Docstoc

Home Based Lifesaving Skills

Document Sample
Home Based Lifesaving Skills Powered By Docstoc
					Home-Based Lifesaving Skills



                                                      Ethiopia

                                                  Lynn M. Sibley, CNM, MS, PhD
                                              Sandra T. Buffington, CNM, MS, FACNM
                         Ethiopian Ministry
                             of Health
                                                           June 4, 2003

     Save the Children
        Focus of this presentation
   Describe community partnership for safe motherhood
    model (CPSM)

   Review home-based lifesaving skills (HBLSS) field-test
    –   Context
    –   Program characteristics
    –   Methods & results


   Next steps & proposed future activities
A community
partnership
model
                                                 for saving lives
                                  HBLSS
                                 • Guides
                             • Women, families
                          • Home birth attendants




                              Community
                              Mobilization
                               • Health promotion
           LSS                 • Referral linkages           LSS
          (Basic)             • Support to Guides         (Advanced)
        • Trainers                                         • Trainers
  • Referral facility staff                          • Referral facility staff
HBLSS field-test context
HBLSS field-test context (cont.)

   Ethnically diverse agro-pastoral population
    –   Borana, Arsi, Guji & Somali (some returnees)

   MMR
    –   871 deaths per 100,000 live births (Source: Ethiopia, DHS 2000)
   NMR
    –    49 deaths per 1,000 live births (Source: Ethiopia, DHS 2000)
        ( 61 deaths per 1,000 live births rural Oromiya)

   Homebirth with unskilled attendants
    –   90% + (Source:   Save the Children KPC Survey 2001)
HBLSS field-test context (cont.)

   Limited access to emergency obstetric care (EmOC)
    –   Great distance & difficult terrain
    –   Lack & cost of transport
    –   Lack of emergency communications
    –   District hospital capable, but unreliable
            Staffing
            Infrastructure (e.g. running water, electricity)
            Essential supplies
            Quality of care
   Need for EmOC not met
    –   6% deliveries take place in district hospital
HBLSS field-test context (cont.)
Health post      ~ Distance
                 to hospital
   Negelle        20 km
   Harakelo       35 km
   Jiddola        64 km
   Mugayo         31 km
   Ganale         54 km
   Bulbul         60 km
 Alge             90 km
   Measa          30 km
   Melka Guba     98 km
HBLSS field-test context (cont.)

   Child Survival-13 & Child Survival 17 Projects
   Development Assistance Project
    –   Integrated development
            Maternal & newborn health
            Family planning
            Child survival
            Water & food security
            Livestock health
            Range management
    –   Extensive community mobilization
SC/MOH structure-health programs

                Liben Impact Area Manager

    MOH           Health Sector Manager

  EPI     FP    Nutrition     Training    MCH          HIV/AIDS

    Health                  HAs   SPAs
   Facilities
                      HAC Leaders / HACs
                                                • HA, health assistant
                            TBAs / BHTs         • SPA, senior program assistant
                                                • HAC, health action committee
                                                • BHT, bridge to health team
                            Community           • TBA, traditional birth attendant
             HBLSS-- objectives

   Increase access to life-saving
    measures within home &
    community
   Decrease delays in referral
   Increase use of postpartum
    & post abortion family
    planning
    HBLSS– intended audience

   Intended audience
    –   Pregnant women
        & family caregivers
                      HBLSS-- focus

                            Mother Topics
                             Too much bleeding *
Core Topics                  Sickness with pain & fever *
 Introduction *             Birth delay
 Woman & baby               Pregnancy swelling & fits
  problems *                 Too many children
 Preventing problems       …………………………………
 Referral *                Baby Topics
                             Trouble breathing at birth
    * Topic covered
                             Born too small
                             Baby falls sick *
       HBLSS-- approach

Step 1. Guide reviews previous meeting with participants
Step 2. Guide learns what participants know & do about
          the problem topic e.g., ‘Too Much Bleeding’

Step 3. Guide explains what trained health workers would
          do vis-à-vis the problem

Step 4. Guide & participants discuss similarities &
          differences, come to agreement on what is
          feasible & acceptable in the home setting
HBLSS-- approach (cont.)

Step 5. Participants practice the agreed actions
Step 6. Participants decide how they will know if the
          actions they have taken have solved the problem

Step 7. Participants discuss how to prevent the problem
Example-- Take Action Card
  ‘Too Much Bleeding After Birth’
   Problem side           Action Side
    HBLSS training cascade

2 ACNM staff

   4 district hospital & 1 SC staff
     17 district health post staff

        209 HBLSS guides (300 to be trained)


                   Est. 7,400 pregnant women & families
                              6,900 newborns
Pre-testing…
Practicing...
        HBLSS program review

   Descriptive
   Focus
    –   HBLSS guide performance
    –   Case management
    –   Coverage (exposure of pregnant women to HBLSS)
    –   Community support
    –   Cost
                Sentinel sites

   4 health post catchment areas
   Considerations…
    –   Number TBA attended births
    –   Presence of SPA
    –   Ethnic group representation
    –   Feasibility
     Performance assessment
   Measure
    –   % ‘satisfactory’ performance

   Subjects
    –   83 HBLSS guides trained in 2002
    –   68 HBLSS guides trained in 2001

   Method
    –   Observation, HBLSS Skills
        Checklists
            Immediate pre-post (2002 cohort)
            1 year ex-post (2001 cohort)
                        Performance– results
 TOPIC                             (n)      Too Much Bleeding            Referral of Woman
                                             Avg. Score         p        Avg. Score      p
                                                (%)          Value a        (%)       Value b
                                                             (z score)                (z score)
    Pre-test                      79          38 + 17          --        46 + 24        --

