Advocacy & Health Policy: Bringing Solutions for Postpartum Hemorrhage (PPH) to Zambia—An Update on ACOG’s Work with Saving Mothers Giving Life (SMGL)

 
From left to right: Synne Holan (ICM), Genevieve Mwale (MAZ),
Dr. Vineeta Gupta (ACOG), Prof. Elwyn Chomba (MCDMCH),
Dr Christine Kaseba-Sata (Former First Lady of Zambia),
Dr. Claudia Morrissey Conlon (USAID)

In July 2015, ACOG Fellow Melody Eckardt, MD, Faculty and Director of Maternal Health, Massachusetts General Hospital, and ACOG Technical Director of Global Women’s Health Vineeta Gupta, MD, traveled to Zambia to train local health care workers in uterine balloon tamponade (UBT), a low-cost solution for postpartum hemorrhage (PPH). PPH is the most common cause of maternal morbidity and mortality in developing countries. More than 30 percent of all maternal deaths worldwide are attributable to PPH, accounting for approximately 130,000 deaths and 2.6 million disabled women every year. The vast majority of cases of PPH occur in low and middle-income countries. UBT is a minimally invasive, cost-effective, and easy-to-learn procedure that has been proven to reduce blood loss, the likelihood of surgical interventions, or the need for blood transfusions, and is a good addition to the toolbox for management and treatment of PPH. The UBT kit includes a Foley catheter, condom, ties, syringe, data card, and, additionally, requires water. 

Funding for the meetings held in Lusaka was provided as part of an ongoing partnership with Saving Mothers Giving Life (SMGL). SMGL was launched to accelerate the reduction of maternal and newborn deaths in sub-Saharan African countries. ACOG is one of the founding partners of SMGL.

An earlier trip in March 2015 addressed the technical and programmatic questions about incorporating UBT into a larger PPH management action plan. Attendees included representatives from the Emergency Obstetric Newborn Care (EmONC) working group, Zambia Association of Gynaecologists & Obstetricians (ZAGO), University Training Hospital (UTH), and the SMGL local working group. After the meetings in March, ZAGO and other officials solicited government support to include midwives in training and to incorporate UBT into the PPH management policy by assuring them that UBT would align with their national approach to PPH management.

The July trip took place from July 29–31, 2015, and was the first step in the implementation of UBT training as a life-saving intervention in the SMGL Zambia districts.

During the first day of the July meeting, 49 maternal health care providers were introduced to UBT. This included doctors (ob-gyns and general physicians), midwives, nurses from the SMGL districts, midwifery nursing association leaders and members [Midwives Association of Zambia (MAZ) and International Confederation of Midwives (ICM)], faculty from the University Teaching Hospital (UTH), members of the Zambia EmONC working group, maternal and child health officials from the Ministry of Health, and clinical providers from USAID implementing organizations.

The meeting provided a demonstration of UBT and skills-building exercises and addressed the technical concerns as well as the challenges of integrating UBT in PPH. The participants received training manuals and UBT kits.

The second day of meetings, July 30, was held to encourage open and robust discussion regarding mainstreaming and incorporating UBT as a low-cost tool and rescue device in the management of PPH.

There were 30 participants, including Professor Elwyn Chomba, Permanent Secretary, Ministry of Community Development, Mother and Child Health; Claudia Morrisey Conlon, MD, SMGL lead; ZAGO officials; representatives from MAZ, ICM, UTH, and EmONC; and ob-gyn and former First Lady of Zambia Dr. Christine Kaseba-Sata, who gave the keynote speech.

There were various presentations during the meeting. A presentation on options in PPH management was given by UTH Chair Dr. Bellington Vwalika, while Dr. Conlon of USAID led a discussion of the SMGL approach to health care. ACOG’s Dr. Gupta also gave a synopsis on UBT.

The presentations were followed by a panel discussion representing a diverse group of maternal health stakeholders. The purpose of the panel was to make a case for PPH prevention intervention regardless of whether deliveries occur in urban or rural areas, with a particular focus on adding UBT as a rescue device in the PPH prevention interventions.

Going forward, there will be another trip to Zambia with the intention of conducting Training of Trainers (TOT) in UBT in some of the SMGL districts.

Additional Resources:

 

American Congress of Obstetricians and Gynecologists
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