Improving the quality of reproductive healthcare in Georgia – About the creation of a Georgian birth registry

Maternal and perinatal mortality and morbidity are frequently referred to as the most important indicators related to the health of a nation and is used as a measure of quality of the reproductive health care system. One of the major challenges to improve a health care system is unreliable patient-data and methods of collecting data. A country can improve the quality and efficiency of their reproductive health care system with the use of a medical birth registry with high quality and accurate data, as has been done in Georgia.   

Health data in Georgia

Georgia is a developing country with several problems related to their healthcare system. Among the challenges are how to improve the quality of care and its effectiveness. Reduction of maternal and children morbidity and mortality has been an important goal for the United Nations Millennium Development Goals (MDG) and is now the priority for the Sustainable Development Goals (SDG). Maternal and newborns deaths are crucial to report accurately. However, Georgia has been lacking precise and longitudinal data dealing with maternal and newborns mortality and morbidity. Until 2016, data on reproductive health services came from sporadic on-demand surveys. Routine info on mortality and morbidity was available as aggregated data with a lack of epidemiological analysis.

 

Using data for research and education

The Georgian Birth Registry (GBR) was implemented 1January 2016 with the aim of collecting reliable information and ensuring accurate reporting of data with high quality and completeness. It is the first developing country to implement a national, digital medical birth registry, and it was made possible by the initiative and great enthusiasm from the involved actors.

The introduction of the GBR in Georgia has made it possible to create a database, which can be used for epidemiological analysis and recommend evidence-based findings. We are three PhD-students (two Georgians living in Georgia and one Norwegian) accepted at UiT The Arctic University of Norway in the Department of Community Medicine to work and develop our studies. We are all using data from the GBR and our projects deal with maternal and perinatal mortality and morbidity, and cesareans sections.

The supervising team consists of main supervisors in Norway and co-supervisors in Georgia from different scientific backgrounds and clinical experience.

How it works

We started our PhD in January 2017 and we all study full-time. We attend relevant PhD-courses together in Norway and gather for common supervision either in Norway or in Georgia at least four times a year. We also have weekly communication by Skype. We arranged a writing gathering in February 2018 where supervisors and PhD-students came together for a week in the mountains of Georgia to write the outline of our first paper, a highly effective way of working and something we would recommend for other PhD-students working on common data material. The Norwegian and Georgian partners in the project also organize annual conferences to review progress and challenges with the birth registry and other parts of the project.

Due to the recent implementation of the GBR, we have spent much time reviewing the quality of the variables in the registry, trying to find out why some are poorly filled out while others seem to be misunderstood. It is also important to make a detailed and up-to-date codebook of all the 470 variables with detailed explanations of coding and meaning, to avoid misunderstandings and provide a working tool for all those involved in using the GBR data. This work is not directly related to our projects, but is valuable to understand how a national registry is set up, what it takes to make it work and not the least how much time it takes to clean a dataset before it is ready for analyses!

Outcomes

We believe that our studies, through our PhD-projects, can contribute to the improvement of the Georgian reproductive health system by providing descriptions and analyses of data never published before and suggestions for improving maternal and newborn health.

 

For more information contact: 

Ingvild Hersoug Nedberg – ingvild.h.nedberg@uit.no 

Natia Skhvitaridze – natia.skhvitaridze@uit.no 

Tinatin Manjavidze – tinatin.manjavidze@uit.no