17th Midwives Conference 2

7/27/2019 17th Midwives Conference 2

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VENUE KAKAMEGEGOLF HOTEL

PRESENTATION ON

THE

USE OFMISOPROSTOL

FOR CONTROL OFPPH

IN EMUHAYADISTRICT

BY

NELLIE LUCHEMO

SCHNAIDE KOLWA


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IMPLIMENTING URGENCYAGENCIES

ORGANIZATION FOR HEALTH EDUCATION

RESEARCH SERVICES (OHERS)VENTURE STRATEGIES INNOVATIONS (VSI)

UNIVERSITY OF NAIROBI (OBS &GYN)

MINISTRY OF HEALTH


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MAIN OBJECTIVE To increase awareness in the community on the

dangers of PPH, and how to control PPH at thecommunity level using the easily accessibleintervention by aid of domiciliary midwives

To generate additional evidence to advancecommunity-level distribution of misoprostol tablets by

focusing on the role of community midwives (CMs) To inform policy decision makers about distribution of

misoprostol through CMs at the district and nationallevels.


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SPECIFIC OBJECTIVES To Promote greater awareness of safe motherhood and the

use of misoprostol for prevention of postpartumhemorrhage (PPH) among rural communities in Emuhaya

district; Equip CMs and pharmacists with the skills and knowledge

to distribute misoprostol for prevention of PPH, therebyincreasing the number of women receiving skilledattendance and uterotonic drug at delivery; and

Generate evidence that CMs are a feasible and effectivedistribution mechanism for dispensing misoprostol forPPH prevention to women who are unable to deliver at afacility and thus, give birth at home with a CM.


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LOCATION OF PROJECT This project was implemented in Emuhaya district in

Western Province by Organization for Health Educationand Research Services (OHERS) from in May2010 to June2011

OHERS chose to implement this project in Emuhaya

district because its maternal health statistics are muchworse than the Kenyan national averages, based on thenational reproductive indicators of Emuhaya (KDHS,1998), in addition based on the previous experienceOHERS was working in Emuhaya District on prevention of

postpartum hemorrhage using Active Management ofThird Stage Labour (AMSTL).


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METHDOLOGYTraining of CMs and CHWs, IEC/BCC materials,M&E,

Documentation

Community awareness campaign

To raise community awareness about birth preparednessand PPH prevention, including misoprostol, the projectemployed several different communication strategies:

If women were attending antenatal care (ANC) with CMs:the CMs educated them on the key messages of thecampaign, including the use of misoprostol for PPHprevention, and that they could obtain misoprostol if theyinvolved the cm at the time of delivery.


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Provision of misoprostol by

community midwives (CMs CMs enrolled women in the project during pregnancy

and at the deliveries they attended

after obtaining informed consent to participate fromeach woman, and screened them for eligibility toreceive misoprostol Immediately after delivery, theCMs administered three tablets (600 micrograms) of

misoprostol orally to women eligible to receivemisoprostol .

The CM was also responsible for monitoringestimated blood loss


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RESULTS Total Number of people sensitized in the community

83,592reached Total number of deliveries 180 The community feedback on the project and misoprostol

reported by the CHWs was overwhelmingly positive. This project changed the women positively. They now

know importance of delivering with a skilled midwife-agood number of people are happy with the project so thepregnant women are going to a community midwives whoare near to them.

Rise in level of knowledge in identification of danger sings

in pregnancy ,delivery and postnataly


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CONT... Increase of skilled deliveries both by CMs and health

facility setting from 21% to 29% to date

Reduction of maternal deaths from 1 in 2009, 1 in 2010and 0 (zero) 2011

Reduced number of PPH cases among others that wentsilently un captured


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CHALLENGES 1. Limitations of CMs to reach all women needing

services in the community.

2.Limitation of incentives, updates and replenishmentof commodities to the CM and CHWs

3. Cost implications on the purchase of themisoprostol for continued supply

4.Unclear guidelines by MOH on use of Misoprostol


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CONCLUSIONS The results of this project in Emuhaya district

contribute to evidence in support of distribution ofmisoprostol at the community level, and show thesignificance of community midwives (CMs) andcommunity health workers (CHWs) in combatingmaternal mortality resulting from PPH, and postabortion in Kenya


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RECOMMENDATIONS CHWs be given more resources to be able to make an even

greater impact in their community health education work.(CHWs KIT)

Retention ofmidwives on payroll even after retirement because

they do not retire their skills Provide more/ adequate MVA kits with the correct canulars in all

health facilities including the mission and private facilities Train more health workers on CAC services ased on these results,

the Community Midwifery model should be expanded to otherdistricts in Kenya, especially those with similar demographic and

health profiles as Emuhaya. Provide stronger linkage between TBAs and skilled midwives

because TBAs still attract 71% of mothers for delivery verses 21%who seek skilled


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THANK YOU,

Documents

17th Midwives Conference 2