BJOG: The prevention and treatment of postpartum haemorrhage

‘Postpartum haemorrhage (PPH) remains the most common cause of maternal mortality worldwide.[1] It is responsible for around 30% of maternal deaths, equivalent to 86 000 deaths per year annually or ten deaths every hour…’

Below is the citation and abstract of a review in the January 2015 issue of BJO – An International Journal of Obstetrics and Gynaecology. The full text is available here: http://onlinelibrary.wiley.com/doi/10.1111/1471-0528.13098/full

I was particularly struck by the following statement, in the full text:

‘How best to deliver emergency care

In 2005 Hussein called for the development of ‘obstetric first aid’ skills and for its training in the community to be given as much priority as cardiopulmonary resuscitation.[57] Sadly, a decade later, little has progressed in achieving this aim and there is no agreed, coherent first-aid strategy for PPH…’

This suggests a serious failure of global health research translation and I would like to invite comment from HIFA members. As previously discussed on HIFA, the World Health Organization, among others, have provided guidance on emergency care for PPH: WHO recommendations for the prevention and treatment of postpartum haemorrhage (2012). http://apps.who.int/iris/bitstream/10665/75411/1/9789241548502_eng.pdf  

Is this guidance not agreed and/or coherent?

CITATION: Weeks, A. The prevention and treatment of postpartum haemorrhage: what do we know, and where do we go to next? BJOG: An International Journal of Obstetrics & Gynaecology. 2015. 122; 2: 202-210. http://dx.doi.org/10.1111/1471-0528.13098

ABSTRACT: Postpartum haemorrhage (PPH) remains a major cause of maternal deaths worldwide, and is estimated to cause the death of a woman every 10 minutes. This review presents the latest clinical advice, including new evidence on controlled cord traction, misoprostol, and oxytocin. The controversy around the diagnosis of PPH, the limitations of universal prophylaxis, and novel ways to provide obstetric first aid are also presented. It ends with a call to develop high-quality front-line obstetric services that can deal rapidly with unexpected haemorrhages as well as minimising blood loss at critical times: major abruption, placenta praevia, and caesarean for prolonged labour.

Best wishes, Neil

Let’s build a future where people are no longer dying for lack of healthcare knowledge – Join HIFA: www.hifa2015.org  

The global met need for emergency obstetric care: a systematic review

Systematic Review: The global met need for emergency obstetric care: a systematic review

The January 2015 issue of BJOG – An International Journal of Obstetrics and Gynaecology – is a Special Issue on the theme of ‘Beyond 2015: The future of women’s health globally’. All the papers in this issue are freely available here:

http://onlinelibrary.wiley.com/doi/10.1111/bjo.2014.122.issue-2/issuetoc?utm_source=MHTF+Subscribers&utm_campaign=51df2c5448-MH_Buzz_January_13_2015&utm_medium=email&utm_term=0_8ac9c53ad4-51df2c5448-183741561

Below is the citation and abstract of one of the papers.

CITATION: Systematic Review: The global met need for emergency obstetric care: a systematic review

H Holmer, K Oyerinde, JG Meara1, R Gillies, J Liljestrand, and L Hagander

Article first published online: 26 DEC 2014

DOI: 10.1111/1471-0528.13230

ABSTRACT

Background: Of the 287 000 maternal deaths every year, 99% happen in low- and middle-income countries. The vast majority could be averted with timely access to appropriate emergency obstetric care (EmOC). The proportion of women with complications of pregnancy or childbirth who actually receive treatment is reported as ‘Met need for EmOC’.

Objective: To estimate the global met need for EmOC and to examine the correlation between met need, maternal mortality ratio and other indicators.

Search strategy: A systematic review was performed according to the PRISMA guidelines. Searches were made in PubMed, EMBASE and Google Scholar.

Selection criteria: Studies containing data on met need in EmOC were selected.

Data collection and analysis: Analysis was performed with data extracted from 62 studies representing 51 countries. World Bank data were used for univariate and multiple linear regression.

