).
Getting clear about Risk Factors
According to the official national data, the maternal health in Ukraine is significantly influenced by extra-genital pathologies (non-obstetrical ones). This factor is also a main contributor to maternal mortality (up to 70% of deaths). Among the extra-genital pathologies the main symptoms and diseases are hypertension, diabetes, thyroid dysfunction, blood circulation diseases, etc. Most of them are caused by unhealthy life style, weak promotional and preventive campaigns, late admission and, thus, diagnostic and referral, non-standardized treatment. Mentioned factors are interrelated: lack of effective health promotion leads to unbalanced diet and lack of physical activity; poor efficiency of treatment causes distrust of patients that leads to late admission and diagnostic.
The extra-genital pathologies create additional risk factors for the pregnancy and delivery. The most common problem is anemia of pregnant women. One quarter of all pregnancies in Ukraine are faced with this diagnosis. More than 10% of pregnancies are complicated by different forms of cardio-vascular diseases, most often – hypertension that causes eclampsia. And around 10% of pregnant women have thyroid dysfunctions (referred to as ‘Chornobyl heritage’).
Figure 1 NCD risk factors in pregnant woman (Ministry of Health of Ukraine data, 2011)
Why introducing a Perinatal Registry?Analysing the epidemiological situation of maternity related illnesses and associated risk factors had been very limited in Ukraine due to lack of timely and accurate data and information. Paper records on pregnancy and childbirth at facility level are still the predominant means for collecting information. As a consequence this situation led to late referrals, to avoidable complications during delivery and unnecessary high numbers of deliveries at tertiary care centers. The new Registry generates further automatically reports for the MoH statistics department that needed to be compiled manually before and thus alleviating administrative burde
Figure 2 Screen shot illustrating application and data sets
The aim of introducing an information system is to get access to real time information not only for hospitals, but also for higher referral levels and health care managers on deliveries at each facility and related risk factors. Further, the aim is to support the identification of pregnant woman with risk factors and thus allowing appropriate management of critical patients across different levels of care.
The profile of the Application and implementation
The electronic perinatal registry software is a web-based application that can be accessed over a network such as the Internet. It is based on open-source technologies and has multi-language capability. The system is essentially a web-site which can be accessed through a standard web browser. It is currently bilingual (English and Ukrainian), but it can be easily translated into any other language.
The system allocates access rights (Provincial or individual Institution level) according to the user privileges. For example, provincial health care managers or specialists may be able to view and analyse the statistical data without having access to personal data of the patients.
Obstetricians, nurses and midwives are the main users of the system, registering data for further follow-up of cases by clinicians and analysis of indicators by decision-makers. This analysis is enabled through reports that aggregate registered data into statistical reports related to pregnancy and delivery. Reports to support service planning such as listings of scheduled patient visits or expected deliveries have also been implemented. Furthermore a third type of reports is available to support the follow-up of pregnancies with predisposing conditions that place them at higher risk, providing summaries of relevant data for that purpose.
The potential of the Perinatal Registry in preventing NCD’s
As previously outlined, the Perinatal Registry pursues service provision improvement on three counts: First, to improve the clinical decision making, and thus, providing benefits for each individual patient. Second, to support the service planning for operational needs such as referrals, and for more strategic objectives like the optimization of services provision. Third, it is a powerful tool for health management statistics.
With this functionality, the Perinatal Registry has the potentials to simplify the process of data collection and to assure the reliable, valid and transparent data for analysis. This is important to have a clearer picture on the maternal health status. Available data can further be utilised for targeted improvement projects, such as to plan additional training for medical personnel or to conduct mortality audits. An unexploited potential is to utilise the available data and information for health promotion and disease prevention purposes. The need to have an enhanced focus on non communicable diseases in reproductive health had been layed out in the beginning of the article. The Perinatal Registry is therefore seen as an innovative contribution to the reduction of NCD’s in women and newborns.
Figure 3 The Perinatal Registry: Contributing to healthy mothers and newborns (project picture, 2011)
*All authors are part of the workforce of the Ukraine Swiss Mother and Child Health Programme. Natalia Riabtseva is the head of the Project Implementation Office in Kiev. Martin Raab is the programme leader and head of the Health Technology and Telemedicine Unit of Swiss TPH. Grigory Naumovets is the ICT coordinator in the frame of the programme and Goncalo Castro is the health information consultant in charge of designing and realizing the Perinatal Registry.
Swiss Tropical and Public Health Institute, Socinstrasse 57, P.O.Box, 4002 Basel, Switzerland
Mother and Child Health Programme; 3/1 Zankovetskoy Str., of.27; 01001 Kyiv, Ukraine www.mch.org.ua