Pregnancy and Childbirth (Uganda) PSP question verification form
- Published: 27 November 2024
- Version: V1 - November 2024
- 3 min read
The purpose of this Question Verification Form is to enable Priority Setting Partnerships (PSPs) to describe clearly how they checked that their questions were unanswered, before starting the interim prioritisation stage of the process.
The JLA requires PSPs to be transparent and accountable in defining their own scope and evidence checking process. This will enable researchers and other stakeholders to understand how individual PSPs decided that their questions were unanswered, and any limitations of their evidence checking.
Name of the PSP
Pregnancy and Childbirth (Uganda) – Priority Setting Partnership (PC – PSP)
Please describe the scope of the PSP
The P&C - PSP covered aspects of care during pregnancy and childbirth, and the management of complications that arise during this period. We included women who are trying for pregnancy, those who have experienced pregnancy-related conditions and their associated complications during pregnancy (including early pregnancy and miscarriage), childbirth and up to 6 weeks into the postpartum period. We also included carers of these women and clinicians / health workers that offer clinical and (or) supportive care to these women.
Please provide a brief overview of your approach to checking whether the questions were unanswered
There were initially 1276 questions collected from the consultation. These were coded into broad areas of pregnancy, neonatal and postnatal care. There were some very specific questions amongst the initial sample of 1276, but these were largely subsumed into broad questions related to themes like infection and access to health care. Of the 60 summary questions generated from the 1276, 55 were broad overview questions such as ‘how can women be encouraged to engage with modern medical practices?’ or ‘what causes miscarriages and how can they be prevented?’. The remaining 5 questions were more specific and included questions about the causes of symptoms in routine neonatal care, and the adverse obstetric outcomes of HIV in pregnancy.
In general, we considered that although aspects of the broader questions would have been answered, particularly in the more developed world, the applicability of the existing evidence to the rural Ugandan setting would lack relevance. We therefore focused our attention on the more specific questions, and sought evidence from high-quality guidelines, systematic reviews and randomised trials to see if they had been answered.
Please list the type(s) of evidence you used to verify your questions as unanswered
We sought high-quality, evidence-based guidelines relevant to the local context and published within the last 10 years. This included Ugandan national or regional guidelines and those produced by WHO. In the absence of these, we sought high-quality guidelines produced from elsewhere in the world, but only included those that we considered were relevant to the Ugandan setting.
Please list the sources that you searched in order to identify that evidence
- Ministry of Health Essential Maternal and Newborn Clinical Guidelines for Uganda, May 2022.
- British HIV Association guidelines for the management of HIV in pregnancy and postpartum 2018 (2020 third interim update).
- WHO Recommendations on Antenatal Care for a Positive Pregnancy Experience (2016).
The Ugandan Ministry of Health guidelines provided answers to the 3 questions about the causes of symptoms in Ugandan babies: ‘why do newborn babies convulse?’, ‘why do newborn babies pass blood in urine / faeces / vomitus / vagina / penis?’ and ‘why do babies develop jaundice?’ As recent Ugandan guidelines provided complete questions to these answers, no further search was needed.
The answer to the question, ‘What adverse obstetric outcomes are associated with HIV infection?’ was more difficult to identify. We initially searched for a high-quality, evidence-based guideline that answered this question. There were no such guidelines from Uganda or WHO, but the WHO HIV clinical care website directed readers to the British HIV Association Guidelines 2018. This guideline provided a high-quality answer to the research question that was relevant to care throughout the world. This research question was therefore considered answered.
The question ‘What is the optimal number of antenatal visits?’ The World Health Organisation has reviewed this in depth and produced evidence-based guidelines on the question in 2016. This research question was therefore considered answered.
What search terms did you use?
As above.
Please describe the parameters of the search (eg time limits, excluded sources, country/language) and the rationale for any limitations
Guidelines and systematic reviews had to be produced within the last 10 years, be in English and be relevant to the Ugandan context. As WHO guidelines are produced specifically for low and middle-income countries, they were considered relevant to Uganda.
Names of individuals who undertook the evidence checking
Prof Andrew Weeks
On what date was the question verification process completed?
30th September 2024.
Any other relevant information
N/A