Presentation at the Global Maternal Newborn Health Conference, October 19, 2015
Background: Decades of armed conflict in South Sudan has resulted in weak educational and health systems, a very low adult literacy rate (27%), low institutional delivery rate (11.5%) and maternal mortality rate of 2054/100,000. Post-partum hemorrhage (PPH) is the single leading direct cause of maternal mortality.
Methodology: To support the Ministry of Health to implement a community based PPH prevention program, HHPs were selected based on their interest and community recommendations. HPPs recruited for the initial learning phase were female, volunteers and illiterate. A 4-day training was designed to use pictorial IEC training materials and reporting forms. Interactive, participatory training approaches included role-plays and community-based practical sessions. Each HHP needed to demonstrate competence in interpersonal counseling skills for birth preparedness and complication readiness (BPCR) and use of misoprostol for PPH prevention in home births. A total of 260 HHPs were trained and supervised for seven months.
Results: After training, HHPs demonstrated adequate knowledge in counseling using the BPCR cards and to identify danger signs. Follow up after the initial training demonstrated consistent transfer of knowledge by HPPs to pregnant women and their families as measured by: 1) women’s identification of danger signs, 2) knowledge of BPCR core elements; 3) self-reported development of BPCR plans, including saving money. 533 women counseled by HHPs delivered at home. 437 (99.5%) of 439 interviewed reported self-administration of misoprostol correctly; 85% of women could correctly identify common side effects of misoprostol.
Conclusion: Although volunteers, the opportunity to actively participate in their communities to reduce maternal deaths from PPH, through BPCR counseling and provision of misoprostol for self-administration in home births motivated the HHPs. The program demonstrated a replicable and feasible model in a high-mortality setting for engaging illiterate female community members in the prevention of PPH.