Monday, 19 November 2007

Training of non-obstetrician healthcare workers can stem haemorrhage

Dr. Sadauki and Prof. Otolorin during a session at the SOGON conference.

FRIDAY Nov 16, 2007

BENIN NIGERIA ----- The Effective competency-based training of non-obstetrician healthcare workers can lead to the successful management and prevention of Post partum haemorrhage (PPH) which has been acknowledged to be the leading cause of death among women globally and particularly in Nigeria. In the same vein, the use of anatomic models has been found to be invaluable for clinical skills development in the absence of PPH client load.

This result of the study conducted by Access to Clinical and Community Maternal, neonatal and Women’s Health Services (ACCESS, Nigeria) with the support of USAID was disseminated at the ongoing 41st scientific conference and AGM of the Society of Obstetrics and Gynaecology of Nigeria (SOGON) by Professor Emmanuel Dipo Otolorin, Chief of Party of ACCESS, Nigeria in a presentation titled ‘Competency Based Training for the Prevention and Management of Postpartum Haemorrhage’.

According to Professor Otolorin, since PPH can be drastically reduced with the Active Management of the Third Stage of Labour (AMTSL) and other medical skills, there is a critical need to ensure that birth attendants develop skills for managing this stage and other skills such as Manual removal of placenta; Repair of episiotomy and vaginal/perineal lacerations; Repair of cervical lacerations; Compression of abdominal aorta and the Bimanual compression of uterus.

The study which showed that there was marked improvement in the competence levels of the study participants was conducted in Zamfara and Kano States in Northern Nigeria. The maternal mortality rate in northern Nigeria is estimated at 1000 per 100, 000 live births and this can be attributed to the fact that many deliveries are done with no skilled attendant present and where they are present, may lack the skills required to manage the haemorrhage. The simulated scenarios which required different cadre of health personnel such as the laboratory scientist, anesthesian, working together brought to fore the need to develop and encourage the effective collaboration/team spirit among different medical personnel.

In the study, both skilled and semi-skilled health workers were trained using Anatomic models which included childbirth simulator, Fetal model, Placenta model with velcro attachment to abdominal wall, Cloth placenta with membranes and Foam blocks. While equipment such as Delivery kit, Episiotomy repair kit and print teaching materials were used and the study participants made to use Personal protective equipment, Decontamination equipment and Sharps disposal boxes.

However, the study showed that there was a need to step down the language of the training package for Community Health Extension Workers (CHEWs) besides training more midwives and CHEWs who are closest to these women in the community. Otolorin pointed that other skills that needs to be included in the curriculum include Suturing and knot tying (simple, vertical and longitudinal mattress stitches), conducting bedside clotting test, Use of hydrostatic balloon, and the use of antishock garment.

Otolorin concluded that competence-trainings should be a regular feature in Nigerian health facilities and for personnel in different fields relevant to maternal and neonatal health. This will ensure the properly management of emergency pregnancy complications but attention should be paid to the training of the community extension workers who are the people closest to the women in resource poor settings.

*Reported by Nnenna Ike

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