Improving Quality of Maternal Care through Midwifery Refresher Courses

A project experience in two districts of KPPrime Foundation PakistanDr. Aysha MasoodDr. Usman Ahmad RazaDr. Saeed AnwarDr. Farhat Rehana MalikDr. Faisal Ali Shah

Devastation caused by the floods of 2010 in Nowshera and Charsaada

1 million females affected

Shortage of skilled birth attendants (SBAs) and low antenatal coverage in Nowshera and Charsaada

Further rise in maternal mortality due to floods and inadequate maternal services

Project planned to contribute towards improvement of quality of care being provided by the midwives practicing in the community

Refresher training designed to fill gaps in knowledge and practices of SBAs

To contribute towards the improvement of maternal health through capacity building of midwives practising in the districts of Charsaada and Nowshera, by improving their midwifery skills and knowledge

Needs Assessment ConductedCoordination with District Health Officers Enrolment Criteria EstablishedLocation and Trainers for Training SelectedShort listing of Received ApplicationsPre and Post Test Assessments of the traineesAnalysis of Results

Location: Ob-Gyn Dept of Kuwait Teaching Hospital, Peshawar equipped with OTs and labour roomsResource persons included experienced obstetricians, nursesTrainees provided full boarding and lodging and stipendAV aids and Mannequins used for interactive sessionsRotations in ward including day and night shiftsWeekly feedback sessions on training quality from traineesWeekly assessments of log books to tailor the practical component of curriculum according to needs of midwivesPre/Post tests conducted to track effectiveness of training

Health EducationReview of Pelvic Anatomy & PhysiologyPuerperium & its complicationsEssential Care of New BornAntenatal Care Practical Basic Nursing SkillsRecognition of signs of Birth Asphyxia + PracticalEarly Recognition of Danger Signs & ReferralPartogram PracticalLabour and its management PracticalEclampsia

Marked increase in the knowledge and skills of the traineesResults signify the need for improvement in midwifery skillsA focused, need based curriculum delivered in a hands-on manner can almost double the knowledge and skill levels of midwivesTrained midwives are practicing in the community and contributing to improved maternal care in their localitiesSustainability of the training hampered dependent on continued funding

UNICEF. Pakistan Statistics. http://www.unicef.org/infobycountry/pakistan_pakistan_statistics.html (Accessed 10 October 2013) National Institute of Population Studies (NIPS) [Pakistan] and Macro International. 2008. Pakistan Demographic and Health Survey 2006-07: Key Findings. Calverton, Maryland, USA: NIPS and Macro International. Trends in maternal mortality: 1990 to 2010. WHO, UNICEF, UNFPA and The World Bank estimates. World Health Organization 2012. Fikhree FF. Reproductive Health In Pakistan: Evidence and future directions.JPMA. 2000. Provincial Bureau Of statistics- KPK. Early Recovery Priorities for Flood 2010 in Khyber Pakhtunkhwa. 2010. Provincial Disaster Management Authority Khyber Pakhtunkhwa.

Shadoul AF, Akhtar F, Bile KM. Maternal, neonatal and child health in Pakistan: towards the MDGs by moving from desire to reality.EMHJ 16 2010.