Main results: Global met need for EmOC was 45% (IQR: 28–57%), with significant disparity between low- (21% [12–31%]), middle- (32% [15-56%]), and high-income countries (99% [99–99%]), (P = 0.041). This corresponds to 11.4 million (8.8–14.8) untreated complications yearly and 951 million (645–1174 million) women without access to EmOC. We found an inverse correlation between met need and maternal mortality ratio (r = -0.42, P < 0.001). Met need was significantly correlated with the proportion of births attended by skilled birth attendants (ß = 0.53 [95% CI 0.41–0.65], P < 0.001).

Authors’ conclusions: The results suggest a considerable inadequacy in global met need for EmOC, with vast disparities between countries of different income levels. Met need is a powerful indicator of the response to maternal mortality and strategies to improve EmOC act in synergy with the expansion of skilled birth attendance.

Best wishes,

Neil

Let’s build a future where people are no longer dying for lack of healthcare knowledge – Join HIFA: www.hifa2015.org  

Reviving rural towns would help drive to curb poverty

One of the most bewildering things when driving through the Eastern Cape’s many rural towns is the state of disrepair of the roads, the decaying infrastructure, the hopelessness in the eyes of the many poor residents. Poverty is endemic and it seems to me every year we plunge to new depths of despair. Local town administrators are doing their best it seems but these areas won’t get out of the starting blocks without massive infrastructure investment…..more

Youth the Soweto looting instigators

The youth are the instigators behind the looting of foreign-owned shops in Soweto, Gauteng police commissioner Lt-Gen Lesetja Mothiba said on Thursday…..more and more

Resources for the community

Some useful resources can be accessed from the broad reach website ! broadreach educational material

Facts for Life

Facts For Life, a ‘trusted resource that is written in easy-to-understand language [and] translated into 215 languages’ http://rehydrate.org/ffl/ . It is indeed urgent and vital that content such as Facts for Life – produced and ratified by reputable health organisations – is universally made available to citizens worldwide

After 10 years, few payoffs from Bill Gates’ ‘Grand Challenges’

When he took the stage this fall to celebrate the 10th anniversary of his signature global health research initiative, Bill Gates used the word “naive” — four times — to describe himself and his charitable foundation. It was a surprising admission coming from the world’s richest man…..more

HealthPhone: Weekly news and social media on health and nutrition educational, instructional, tutorials and training videos

HealthPhone is a curated video library of some of the world’s best producers of health and nutrition educational, instructional, tutorials and training content for personal computers, mobile phones and tablets. The videos are freely available for immediate viewing and download at our web site ( http://healthphone.org ) which houses a fast growing library of over 2,500 videos across 77 languages.

HealthPhone’s main objective is to facilitate the flow of knowledge to rural low- middle-income families and health workers that serve them; delivering information to educate, motivate, empower and inspire communities around better health and nutrition practices.

The topics covered are primarily in the area of nutrition, water, timing births, safe motherhood, newborn health, child development, early learning, breastfeeding, nutrition, growth, immunization, diarrhoea, coughs, colds, serious illnesses, hygiene, malaria, HIV, child protection, injury prevention, emergencies preparedness and response.

Videos are promoted daily on our Twitter ( https://twitter.com/HealthPhone ) and Facebook ( https://www.facebook.com/HealthPhone ) pages and also through the weekly on-line issue of HealthPhone News ( http://paper.li/HealthPhone/1372198680 ). Vist our web site, connect with us on social media and subscribe to our weekly news and YouTube channel ( https://www.youtube.com/user/HealthPhone ) for the latest in health and nutrition video content.

be well, nand

Nand Wadhwani

The Mother and Child Health and Education Trust

http://motherchildtrust.org  |  http://healthphone.org

Now that we can, we must!

WHO publishes systematic review of eLearning in health professional education

WHO has just published eLearning for undergraduate health professional education – a systematic review informing a radical transformation of health workforce development.