    Post-test                     77          87 + 16        .000        92 + 12      .000
                                                              (-7.51)                  (-7.45)


    Ex-post test                  68          70 + 16        .000        81 + 17      .000
                                                              (-6.42)                  (-4.36)
     (1 yr)
a Wilcoxon   signed-ranks test.   b Mann-Whitney   U test.
                      Performance-- results
 TOPIC                             (n)              Baby Falls Sick         Referral of Baby
                                                   Avg. Score     p         Avg. Score     p
                                                      (%)       Value a        (%)       Value b
                                                                (z score)                (z score)

    Pre-test                      75               34 + 20                  50 + 25        --

    Post-test                     77               95 + 14      .000        96 + 09      .000
                                                                 (-7.56)                  (-7.60)


    Ex-post test                  68               62 + 28      .000        69 + 27      .000
                                                                 (-8.15)                  (-7.50)
     (1 yr)
a Wilcoxon   signed-ranks test.   b Mann-Whitney   U test.
    Case management review

   Measure
    –   % ‘appropriate’ case management

   Subjects
    –   29 cases managed by HBLSS guides
    –   23 cases managed by other ‘unskilled’ attendants

   Methods
    –   Case identification,TBA Picture Report
    –   In-depth interview, Complication Audit
    –   Hospital record review & verification, TBA Referral Log
    –   MCH Unit Head reporting, HBLSS Monthly Report
         Case management-- results
COMPLICATION                HBLSS guide     Other unskilled         p
(Signs of…)                                   attendant          Value a
                                                                 (z score)
                           Event Avg. Score Event   Avg. Score
                            (n)     (%)      (n)       (%)

Antepartum bleeding         7     69 + 26    10      52 + 17      .102
                                                                  (-1.27)

Postpartum bleeding         17    69 + 15    11      36 + 21      .000
                                                                  (-3.52)
(PPH)
Maternal Infection          3     33 + 17     4      21 + 16      .176
                                                                   (-.93)

Newborn infection           3     60 + 40     3      53 + 31      .409
                                                                   (-23)
a Mann-Whitney   U test.
       Case management-- results
REFERRAL                    HBLSS guide     Other unskilled       p
                                              attendant        Value a

                           Event Avg. Score Event   Avg. Score (Exact)
                            (n)     (%)      (n)       (%)

   Maternal                3     50 + 17     7      60 + 25    .319
                                                                (z=-.469)

   Newborn                 3     50 + 44     3      67 + 29    .412
                                                               (z = -.221)


a Mann-Whitney   U test.
                       Coverage

   Measures
    –   % Women attended by HBLSS guide
    –   % Women exposed to HBLSS teaching

   Subjects
    –   1,700 Estimated births per 4th quarter 2002
    –      52 Cases reviewed

   Methods
    –   Record review, MCH Unit Head Quarterly Report, October-
          December 2002
    –   Case management review
                               Coverage– results
  SITE                 Est. Birth                 Attended                Attended                 Attended
                      Per Quarter a                 TBA                 Trained TBA               HBLSS Guide
                           (n)                       (n)                     (%)                      (%)
  Mugayo                       77                       31                       14                      25

  Ganale                      150                       26                                     17

  Harakelo                    469                      130                                     28

  Negelle                   1,003                      189                                     19

  TOTAL                     1,700                      586                                     34
a Based   on the total population of each site & a crude birth rate of 46.6 per 1000 population x .25.
            Coverage-- results

   38% Cases (women)
    exposed to HBLSS
    teaching
    –   52% HBLSS guide
        cases
    –   22% Other ‘unskilled’
        attendant cases
           Community support
   Measures
    –   % Pastoral Associations (PA) with HAC supporting HBLSS
        guide
    –   % PA with reliable emergency transport

   Subjects
    –   8 HAC chairmen representing 31 PA

   Method
    –   Focus group discussion
Community support-- results
   100% PA with HAC supporting HBLSS guide
     0% PA with reliable emergency transport
Summing up…

         HBLSS ‘on track’
         Still much to do
         Committed capable
          people
                        Next steps
   Liben project
    –   Continued HBLSS training & support
    –   Increased reach of HBLSS Guides
    –   Further capacity-building for district level EmOC
            Staff training (e.g., health post staff in basic LSS)
            Referral linkages (e.g., transport & 2-way radio communications)
            Ensuring availability of essential drugs & supplies
            Increasing community & facility-based vital events reporting
     Proposed future activities

   Ethiopia
    –   Expand partnerships
            SC, MOH, CARE, ACNM
            Ethiopian Midwifery Association
            Ethiopian Society of Obstetricians & Gynecologists
            National Reproductive Health Task Force

    –   Increase in-country capacity for EmOC
            Establish HBLSS / LSS training sites for continuing education

    –   Assess new HBLSS program to be integrated into Afdher
        Zone, Somali Region, Fall 2003
             Acknowledgements

   Ethiopian MOH                HBLSS field-test team
   Save-the-Children             D. H/yesus, L.Tadesse, H.Tessema, T.
   NGO Networks for Health       T/Miriam, K. Ibrahim, A. G/Silase, M. Negash,
                                  Z. G/Tsadic, C. Dulo, T. Fekede, B. Gorge, B.
   USAID                         Kebede, S. G/Mariam, N. Kureshy, D. Vivio, P.
                                  J. Long, M. Heymann, A. Clark, M. Kroeger

                                 HAC, BHT & HBLSS guides
                                 Women & families of Liben District

				
DOCUMENT INFO
Shared By:
Categories:
Stats:
views:84
posted:4/26/2008
language:English
pages:37