Figures & Tables
Figures
- FIGURE
Expert Consultation Process Flow
Tables
Criterion Definition Feasibility Can be addressed with ethical research/learning
Can be answered within the resources and time frame available
Technical importance Has notable gaps in evidence from LMIC settings
Is of interest, debate, and discussion among technical peers and leaders in the field
Has the potential for a large effect on reproductive, maternal, newborn, child, and adolescent health outcomes and/or the wellbeing of women and newborns
Unsaturated topic Extensive, quality research/learning relevant to LMIC settings is not already being conducted
Avoids redundancy with other projects’ learning agendas (where cross-project learning would not be useful/efficient)
Potential for program impact Research/learning can result in effective and sustainable interventions/programs
Aligns with global and national priorities and commitments
Research/learning can clearly lead to action and change how services or programs are delivered in a short time frame
Research/learning has potential to generate guidance for large-scale implementation and sustainability through existing systems
Prioritizes marginalized groups and/or seeks to reduce inequities in access to services or coverage
Relevant to multiple LMICs
Abbreviation: LMICs, low- and middle-income countries.
- TABLE 2.
Distribution of the Expert Group’s Ratings of Research Topics Across Priority Technical Areas
Priority Technical Areas Surgical Obstetric Care Fistula Prevention and Treatment Family Planning Cross-Cutting Safe Surgery Number of topics 18 20 8 17 Minimum rating 3.54 3.25 3.72 3.51 Maximum rating 4.16 4.15 4.09 4.35 Average rating 3.82 3.77 3.85 3.95 Median rating 3.78 3.86 3.82 3.94 Third quartile (Q3) (top 25%) 3.95 3.99 3.89 4.07 Number of topics scoring in top 25% 5 6 2 5 Cutoff/decision rule for subsequent ranking Q3 Q3 Top 5 Q3 Rating Topic n Feasibility Technical Importance Unsaturated Topic Potential for Impact Overall 1. Using post-discharge/postoperative visits (in person or telehealth) to monitor postoperative morbidity and neonatal outcomes 28 4.25 4.28 3.86 4.24 4.16 2. Use of tools such as clinical checklists and audits for CD and peripartum hysterectomy to enhance decision-making as part of quality improvement 29 4.55 4.30 3.50 4.17 4.13 3. Intrapartum/midwifery care practices to reduce unnecessary CD 29 4.07 4.34 3.55 4.38 4.09 4. Trial of labor after CD or vaginal birth after CD: LMIC practices, availability/coverage, outcomes 27 4.37 4.30 3.81 4.19 4.01 5. LMIC policies and practices for subsequent pregnancies/deliveries post-CD 28 3.96 4.00 4.00 3.93 3.97 Abbreviations: CD, cesarean delivery; LMIC, low- and middle-income country.
Rating Topic n Feasibility Technical Importance Unsaturated Topic Potential for Impact Overall 1. High-impact social and behavior change strategies for community engagement for fistula prevention 24 4.17 4.42 3.79 4.21 4.15 2. Coverage of fistula care within basic health care provision funds and social health insurance schemes 23 4.04 4.09 4.3 4.17 4.15 3. Gaps in fistula knowledge/skills in midwifery training 26 4.5 4.35 3.65 3.92 4.11 4. Effective rehabilitation and reintegration interventions for fistula clients 24 3.79 4.33 3.67 4.29 4.02 5. Integration of fistula screening and referral in other health care 23 3.96 4.00 4.09 3.96 4.00 6. Implications of iatrogenic fistula trends for fistula care financing and programming strategies 23 3.96 3.91 4.13 3.96 3.99 Rating Topic n Feasibility Technical Importance Unsaturated Topic Potential for Impact Overall 1. Task sharing for implant removal procedures: feasibility, effectiveness, recommended settings 24 4.38 4.13 3.71 4.17 4.09 2. Effectiveness of interventions to increase postabortion contraception uptake and continuance 24 4.08 4.29 3.08 4.46 3.98 3. SBC strategies focusing on men as supportive partners, co-decision makers, and clients of LARCs/PMs 24 4.04 3.96 3.50 3.96 3.86 4. Impact of human-centered designed SBC activities on LARC/PM awareness and uptake 25 3.84 4.20 3.29 4.04 3.84 5. Effective strategies for youth-led organizations to increase capacity to implement evidence-informed interventions to expand access to LARCs/PMs 24 3.58 3.96 3.67 4.00 3.80 Abbreviations: LARCs, long-acting and reversible contraceptives; PMs, permanent methods; SBC, social and behavior change.
