CAPACITY BUILDING FOR MIDWIVES AND NURSES IN EFFECTIVE MANAGEMENT OF POST-PARTUM HAEMORRHAGE(PPH) IN

GHANAEugenia Doku (Mentee); Vida Amina Yakubu (Mentor); Mary Ani-Amponsah (Faculty Advisor) & Lydia Aziato

BackgroundPostpartum haemorrhage (PPH) isdefined as blood loss in excess of 500mL within 24 hours after birth and it isknown to be the leading cause ofmaternal deaths worldwide (WHO,2018). PPH accounts for 25% ofmaternal mortality in Africa and itplaces a heavy burden on nationalhealth systems. In Ghana,haemorrhage (39%) continues to bethe leading cause of maternal death inthe country (Family Health DivisionAnnual Report, Ghana Health Service,2016).

ConclusionTraining of frontline health care providers in maternal health care delivery iscritical for preventing PPH and its complications and related deaths. Delayedaccess to timely emergency obstetric care, transportation challenges andreferral gaps, care provider inadequacies are contextual factors that impactthe occurrence of PPH. Health system support, care provider competencieson effective management, and family health literacy on PPH prevention arecritical for saving women’s lives.

PurposeTo build the capacity of nurses andmidwives who work in the frontline ofmaternal and health care delivery onthe early identification of and effectivemanagement of PPH. The projectfollowed the approach of Kouzes andPosner’s Leadership Model.

Research Objectivesi. Identify contextual factors that

impact the occurrence of PPHii. Build the capacity of nurses and

midwives in the effectivemanagement of PPH

iii.Improve nurses and midwives’utilization of tools for blood lossestimation

iv.Develop alternative strategies formobilizing and stocking blood andother blood products

v. Identify sources of referral facilitiesthat require support in appropriateuse of the partograph and activemanagement of the third stage oflabour (AMSTL)

MethodologyA cross sectional design was used to accessmidwives and nurses in the obstetric departmentof the Greater Accra Regional Hospital.Data Collection: Questionnaires were used toassess midwives and nurses’ knowledge of PPH,pre- and post training intervention.Implementation of interventions: The approach ofKouzes and Posner’s Leadership was used to modelthe way, inspire a shared vision, challenge theprocess, enable others to act and encourage theheartEthical approval: The Scientific Committee of theSchool of Nursing and Midwifery, University ofGhana, gave approval.

Project SettingObstetric and Gynaecological Department of the

Greater Accra Regional Hospital, Accra-Ghana

ReferencesFamily Health division annual report 2016, Ghana health service, 2016.Kouzes, J.M. & Posner, B.Z. 2017. The leadership challenge. 6th edn. New Jersey: John Wiley & Sons Inc.Helping Mothers Survive(HMS) Initiative; High Risk Pregnancy 4th ed (chapter 75, p1283).WHO (2018). Annual Statistical Report. Retrieved from https://apps.who.int/iris/bitstream/handle/10665/272596/9789241565585-eng.pdf?ua=1

FindingsAnalyses of the project data establishes that more than 75%of midwives and nurses are aware of PPH protocol availability,25% of midwives and nurses lack the skills, competencies, andefficiency in effective management of PPH. Overall, 57.9% ofnurses and midwives working in the obstetric andgynaecological departments were trained in the effectivemanagement of PPH. Based on these findings, the nurses andmidwives were further trained in Life Saving Skills andObstetric Emergencies to facilitate the improvement of PPHmanagement. The Leadership Model was found to be avaluable approach to guide the project.

Excellent Very Good Good N/A No response

AMSTL 27.90% 31.10% 27% 13.10% 0

Manual removal 9.80% 26.20% 18.00% 40.10% 4.90%

passing condom 3.30% 6.60% 24.60% 68.90% 0

Abdominal Aortacompression

1.60% 8.20% 16.40% 73.80% 0

Internal bimanualcompression

1.60% 3.30% 23% 72.10% 0

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

80.00%

Skills competency & Efficiency in Managing PPH

Training Sessions with Nurses and Midwives on PPH Management

Available and easily accessible75%

Available but not easily accessible12%

Not available8%

No response5%

Availability of equipments/medications

Available and easily accessible Available but not easily accessible

Not available No response

Available and easily accessible

75%

Available but not easily accessible

12%

Not available8%

No response5%

Availability of protocols

Available and easily accessible

Available but not easily accessible

Not available

No response

Second Interprofessional Education & Collaborative Practice for Africa Conference ● 30 July - 2 August 2019 ● Nairobi, Kenya 00