Improving Perinatal Care

Photo of paper patient records in a health facility in Lusaka, Zambia in 2002.In Zambia in 2000 an estimated 750 out of every 100,000 mothers died in childbirth, while neonatal mortality was estimated at a rate of 40 in every 1,000 live births (WHO 2000). A women's lifetime risk of death in pregnancy was an estimated 1 in 25. Nearly 1/3 of pregnant women in Lusaka infected with HIV (Joint UAB-Zambian studies). Nearly half of these mothers would  transmit HIV to their babies. (Joint UAB-Zambian studies). Virtually all modern health care for more than 1 million people was provided by 23 clinics and the University Teaching Hospital (UTH). All medical records were maintained on paper.

In early 2001 a team of physicians at the University of Alabama at Birmingham (UAB) and visiting Zambian physician Dr. Moses Sinkala conceived the idea based on a successful electronic perinatal record system that the UAB had developed and proven in clinics in Birmingham. In July 2001 the Bill & Melinda Gates Foundation awarded a grant to the UAB to develop a similar system to serve public obstetric clinics in Lusaka, Zambia.

The UAB team solicited proposals for the technical design and implementation of the system from several private sector information technology firms, including Electronic Data Systems, before awarding a contract to RTI. Other project partners included the Center for Infectious Disease Research in Zambia (CIDRZ) and the Lusaka District Health Management Team of the Zambian Central Board of Health.


ZEPRS team at the launch of the electronic referral system in 2005.The Zambia Electronic Perinatal Record System (ZEPRS) is an Electronic Medical Record (EMR) system used by public obstetric clinics and a hospital (the University Teaching Hospital) in Lusaka, Zambia to improve patient care. The University of Alabama Birmingham (UAB) Center for Research in Women's Health (CRWH), RTI, and the Center for Infectious Disease Research in Zambia (CIDRZ) developed ZEPRS with local medical expertise and project engagement from the Lusaka Urban Health District, Central Board of Health and funding support from the Bill & Melinda Gates Foundation.

ZEPRS has been designed to improve maternal and perinatal outcomes by:

  1. Improving perinatal care to women and postnatal care to neonates by:
    • Promoting adherence to good standard of care practices
      Identifying and document potential medical/
    • obstetrical problems so that effective therapies can be administered
    • Improving communication and referrals among providers
    • Enhancing monitoring and evaluation of outcomes, clinics, and providers
  2. Improving efficiency, completeness, accuracy of documentation and reporting

How is ZEPRS Being Used?

ZEPRS, an electronic-first medical records and referral system, is one of the first of its kind in sub-Saharan Africa. ZEPRS is helping medical personnel to improve care, combat the spread of HIV/AIDS, and manage records for perinatal patients and infants (antenatal through 6 weeks after delivery) in clinics, the UTH, the Lusaka District Health Management Team, and the Ministry of Health.

ZEPRS operates over a 27-km diameter high-speed point-to-point wireless voice and data network that interconnects 24 clinics and the UTH. A lower speed wireless network in each clinic connects at least one printer and three to nine mobile cart-mounted computers located strategically throughout the facility to support patient care. Using these computers, clinicians display and update patient records as they register and provide care to patients. Patient records are maintained in a central database at the ZEPRS data center maintained by CIDRZ.

Photo of clinicians learning to use the new ZEPRS electronic patient referral system module.

ZEPRS achieves its objectives by providing the following:

  • An electronic patient record system with patient record database shared among facilities
  • A system that guides clinicians through the Zambian standard of care
  • Intelligent rules that alert clinicians to problems and recommend patient referral when appropriate
  • Standard & ad hoc reporting for supportive supervision, surveillance, analysis
  • An electronic-first system use by clinicians during the course of patient care
  • An electronic referral system to improve the efficiency and effectiveness of referrals

RTI has continued working to enhance the ZEPRS software based on feedback from clinicians, and has adapted the software to meet several other needs. Recent enhancements include:

ZEPRS has been developed using open source software and can operate in networked or stand-alone applications. ZEPRS Zcore™ architecture permits the software to be adapted to other environments and applications. ZEPRS is free and open source software, and is available under a royalty-free license.

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