Click to edit Master title style - wilsoncenter.org. Shabnam Shahnaz Presentation.pdf · • Kanga...
Transcript of Click to edit Master title style - wilsoncenter.org. Shabnam Shahnaz Presentation.pdf · • Kanga...
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The Use of Safe Birthing Kits and The Use of Safe Birthing Kits and Misoprostol for Home Deliveries as Part of Misoprostol for Home Deliveries as Part of
the Continuum of Care for Prevention and the Continuum of Care for Prevention and Management of PPHManagement of PPH
Shabnam Shahnaz, MD, MPH
Pathfinder International, Bangladesh
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BackgroundBackground• Postpartum hemorrhage (PPH) accounts for about 28% of
maternal deaths in Bangladesh.
• 82% of deliveries in Bangladesh occur at home with unskilled
birth attendants.
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The GapThe GapDuring delivery AfterBefore
Interaction with a
health, or
development
worker for FP, ANC;
other health
interventions
85% of deliveries
occur at home by
unskilled birth
attendants
Most births assisted
by ‘Dais’, followed by
friends and relatives
Interaction with
health service
providers for
maternal
complications, EPI,
childhood diseases
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Mayer Shasthya: The InterventionMayer Shasthya: The InterventionEffective prevention
• Use of Misoprostol
• Active Management of Third Stage of Labor (AMTSL)
Timely identification of PPH
• Use of blood collection mat
Appropriate referral
• Establishing an appropriate referral system
• Use of PPH management kit
• Use of NASG
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Effective PreventionEffective Prevention
• Counseling: ANC, PNC, prevention and management of PPH,
and referrals
• Distribution of Mayer Shasthya PPH bag– Delivery Kit– Misoprostol
– Blood Collection Mat
– Registration and referral Card
• Correct and timely identification of PPH
• Follow‐up
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Timely Identification of PPHTimely Identification of PPHWhy measure blood loss?
• Woman are ignorant about the amount of life threatening blood
loss during postpartum period
• Non‐availability of any easy method of measuring blood loss
• Even obstetricians rely on subjective assessment, difficult to
standardize
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Estimation of Blood LossEstimation of Blood Loss
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Estimation of Blood LossEstimation of Blood Loss
• Blood Collection Drape
• Visual estimation
• Calibrated Jugs – Nigeria
• Kelly’s Pad –
India
• Cloth Mat –
Bangladesh
• Kanga – Tanzania
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Accurate Estimation of Blood LossAccurate Estimation of Blood Loss
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Appropriate ReferralAppropriate Referral
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Progress so far..Progress so far..Mayer Shasthy PPH bags
• 13,381 pregnant women registered in project area
• 8,434 PPH bags distributed to pregnant women
• 8,026 women delivered, used the bag and took Misoprostol
PPH Management Kit Box:
• Provided to each of the referral centers
Orientation and training of providers:
• Provided training
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Progress so far..Progress so far..Household Meetings: • 1,855 meetings organized
• 21,996 pregnant women and family
members reached
Community Group Meetings: • 167 meetings organized
• 4,337 community members reached
Two Ambassadors for Project:• Rupam Rani receives “Badge of Honor”
from WRA Bangladesh (USAID‐
sponsored)
Policy :• Misoprostol incorporated into the Essential Drug List
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Success so far..Success so far..
Management of PPH cases:
• 20 PPH cases identified and managed
in the Mayer Shasthya Project areas
• All women used Misoprostol tablet, blood collection mat and
delivery kit supplied by the project
• NASG was used for 1 woman
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ChallengesChallenges• Understanding on the need to empower pregnant women
• Migration of the pregnant women
• Lack of reliable data on pregnant women and pregnancy
outcomes
• Insufficient supplies of maternal health commodities (e.g.,
Misoprostol, magnesium sulfate, birth kits)
• Maintaining the responsiveness and competence of referral
centers
• Financial constraints of families and transportation
arrangements
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Do not go where the path may lead, go instead where there is no
path and leave a trail.‐Ralph Waldo Emerson