You can download a copy of the report from: http://whoeducationguidelines.org/content/elearning-report

The World Health Organization (WHO) Department of Health Workforce in collaboration with the Department of Knowledge, Ethics and Research commissioned the Global eHealth Unit (GeHU) at Imperial College London to conduct a systematic review of the scientific literature to evaluate the effectiveness of eLearning for undergraduate health professional education. The review is based on a rigorous search, analysis and presentation of data that provides decision-makers with an up-to-date picture of current knowledge on eLearning for undergraduate professional education. It responds to a need at the country level for evidence to inform and guide health professional education as an important vehicle in preparing health professionals to be ‘fit-for-purpose’.

At a global level, it will assist in the implementation of the WHO’s global human resources for health strategy by providing the best evidence of how and where eLearning can best be used in country settings. The report also provides a foundation for the development of future WHO guidelines for pre-service training and the direction for  future research.

Kind regards,

Rebecca

Rebecca Bailey | Health Workforce Development Team Lead

IntraHealth International | Because Health Workers Save Lives.

6340 Quadrangle Drive, Suite 200 | Chapel Hill, NC 27517

m. +1 (919) 360-3339

rbailey@intrahealth.org

Webinar: Resources that support children who are hard of hearing

I would like to announce an upcoming webinar titled “Resources for service providers, family, and caretakers of children who are hard of hearing”.

Join Audiologist Larrain Bratt, staff and parents from the Center for Early Intervention on Deafness, and Hesperian’s Executive Director Sarah Shannon for a webinar and discussion about Hesperian materials and resources that support anyone who works with or cares for children who are hard of hearing.

Learn about Hesperian’s print and digital resources in many languages and hear examples and stories of putting these resources into action in a variety of scenarios- from the clinic to the home.

When: Tuesday, January 27th

1:00 pm PST; 4:00 pm EST

Click to sign up for the webinar:

https://attendee.gotowebinar.com/register/4265772327572275970

Speakers:

Larrain Bratt, Audiologist with a focus on newborn hearing screening, infant diagnostics, and educational follow-up.

Helisa Katz, M.A. Teacher of the Deaf, Center for Early Intervention on Deafness

Melissa Lopez, Parent, Center for Early Intervention on Deafness

Sarah Shannon, Executive Director, Hesperian Health Guides

Special thanks to the California Communications Access Foundation for their support.

Warm Regards,

Libby Engles

Media and Communications Associate

libby@hesperian.org

510-845-1447 ext. 224

Physiopedia

Physiopedia is run by volunteers for physiotherapists globally, and is accessible online. http://www.physio-pedia.com/

Strengthening Community Health Systems through CHWs and mHealth

I was interested to see this new publication from the CORE Group, which ‘improves and expands community health practices for underserved populations, especially women and children, through collaborative action and learning’, with support from USAID. Below are some extracts of particular relevance to HIFA, for further discussion:

Strengthening Community Health Systems through CHWs and mHealth

http://www.coregroup.org/storage/documents/Fall_Conference_2014/Strengthening_Community_Health_Systems_through_CHWs_and_mHealth.pdf

‘Community health workers (CHWs) have been called the “world’s most promising health workforce resource” in terms of enabling health systems in resource-constrained settings.’

‘What seems like a straightforward health promotion and service delivery strategy, of recruiting, training and supporting local people to supplement health professionals at the community level, is in fact quite complex.’

‘Increasingly, there is a trend towards using mobile technology to train and support CHWs.’

‘Amref Health Africa looked at whether they could reduce face-to-face training time and still retain the quality of the CHW’s training using mLearning in Kenya. Before getting started, Amref tackled key questions such as, what type of phone to use, basic or smart; whether to develop a platform independently or build

partnerships; what curriculum to use; and what the guiding principles of their mLearning initiative should be. At the start of the initiative, 97% of CHWs in Kenya had mobile phones, with about 70% of CHWs having a basic phone. Thus, Amref decided to leverage current technology (basic phones) in the hands of CHWs for scalability and sustainability reasons. Additionally, Amref established partnerships with Accenture, Safaricom/Vodafone, Mezzanine, and the Kenyan Ministry of Health (MOH). With Amref taking the lead, they developed the Health Enablement and Learning Platform (HELP).’

