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    TheUseofSafeBirthingKitsandTheUseofSafeBirthingKitsand MisoprostolforHomeDeliveriesasPartofMisoprostolforHomeDeliveriesasPartof

    theContinuumofCareforPreventionandtheContinuumofCareforPreventionand ManagementofPPHManagementofPPH

    ShabnamShahnaz,MD,MPH

    PathfinderInternational,Bangladesh

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    BackgroundBackground Postpartumhemorrhage(PPH)accountsforabout28%of

    maternaldeathsinBangladesh.

    82%ofdeliveriesinBangladeshoccurathomewithunskilled birthattendants.

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    TheGapTheGapDuringdelivery AfterBefore

    Interactionwitha

    health,or

    development

    workerforFP,ANC;

    otherhealth

    interventions

    85%ofdeliveries

    occurathomeby

    unskilledbirth

    attendants

    Mostbirthsassisted

    byDais,followedby

    friendsandrelatives

    Interactionwith

    healthservice

    providersfor

    maternal

    complications,EPI,

    childhooddiseases

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    MayerShasthya:TheInterventionMayerShasthya:TheInterventionEffectiveprevention

    UseofMisoprostol ActiveManagementofThirdStageofLabor(AMTSL)

    TimelyidentificationofPPH

    Useofbloodcollectionmat

    Appropriatereferral

    Establishinganappropriatereferralsystem UseofPPHmanagementkit UseofNASG

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    EffectivePreventionEffectivePrevention

    Counseling:ANC,PNC,preventionandmanagementofPPH, andreferrals

    DistributionofMayerShasthyaPPHbag DeliveryKit Misoprostol BloodCollectionMat RegistrationandreferralCard

    CorrectandtimelyidentificationofPPH

    Followup

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    TimelyIdentificationofPPHTimelyIdentificationofPPHWhymeasurebloodloss?

    Womanareignorantabouttheamountoflifethreateningblood lossduringpostpartumperiod

    Nonavailabilityofanyeasymethodofmeasuringbloodloss

    Evenobstetriciansrelyonsubjectiveassessment,difficultto standardize

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    EstimationofBloodLossEstimationofBloodLoss

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    EstimationofBloodLossEstimationofBloodLoss

    BloodCollectionDrape

    Visualestimation

    CalibratedJugs Nigeria

    KellysPad

    India

    ClothMat

    Bangladesh

    Kanga Tanzania

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    AccurateEstimationofBloodLossAccurateEstimationofBloodLoss

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    AppropriateReferralAppropriateReferral

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    Progresssofar..Progresssofar..MayerShasthyPPHbags

    13,381pregnantwomenregisteredinprojectarea 8,434PPHbagsdistributedtopregnantwomen 8,026womendelivered,usedthebagandtookMisoprostol

    PPHManagementKitBox:

    Providedtoeachofthereferralcenters

    Orientationandtrainingofproviders:

    Providedtraining

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    Progresssofar..Progresssofar..HouseholdMeetings: 1,855meetingsorganized 21,996pregnantwomenandfamily

    membersreached

    CommunityGroupMeetings: 167meetingsorganized 4,337communitymembersreached

    TwoAmbassadorsforProject: RupamRanireceivesBadgeofHonor

    fromWRABangladesh(USAID

    sponsored)

    Policy: MisoprostolincorporatedintotheEssentialDrugList

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    Successsofar..Successsofar..

    ManagementofPPHcases:

    20PPHcasesidentifiedandmanaged intheMayerShasthyaProjectareas

    AllwomenusedMisoprostoltablet,bloodcollectionmatand deliverykitsuppliedbytheproject

    NASGwasusedfor1woman

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    ChallengesChallenges Understandingontheneedtoempowerpregnantwomen

    Migrationofthepregnantwomen

    Lackofreliabledataonpregnantwomenandpregnancy outcomes

    Insufficientsuppliesofmaternalhealthcommodities(e.g., Misoprostol,magnesiumsulfate,birthkits)

    Maintainingtheresponsivenessandcompetenceofreferral centers

    Financialconstraintsoffamiliesandtransportation arrangements

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    Donotgowherethepathmaylead,goinsteadwherethereisno

    pathandleaveatrail.RalphWaldoEmerson

    Shabnam Shahnaz, MD, MPHPathfinder International, BangladeshBackgroundThe GapMayer Shasthya: The InterventionEffective PreventionTimely Identification of PPHEstimation of Blood LossEstimation of Blood LossAccurate Estimation of Blood LossSlide Number 10Slide Number 11Appropriate ReferralProgress so far..Progress so far..Success so far..ChallengesSlide Number 17