Rating Topic n Feasibility Technical Importance Unsaturated Topic Potential for Impact Overall 1. Effective strategies to strengthen key aspects of the safe surgery ecosystem (e.g., anesthesia supplies, blood, and oxygen) 26 4.12 4.65 3.96 4.65 4.35 2. Effective strategies for surgical team capability building in LMICs: teamwork, communication, respectful care 26 3.77 4.35 4.04 4.38 4.13 3. Effective measurement approaches to monitor post-surgical/post-discharge maternal and newborn outcomes in the community 27 3.85 4.15 4.08 4.30 4.09 4. Integration of mental health care skills (e.g., mental health first aid) into fistula/MH/FP provider training 27 4.00 4.07 4.15 4.15 4.09 5. Client definitions of respectful surgical care 25 4.32 3.92 4.12 3.92 4.07 Abbreviations: FP, family planning; LMICs, low- and middle-income countries; MH, maternal health.
- TABLE 7.
Research and Learning Topics Ranked as Highest Priority by the Expert Consultation Group
Technical Area Topics Surgical Obstetric Care Use of post-discharge/postoperative visits (in person or telehealth) to monitor postoperative morbidity and neonatal outcomes
Use of tools, such as clinical checklists and audits for CD and peripartum hysterectomy, to enhance decision-making as part of quality improvement
TOLAC or VBAC: LMIC practices, availability/coverage, and outcomes
Intrapartum/midwifery care practices to reduce unnecessary CD, specifically: (1) effective practices within intrapartum care (e.g., tools to manage labor and ensure birth accompaniment and respectful care) and (2) ways to strengthen midwifery-led models of care that favor less intervention and empower patients, including by understanding barriers to progress
Fistula Prevention and Treatment Gaps in the knowledge/skills required for provision of holistic fistula care, including midwifery/obstetric care, surgical and nonsurgical fistula repair, and rehabilitation
High-impact SBC strategies for community engagement for fistula prevention and care
Coverage of fistula care within basic healthcare provision funds and social health insurance schemes, including prevention, treatment, screening and referral, and rehabilitation care
Family Planning Task sharing for LARC removal procedures: feasibility, effectiveness, and recommended settings
Effectiveness of interventions to increase voluntary postabortion and postpartum contraception—including LARCs and PMs—uptake and continuance
LARC/PM SBC strategies, including impact of human-centered design activities to strengthen awareness and uptake, and strategies focusing on men as supportive partners, co-decision-makers, and clients
Cross-Cutting Safe Surgery Effective measurement approaches to monitor postsurgical/post-discharge maternal and newborn outcomes in the community
Effective strategies to strengthen key aspects of the safe surgery ecosystem (e.g., anesthesia supplies, blood, and oxygen)
Effective strategies for surgical team capability building in LMICs, including teamwork, communication, and respectful care
Client definitions of respectful surgical care
Integration of mental healthcare skills (e.g., mental health first aid) into fistula, MH, and FP provider training to support provision of mental health assessments of and care to patients
Abbreviations: CD, cesarean delivery; FP, family planning; MH, maternal health; SBC, social and behavior change; LARC, long-acting and reversible contraceptives; LMIC, low- and middle-income country; PMs, permanent methods; TOLAC, trial of labor after cesarean delivery; VBAC, vaginal birth after cesarean delivery.
- TABLE 8.
Illustrative Contributions of MOMENTUM Safe Surgery in Family Planning and Obstetrics Project Activities to Advancing Priority Learning Agenda Topics
Learning Agenda Topic Project Learning Activity Use of tools, such as clinical checklists and audits for cesarean delivery and peripartum hysterectomy, to enhance decision-making as part of quality improvement Safe cesarean checklist: review of the literature, co-design, and pilot testing
Cesarean delivery audit tool development: review of literature for existing tools, provider survey on audit practices and procedures, and design/piloting of consolidated audit tool
Cross-sectional study measuring cesarean delivery complications before and after the implementation of a peripartum surgery diploma program in Mali
Descriptive study on sociodemographic and clinical factors of patient populations undergoing cesarean delivery in Senegal (Robson classification)
Analysis of data captured from the piloting of a cesarean delivery audit mobile application in India
Task sharing for LARC removal procedures: feasibility, effectiveness, and recommended setting Review of training guidelines, regulatory frameworks, and scopes of work to assess the extent to which WHO task sharing guidelines on LARCs and PMs are being implemented in 7 countries42
Survey on provider perspectives on implant and IUD removal
Use of post-discharge/postoperative visits (in-person or telehealth) to monitor postoperative morbidity and neonatal outcomes Prospective cohort study testing the feasibility of post-discharge phone interviews as a method of monitoring post-discharge outcomes in DRC
Effective strategies to strengthen key aspects of the safe surgery ecosystem (e.g., anesthesia supplies, blood, and oxygen) Qualitative study assessing extent to which safe surgery core teams are perceived as effective in driving quality improvement in surgical care in Rwanda
Contribution/influence of anesthesia clinical mentorship on mitigating anesthesia complications in Mali and Rwanda
Abbreviations: DRC, Democratic Republic of the Congo; IUD, intrauterine device; LARCs, long-acting reversible contraceptives; PMs, permanent methods.
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