Rosmini Alice, Mugerwa Kidza, Ochan Awatta Walter, Muwanguzi Sarah, Sake Jemelia, Mwesigwa Richard, Sukere Okpwoku, Schulte-Hillen Catrin, Tran Nguyen Toan
United Nations Population Fund, Humanitarian Response Division, 7 rue de Varembé, 1202, Geneva, Switzerland.
United Nations Population Fund, Uganda Country Office UN House, Kololo, Kampala, Uganda.
Int J MCH AIDS. 2024 Sep 23;13(Suppl 1):S72-S80. doi: 10.25259/IJMA_10_2023. eCollection 2024 Sep.
Maternal mortality remains extremely high in fragile settings, with hemorrhage as the leading cause. This study describes a new model for more effective training on postpartum hemorrhage (PPH) prevention and treatment.
Using a low-dose (of information) and high-frequency (of repetitions) approach (LDHF), the strategy comprised an introductory webinar, self-paced study, 2-day in-person workshops, cascade training, continuous facility-based skills drills, and a WhatsApp community of practice and supervision (CoP). Innovations consisted of the practical, midwifery-centered, and short-duration training, and the integration of tranexamic acid (TXA) and heat-stable carbetocin (HSC) into existing modules from the "Bleeding-After-Birth-Complete" toolkit. Effects were assessed through mixed-methods evaluation. Confidentiality and "do-not-harm" principles were respected.
Nine training sessions were conducted in South Sudan and Uganda combined, engaging 126 participants. Average knowledge increases of 21% in South Sudan and 18% in Uganda were recorded. Feedback also indicated changes in practices and attitudes: enhanced competency, teamwork, clinical protocols adherence, appreciation for midwife-led practical sessions, the LDHF method, and continuous support through the WhatsApp CoP. In post-workshop action plans, facility teams outlined steps to apply acquired knowledge and skills. These included training colleagues, establishing quality improvement projects, conducting skill drills, ensuring job aid visibility, and systematically reporting on PPH in the data collection templates of the facilities.
This case study highlights the value of a practical, LDHF refresher training strategy. This strategy bolstered providers' skills, knowledge, and confidence in using HSC and TXA for PPH prevention and treatment. Findings can guide future training in similar fragile, low-resource, and humanitarian settings. Strengthening midwifery leadership, fostering interdisciplinary collaboration, and using the LDHF training approach can contribute to resilient health systems and taskforce, aligning with global efforts to reduce maternal mortality.
在脆弱环境中，孕产妇死亡率仍然极高，出血是主要原因。本研究描述了一种更有效的产后出血（PPH）预防和治疗培训新模式。
采用低信息量和高重复频率（LDHF）方法，该策略包括一次入门网络研讨会、自主学习、为期2天的面对面工作坊、级联培训、基于机构的持续技能演练，以及一个WhatsApp实践与监督社区（CoP）。创新之处包括实用、以助产为中心且持续时间短的培训，以及将氨甲环酸（TXA）和热稳定卡贝缩宫素（HSC）纳入“产后出血综合”工具包的现有模块。通过混合方法评估效果。尊重保密和“不伤害”原则。
在南苏丹和乌干达共举办了9次培训课程，有126名参与者参加。记录显示，南苏丹的平均知识增加了21%，乌干达增加了18%。反馈还表明实践和态度发生了变化：能力增强、团队合作改善、临床方案依从性提高、对助产士主导的实践课程、LDHF方法以及通过WhatsApp CoP提供的持续支持表示赞赏。在工作坊后的行动计划中，机构团队概述了应用所学知识和技能的步骤。这些步骤包括培训同事、开展质量改进项目、进行技能演练、确保工作辅助工具可见，以及在机构的数据收集模板中系统报告产后出血情况。
本案例研究突出了实用的LDHF复习培训策略的价值。该策略增强了提供者在使用HSC和TXA预防和治疗产后出血方面的技能、知识和信心。研究结果可为未来在类似脆弱、资源匮乏和人道主义环境中的培训提供指导。加强助产士领导力、促进跨学科合作以及采用LDHF培训方法有助于建立有韧性的卫生系统和工作队伍，与全球降低孕产妇死亡率的努力相一致。
