Midwives_training_report

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					           THE UNITED REPUBLIC OF TANZANIA
       PRIME MINISTER’S OFFICE REGIONAL AND LOCAL
                  GOVERNMENTS

             TANGA REGIONAL MEDICAL OFFICER’S OFFICE




                    REPORT ON INTRAPARTUM AND
                   IMMEDIATE   POST PARTUM CARE
                  TRAINING OF MIDWIVES FROM FOUR
                        HOSPITALS OF TANGA

                       Dates: 20th to 29th September 2010




Prepared by:
Dr. F.P. Mtatifikolo
Sr Aisha Mussa
Acknowledgements


We wish to express our sincere gratitude to the Regional Medical officer’s office and the Tanzanian
German Programme to support Health (TGPSH) for making this activity possible. TGPSH provided all
the financial and material support to carry out this training.

Also we would like to thank the Medical Officer in charges of Bombo, Pangani, Teule Muheza and
Korogwe district hospitals for allowing their staff to participate in this important activity. Last but not
least we want to thank the hospital staff of Bombo, Teule and Korogwe district hospitals for providing
space for theoretical sessions and also for allowing their wards to be used for practical sessions.




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Contents

 Acknowledgements................................................................................................................................... 2
 Abbreviations............................................................................................................................................ 4
 Executive Summary.................................................................................................................................. 5
 Introduction and Rationale ...................................................................................................................... 5
 Objectives of the training ......................................................................................................................... 7
 Participants ............................................................................................................................................... 7
 Facilitators ................................................................................................................................................ 7
 Training methodology ............................................................................................................................. 7
 The training contents ............................................................................................................................... 7
 Participants learning: ............................................................................................................................. 12
 List of Participants: Bombo Regional Hospital...................................................................................... 13
 List of Participants: Muheza Teule Hospital ......................................................................................... 14
 List of Participants: Korogwe District Hospital .................................................................................... 15
 List of Facilitators and Support Staff ..................................................................................................... 16




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Abbreviations


AMTSL              - Active Management of Third Stage of Labor

APH        - Ante Partum Hemorrhage

AMO        Assistant Medical Officer
BP         Blood Pressure
CHMT       Council Health Management Team
DMO        District Medical Officer
EDD        Expected Date of Delivery
EmONC      Emergency Obstetric and Newborn Care
EN         Enrolled Nurse
LNMP       Last Normal Menstrual Period
MoHSW      Ministry of Health and Social Welfare
MOI        Medical Officer In-charge
MMR        Maternal Mortality Ratio
NM         Nurse Midwife
NO         Nursing Officer
PHN        Public Health Nurse
PPH        Postpartum Hemorrhage
RCH        Reproductive and Child Health
RN         Registered Nurse
TDHS       Tanzania Demographic Health Survey
TGPSH              Tanzanian Programme to Support Health




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Executive Summary


The Tanga Regional Medical officer’s office with support from Tanzanian German Programme to
Support Health (TGPSH) organized a three days training on intra-partum and immediate postpartum
care. The trainings were conducted in three stations namely Tanga Regional Referral Hospital (Bombo),
Teule hospital Muheza, Korogwe and Pangani district hospitals.          A total of 46 midwives working in
these three district hospitals and hospital were trained. The training was facilitated by two experienced
midwives from the regional hospital. The trainings were conducted from 20th September to 29th
September 2010. The major output of the trainings was presence of 46 midwives who are competent to
provide quality intra-partum and immediate postpartum care to the clients at the same time offering on
the job trainings to their fellow staff at their respective working areas.




Introduction and Rationale


                                                      5
Every year about 600,000 women are estimated to die around the world as a result of pregnancy and
child birth complications. Majority of these deaths occur in developing Countries.

In Tanzania, the problem of maternal mortality is on the increase as revealed by the Tanzania
Demographic and Health Survey (TDHS) of 1996 which showed that 529 women died for every 100,000
live births and the figure for 2004/2005 was 578 deaths for every 100,000 live births. However,
preliminary data from 2010 TDHS shows that there is a slight decrease in the maternal mortality ratio.

The major causes of maternal and peri-natal deaths are same throughout the country; however there are
regional variations in the total number of deaths. The five major direct causes of maternal deaths in
Tanzania are Hemorrhage, Hypertensive disorders, Sepsis, Abortion complications and obstructed
labor. Malaria, severe anemia and HIV/AIDS are the major indirect causes. Generally most of these
conditions could be treated or prevented from causing death if the mother was or is attended by a skilled
service provider at child birth.

