Assing Healthcare Providers' Acceptance of and Readiness to Implement the FIGO Pregnancy Passport at Muhima District Hospital in Kigali, Rwanda

Background:
Cardiometabolic disease risks of pregnancy, such as HDP and GDM, increase the risk of developing chronic diseases later in life. FIGO developed a tool, the FIGO Pregnancy Passport aiming to facilitate screening and follow-up for women at risk for cardiometabolic diseases. However, the implementation of such a tool, especially in LMICs, remains limited. This study accessed healthcare workers’ acceptability of, and readiness to implement the FIGO Pregnancy Passport within MDH and evaluated the level of screening of cardiometabolic disease risk factors among women who delivered within the hospital, as compared to a modified FIGO screening method, between 15 May 2024 and 14 June 2024.

Methods:
We conducted a multi- method study: the quantitative portion employed patient and electronic medical record screening to evaluate the level of screening of cardiometabolic disease risk factors among women who delivered at MDH; the qualitative portion utilized FGDs and KIIs to assess healthcare workers’ acceptability of the FIGO Pregnancy Passport, and the necessary resources needed to implement the FIGO tool.

Results Quantitative:
The study screened 489 postpartum women, The modified FIGO screening tool identified cardiometabolic disease risks in 34% (n=165) of postpartum women, which was over eight times higher than the 4% (n=18) recorded in their electronic medical records (EMRs). While the most common FIGO-identified risk was family history of high blood pressure (33.5%, n=81), the EMRs didn’t record any family history of hypertension but indicated preeclampsia (38.9%, n=7) as the most common recorded risk. Stillbirth was the second most common risk identified by both the FIGO tool (17.8%, n=43) and the EMRs. The discharge summaries showed a percentage of postpartum care instructions (93.3%, n=456) of patients had at least one instruction, with breastfeeding (45.2%, n=221) and medication (38.4%, n=188) being the most common recommendations. However, the FIGO screening process resulted in over 25 times more recommendations for follow-up (33.9%, n=165) compared to the EMR discharge summaries (1.2%, n=6). Over half (53.6%, n=262) were categorized as Ubudehe Category 2.
Qualitative: Three FGDs and two KIIs were conducted to assess HCP acceptability of, and resources required to implement the FIGO Pregnancy Passport. Three core themes emerged: 1) Healthcare providers viewed the management of patients with cardiometabolic disease risks of pregnancy as important, though practices for management varied; 2) The lack of knowledge about cardiometabolic disease risks of pregnancy and their relation to NCDs negatively impacts health delivery and health seeking behavior; 3) Even with resource or health system limitations, health care providers still considered and recommended ways to adapt the FIGO Pregnancy Passport to better fit the Rwandan health system context.

Conclusion:
The findings indicate that MDH has low screening levels, primarily focusing on assessing risks associated with current pregnancies which aligns with standard maternal care practices in LMICs. Screening for NCD prevention among women with cardiometabolic risks is limited, likely due guidelines not reflecting the connection between pre-pregnancy, pregnancy complications, and NCDs. HCPs are enthusiastic about utilization of FIGO Pregnancy Passport but face challenges like lab availability, screening capacity, HCP Knowledge and patient affordability, suggesting the need for system-level changes to address these gaps.