Study links birth control to increased risk of HIV infection

Women using the birth control shot known by the brand name Depo-Provera may have about a 30 percent higher risk of contracting HIV, according to new research. However, the link between hormonal contraception and HIV remains uncertain…..more

Strategy: Draft National Strategic Plan for HIV Prevention, Care and Treatment for Sex Workers

Released by the South African National AIDS Council (SANAC) on 12 January, this 49-page preliminary document outlines plans to, for instance, increase HIV and tuberculosis (TB) prevention, care and treatment among sex workers and families….more

Child grants until age 23

Talks are under way in government to possibly extend child grants for needy children from 18 years of age to 23. The proposal has been met with mixed reaction, with some roleplayers welcoming it and others questioning the timing of the move and saying that such a step will make people that much more dependent on government. “And it is taxpayers who will have to pay,” said Francois Stofberg, economist at the Efficient Group. ….more and more

Seven Gauteng schools kiss the chalkboard goodbye

Seven schools in Tembisa in Ekurhuleni are stepping bravely into the digital future tomorrow morning. Briefing the media at Boitumelong Secondary School this afternoon Gauteng Education MEC Panyaza Lesufi said: “I’m signing the death warrant of the chalk, duster and chalkboard in Gauteng. We are moving on with the times and we are moving to better things.” ….more

Medical Aid Films – new films in 2015

We at Medical Aid Films have new productions coming up in the next few months and would like to inform you of what is in production and will be available for your use in 2015. For those of you who do not know of our work you can access our freely available training and education films which we hope can complement your existing training materials here: http://medicalaidfilms.org/our-films/

For those of you already using our films please take the time to complete our short online survey (https://www.surveymonkey.com/s/JTLC6FQ) as this helps us to improve the films (10 minutes of your time), for those of you who have already done so and continue to provide feedback – thank you our expertise and understanding grows with every new piece of information and our films evolve for better use in your programs.

New films in 2015:

1. Kangaroo Mother Care – we are aware of some great existing materials by a few organisations and will be producing a film that is complementary to these.

2. Respectful Maternity Care Animation about respecting women’s basic human rights in childbirth. White Ribbon Alliance will use the film to train health workers and communities in Nigeria and Malawi, with the film available worldwide in the spring.

3. We are commencing a suite of Fistula Care training films for nurses. We will start with a pilot film, training nurses on pre and post-operative care for fistula surgery patients with Fistula Foundation. Once tested we hope to develop further films in this suite to complement further training.

4. Managing Obstructed Labour for nurse/midwife training will be developed thanks to Vitol Foundation later this year and will serve to complement the Fistula Care suite.

5. As part of 5 films identified for Reproductive Health we will be releasing the first pilot film for testing in February. Thanks so much to Pathfinder International who let us film with them in Nairobi and to so many other partners who gave us so much time and expertise to draft these films. We aim to have the five developed later in 2015 once we have tested the first film.

6. Ebola films for mobile devices – to complement the many training resources on Ebola we are planning two short animations on stigma and rebuilding trust in health systems.

Thank you to so many of you who have helped and supported our work, we make these films in the hope that they can support your training. Some amazing people have shared their stories, contributing to films that really put community members and health workers at the heart. We are hugely grateful to all our partners for their incredible work with us.

Finally, one last ask of HIFA members is that we are improving the look and accessibility of our website as a priority this year, so please let us know your thoughts on what you think works and doesn’t work and how you would like to access our materials by emailing josie@medicalaidfilms.org.  

Anyone particularly interested in any upcoming productions and would like to be involved or give advice please also get in touch with me directly: josie@medicalaidfilms.org

Best wishes from everyone at Medical Aid Films

HIFA profile: Josie Gallo is Content Co-ordinator for Medical Aid Films in the United Kingdom. Professional interests: Media for development.       josie AT medicalaidfilms.org

__________

To send a message to the HIFA forum, simply send an email to: HIFA2015@dgroups.org

Design features of an online CoP as a continuing education strategy

Neil [see note below] notified us a little while ago of this article: Evans, C, Yeung, E, Markoulakis, R and Guilcher, S (2014) An Online Community of Practice to Support Evidence-Based Physiotherapy Practice in Manual Therapy, Journal of Continuing Education in the Health Professions, Volume 34, Issue 4, pages 215?223.