Data from Tanga region PHC 2009 report indicate that maternal mortality ratio is still high-
144/100,000 live deaths (64 deaths). Postpartum hemorrhage (17), Eclampsia (15) and obstructed labor
(14) had the greatest contribution. All these three conditions can be somehow addressed by improving
the quality of intra-partum and immediate postpartum care. Also in the same report the absolute
numbers of fresh still births (FSB) was still unacceptably high- 157 FSB against 35,891 live births.

In order to address the issue of quality of care during intra-partum and immediate postpartum care, the
regional medical officer’s office with support from TGPSH organized this training.

It is hoped that the participants who attended this training from the four selected district hospitals will
help to improve the quality of intra-partum and immediate postpartum care. These few individuals will
also act as change agents in their respective work places through continuous on the job training.




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Objectives of the training


By the end of the three days training participants are expected to be able to;

    1. Describe maternal and peri-natal mortality in terms of definition, predisposing factors and
        possible preventive measures
    2. Describe how to conduct maternal mortality review sessions
    3. Describe normal labor and obstructed labor
    4. Describe the parto-graph and be able to plot on it.
    5. Describe the Vacuum extractor and be able to use and care it
    6. Describe care of the woman and the newborn baby in the first 24 hours
    7. Be a change agent in the reduction of maternal and newborn mortality in his/her respective
        hospital
    8. Be able to keep records of maternal and peri-natal deaths for further review

Participants

A total of 46 participants from Bombo hospital, Pangani, Teule (Muheza) and Korogwe district hospitals
attended the training. Participants were midwives of different cadres from these hospitals (See annex 1:
Participants list)

Facilitators

There were two experienced facilitators who were one senior midwife and one obstetrician who work at
the regional hospital (See annex 2: List of facilitators and supporting staf))

Training methodology

The experiential learning approach was used throughout the training whereby various participatory
techniques such as role plays, case studies, demonstrations and lectures were utilized to impart
knowledge and skills to participants. Skills were acquired by demonstrations on real clients in the
practicum areas or where cases were not available a simulation was performed in the classroom. Clients
attended during practicum sessions were latter presented in plenary discussion sessions.

The training contents




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The training duration was for three days. The first two days were for theoretical/knowledge training
sessions. The third day was used for practicum activities whereby participants went to labor,
postpartum and gynecological wards. In these sites participants picked one client and offered care to her
according to the existing national guidelines. Participants used the problem solving approach to attend
to various clients. Emphasis was put on the practical management of clients and also on the care of the
instruments like BP machines, Vacuum extractors, Fetal Doppler machines etc which are available in
the labor rooms

The following topics were discussed in detail:

1. Introduction to maternal and neonatal mortality and Safe Motherhood Initiative(SMI)
This was discussed under the following objectives;


1.1     Define and classify maternal mortality
1.2     Describe the risk factors for maternal mortality
1.3     Define peri-natal mortality
1.4     Explain some of the contributing factors for peri-natal mortality
1.5     Describe the process of conducting maternal death reviews
1.6     Describe the milestones of SMI




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2. Monitoring progress of labor process
This was discussed in detail under the following objectives;


2.1     Define common medical terms related to labor and delivery
2.2     Explain normal labor
2.3     Describe the mechanism of labor
2.4     Describe parts of parto-graph
2.5     Demonstrate ability to assess the pelvic capacity
2.6     Demonstrate ability to use parto-graph in monitoring progress of labor
2.7     Demonstrate mechanism of labor


In this section participants performed many practical exercises on how to plot and interpret information
in the partogragh


3. Active Management of Third Stage of Labor (AMTSL)
This was discussed under the following objectives;


3.1     Explain the causes of PPH
3.2     Describe how to conduct Active Management of Third Stage of Labor (AMTSL)
3.3     Describe the commonly used uterotonic drugs
3.4     List at least three advantages of AMTSL




                                                     9
4. Managing second stage of labor using Vacuum Extractor

This was discussed and demonstrated under the following objectives;

4.1     List at least three indications for Vacuum extraction
4.2     List at least five preconditions for using a vacuum extractor
4.3     List the contraindications for Vacuum extraction
4.4     Mention the parts of a Vacuum Extractor
4.5     Describe how to perform Vacuum extraction
4.6     Diagnose a failed Vacuum Extraction

In this topic it was emphasized that nurse midwives working in the labor rooms need to have skills to
perform a lift up vacuum instead of waiting for ‘doctor on call’ to come to do it.



5. Care of the woman and her newborn baby in the first 24 hours post delivery

Again this was discussed under the following objectives;


5.1     Describe the normal physiological changes in a woman during postpartum period.
5.2     Care the woman and her baby during the first 24 hours after delivery.
5.3     3) Care the woman and her baby during the subsequent visits after delivery.
5.4     4) List the postpartum dangers signs in the mother and the newborn.


