New innovation at Malindi Sub County Hospital to help reduce postpartum haemorrhage among women

Medical practitioners at the Malindi Sub County Hospital in Kilifi County have come up with an innovation that will help reduce PostPartum haemorrhage among women.

The PPH is a condition that causes excessive bleeding among women who have just given birth under 24 hours and it happens when a woman loses more than 500 millilitres of blood and it is the leading cause of maternal deaths and morbidity in the world.

Statistics from the World Health Organization (WHO) indicate that 14 million women across the globe experience PPH and that 70,000 women die due to excessive bleeding every year.

In Kenya, PPH causes 34 per cent of maternal deaths annually and the new gadget is touted as a game changer that will save the lives of women.

Maureen Were, a lead obstetrician gynaecologist at the Malindi Sub County Hospital led a team of nurses to develop the gadget after a pilot project conducted using the E-MOTIVE technology in four African countries including Kenya, Nigeria, Tanzania and South Africa ended.

The program ran for one year and ended after 200,000 women took part in the study that was funded by the Melinda Gates Foundation in partnership with the WHO and implemented by Birmingham University of Britain.

“We were part of the hospitals that were selected in the E- MOTIVE trial as a trial site and during the study we had to use a drip to collect and estimate how much blood is lost and we did that for a period of one year when the study ended,” she said.

She added that when the study ended, they could no longer get supplies of the E-MOTIVE graduated drip hence they came up with their own version of the drip which is helping them measure the amount of blood that women bleed after giving birth at the facility.

“After the study ended, we got the challenge of not having the graduated drip and so we had to think of ways to continue with the accurate measure of blood because for us we had seen the importance of using proper accurate estimation so that we don’t under diagnose PPH,” she said.

The innovative drip is spread on the bed and the patient sleeps on it and it has strings that are tied around the patient’s waist to avoid it slipping out and when there is bleeding, the blood flows down to the bowl that is marked in millilitres.

The millilitres range from 100 millilitres to 500 millilitres with an interval of 100 millilitres and when the blood surpasses the 300-millilitre mark then medication is administered to the patient.

“We came up with two items, we made a drip made of mackintosh and we had the blood collecting container which is a bowl placed under the bed. The bowl is graduated with measurements that help us estimate the amount of blood and it has several graduations,” she added.

“The several graduations replicate what was in the graduated drip and it was easier now for us and the midwives to pick out what amount of blood the patient had lost so that we know what drugs to give and in good time,” said Were.

Initially, medical staff and midwives used to estimate blood using their naked eyes hence they could not ascertain the correct estimation of blood a patient lost and this forced them to administer blood transfusion or take some patients to the Intensive Care Unit (ICU) while others died of excessive bleeding.

“We are still able to diagnose PPH quite early and with that, we have seen a reduction in the number of mothers who we previously had very bad outcomes with. Initially, we’d have to struggle in trying to look for blood to transfuse these women. Some with acute issues had to be dialyzed and some needed ICU care while some were lost,” she said.

“We have seen a reduction in that and we are transfusing fewer mothers because we can quickly manage PPH in good time. We are not having a lot of morbidity from surgeries that we used to do for these mothers and we are having fewer women being dialyzed,” she added.

During the pilot study, the non-reusable graduated drip made of plastic bags with graduations at the tail end was being provided by the Melinda Gates Foundation at a cost of 2 USD but the innovative one is reusable.

“For the study, the drips were provided and imported from outside the country and because there was a delay in getting that, we decided instead of waiting until we got the drip, we came up with our own drip to have the continuity care,” she added.

The Malindi Sub County Hospital is a high-volume medical facility that serves three counties including Kilifi, Tana River and Lamu and it is estimated that between 80 and 100 women give birth in the facility every week.

“We have roughly 80 to 100 deliveries in a week and about six percent of those would develop PPH which is quite a big number and we have been trying to reduce the severity of that by bringing the number down by accurately estimating the blood loss. Before we would have up to 80 or 60 per cent developing PPH but we are trying now to half that,” she said.

To address community fears for innovation, the hospital is creating awareness among community members and encourages many women to give birth in hospitals.

“When our clients come to the labour wards before we put the drip, we explain to them why we need to have the drip so she sees the importance of it and the uptake is very good. It is clean and the client is not soaked in blood since it flows to the receiver and with the experience they get, they spread the message and more women come to the hospital,” she said.

David Mang’ong’o, who is the Medical Superintendent of the Malindi Sub County Hospital said that the drip technology has benefited more than 6,000 women who gave birth at the facility and encouraged the Ministry of Health to make the study a reality by implementing its recommendations.

Professor Zahida Qureshi who is an Associate Professor, the Department of Obstetrics and Gynaecology at the University of Nairobi said that the E-MOTIVE was piloted in 19 health facilities in Kenya and that Malindi went out of its way to continue the program even after it lapsed.

“We had 19 facilities and in the last part of the trial, we had seven facilities that were carrying out the intervention. The impact of the early detection and then giving the treatment to those women who were recognized to have PPH eventually led to a reduction of severe PPH and maternal mortality and surgery due to PPH by a phenomenal 60 per cent,” she said.

She added that the country was losing 5,000 women through maternal death every year and 40 per cent died due to excessive bleeding.

“PPH is a big issue and in Kenya, we have about 5,000 maternal deaths that happen every year and of the ones that are measured, we have about 40 per cent of maternal death and these are women who are dying as a cause of bleeding after childbirth or during childbirth and so the contribution of PPH to maternal death is about 34 per cent because total bleeding is 40 per cent and so if we can manage PPH then we will have managed a lot and we will have saved a lot of women from having complications of bleeding and also from dying,” she said.

She urged policymakers in government to fast-track the process of having the E- MOTIVE study implemented so that all facilities in the country can practice it.

“We are really looking forward now to having the findings of this study being translated into guidelines starting from WHO coming down to countries and Ministry of health and there is also the component of the quality of medicine which we hope to take up again with the Ministry of health, Pharmacy and Poisons Board and KeMSA so that we have drugs that are going to be of quality,” she said.

Professor Arri Coomarasamy who is the head of Department of Gynaecology and Reproductive Medicine and a Director of Tommy’s National Center for Miscarriage Research in the University of Birmingham in the United Kingdom said that some 25 million women have PPH in the world every year which translates to one woman every second and that it kills 74,000 women every year making it one in every seven minutes.

“Only 50 per cent of PPH is diagnosed and so we developed an intervention called E-MOTIVE where E means early detection and we used a calibrated bag to collect all the blood so we know exactly how much blood is lost and if a woman has lost too much blood on that accurate measurement then we give a bundle of treatment called MOTIVE and has got drugs in it,” he said.

The clinical trial he said was conducted in four countries and 200,000 women took part which turned out successful.

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