I read it and thought I’d share some ideas. The premise of the example is quite simple: to describe the design features of an online CoP as a continuing education strategy and to explore how the community promoted the creation and sharing of new knowledge in evidence-based manual therapy using Wenger’s constructs of mutual engagement, joint enterprise, and shared repertoire as a theoretical framework.

Mutual engagement, joint enterprise and shared repertoire are fundamental but also quite simple:

Mutual engagement refers to membership in a community in which participants, with their unique identities and diverse specializations, draw on each other and are engaged in doing things together.

Joint enterprise is the practices of the community, defined as the result of a collective process of negotiation.

Shared repertoire includes tools, routine, stories, jargon, shortcuts, or any resource that may be used over time in a shared pursuit to negotiate meaning.

They created a ten week course on using research evidence in practice and recruited Canadian physiotherapists all of whom had at least ten years experience. There were weekly activities and debates, and three assignments – carrying out an online search, critical appraisal, and writing a review for publication. The course appears to have been very successful; participants were active and gave good reports afterwards.

The authors argue that the course was in fact a community of practice, and provide evidence to show that it meets all the standard criteria as a learning CoP. It was also clear that this worked in an online format (using the Blackboard learning management system). The activity and the results of the course are convincingly analysed, using a very solid theoretical framework.

But I think the article is perhaps less value than it might sound. The authors conclude:

“Lessons for Practice

– Continuing education courses founded on community of practice principles can provide opportunities for collaborative, interactive learning.

– Participants in an online community of practice can share and create knowledge related to their practice through mutual engagement in shared endeavours.

– Design features such as guiding questions, instructor facilitation, and collaborative assignments help to create active, sustained participation in a fully online course.”

But they had ideal circumstances for the course to succeed: the best kind of participants, experienced professionals, used to consultative practices. And they note themselves that they have no idea if the connections created in this temporary CoP were continued after the course ended. (That goes under the heading of further research needed.)

I think we knew that such courses can succeed, but I am looking for a lot more than that. A CoP has to be ongoing. It might well start with a course that captures the imagination of a bunch of professionals or technicians, but there needs to be a platform for the connections made to continue afterwards. (The authors do not say whether the Blackboard platform remained available for the participants after the course finished. Knowing what universities are like these days, that seems unlikely.) The CoP structure and technology also need to be dynamic to encompass the dynamic requirements of the membership – it is a community, an organic thing – and it will ebb and flow in unpredictable ways. We need to be looking at experiments which deal with much less defined boundaries than a ten week course to find out how best to share knowledge on a continuous basis. [*see note below]

HIFA profile: Rob Parsons is a Healthcare Technology Management Consultant at Health Partners International, UK. Professional interests: Healthcare technology management, open source software, knowledge management, social media, open educational resources. robsub AT ariadne.org.uk

[*Note from HIFA moderator (Neil PW): HIFA itself is a Community of Practice on the Dgroups platform, which has more than 700 active CoPs supported by international development organisations. HIFA was evaluated in 2011 and the report identifies markers of success and recommendations for improvement (which we have only partially been able too implement, due to lack of resources). As Coordinator of HIFA and current Chair of the Dgroups Foundation, I would welcome expressions of interest from researchers who would like to undertake further research on HIFA and/or Dgroups.]

Neuroplasticity

Yesterday, the Chiawelo community practice team attended a fascinating discussion on Neuroplasticity, reading Catherine Malabou’s book called What should we do with our brain.

In the chapter : the central power in crisis, we explored the question: What is the main transition point between the neuronal and the political?

If the biological and the social mirror in each other, how do we think around health promotion, behavior change, and a change in social networking that enables the health revolution at CCP?

Universal Healthcare: the affordable dream

Amartya Sen makes a compelling case for Universal Health coverage.

The pandemic of Ebola has brought health systems strengthening and universal coverage on the agenda.

Do you agree that universal health coverage is both a global and local solution for LMI countries?

Universal healthcare: the affordable dream