In this topic, the contribution of the first 24 hours in the causation of maternal and newborn mortality
was stressed. Participants were urged to be very vigilant when caring these women and newborns
during this period.




                                                    10
6. Conducting maternal death reviews

In this topic participants discussed the subject under the following objectives;

6.1     Explain the reasons for conducting maternal death reviews
6.2     List the five approaches of learning maternal deaths
6.3     Describe facility based maternal death reviews

In this topic the participants went through the national guidelines on how to conduct maternal death
reviews. It was emphasized that ALL maternal deaths need to be reviewed and reported to the next
levels. It was also emphasized that the facilities need to utilize the generated information and act on all
action plans from all maternal deaths (See annex 3: Training schedule)




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       Participants learning:


       The following are the participants’ responses to the questions “What new things have you learned during
       the training?”

  i.       Proper use of the partograph can greatly decrease maternal and peri-natal deaths in our region.
 ii.       Active Management of Third Stage of Labour(AMTSL) is simple to perform and can be employed
           to ALL women in labor
iii.       Proper use of the vacuum extractor can save many lives.
iv.        All maternal and peri-natal deaths need to be discussed and later reported to the next level
 v.        The first 24 hours post delivery are very important for the well being of both the mother and her
           newborn baby




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Annex 1:

List of Participants: Bombo Regional Hospital


S/N         NAME                            DESIGNATION    ADDRESS
1     Catherine Nyellow                         EN        Box 452 Tanga
2     Ashirina Mwanyoka                         EN                 „
3     Esther Mpalahole                          EN                 „
4     Anna Makundi                              RN                 „
5     Salome Kabimba                            EN        Box 452 Tanga
6     Theodora Kiseku                           EN                 „
7     Halima Ricco                              RN                 „
8     Sufiana Bwanda                            EN                 „
9     Josephine Msofe                           RN                 „
10    Fatihia Kilua                             RN        Box 452 Tanga
11    Fatuma Hamisi                             RN                 „
12    Scolastica Gasper                         RN                 „
13    Angellina Machota                         RN                 „
14    Emilly Kimweri                            EN        Box 452 Tanga
15    Mwajuma Mweyombwe                         RN             „
16    Dr Cosmas Mashaka                         AMO            „
17    Faith Mafolle                             RN                 „




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List of Participants: Muheza Teule Hospital


S/N    NAME                                   DESIGNATION   ADDRESS
1     Dr Fatma Ussi                              AMO        Pangani DH
2     Esther Mwone                                EN        Pangani DH
3     Tusajigwa Mdamu                             EN        PanganiDH
4     Bertha Mhaville                             RN        Pangani DH
5     Halima Mahanyu                              EN        Pangani DH
6     Mary Mutuku                                 RN        Teule Hosp
7     Verdiana Henry                              RN        Teule Hosp
8     Tatu Mfuko                                  EN        Teule Hosp
9     Hilda Kallaghe                              EN        Teule Hosp
10    Edna Bondo                                  EN        Teule Hosp
11    Mariam Hemed                                EN        Teule Hosp
12    Zaina Salum                                 RN        Teule Hosp
13    Sonia Mkwizu                                EN        Teule Hosp
14    Janeth Mkunda                               EN        Teule Hssp




                                       14
List of Participants: Korogwe District Hospital


S/N    NAME                                 DESIGNATION   ADDRESS
1     Esther Msangi                               EN      Bombo hosp
2     Tutindaga Mwakabambo                        EN      Bombo Hosp
3     Agnes Mhina                                 EN      Bombo Hosp
4     Dr Olga Jeremia                             AMO     Bombo Hosp
5     Deodatha Ngereza                            RN      Bombo Hosp
6     Dr Omari Sukari                             MO      Korogwe DH
7     Christina Daudi                             RN      Korogwe DH
8     Blandina Ngowi                              EN      Korogwe DH
9     Dorice Mwema                                RN      Korogwe DH
10    Miriam Mshami                               RN      Korogwe DH
11    Stella Mtangi                               EN      Korogwe DH
12    Beatrice David                              RN      Korogwe DH
13    Beatrice Kisanga                            RN      Korogwe DH
14    Ndeana Malisa                               RN      Korogwe DH
15    Christina David                             RN      Korogwe DH




                                       15
Annex 2

List of Facilitators and Support Staff


S/N          NAME                             DESIGNATION   ADDRESS
1     Dr F.P. Mtatifikolo                 Obstetrician      Bombo Hospital
2     Aisha Mussa                         Nurse Officer     Bombo Hospital
3     Lydia Mtoi                          Accountant        TGPSH Tanga
4     Kassimu Lubwaza                     Driver            Bombo Hospital




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