Presentations/Documents

POPPHI Final PPH Meeting: Tackling the biggest maternal killer: Progress and challenges in preventing postpartum hemorrhage, November 20, 2009, Woodrow Wilson Center, Washington DC

The POPPHI Project held its final meeting to discuss its work over the past five years. This full day even brought in presenters from all over the world to talk about the work surrounding PPH prevention that was being done. The agenda for the event can be found here.

Presentations:

Scale-up and Impact: How far have we come and where to next?: Deborah Armbruster, PATH
Toward national impact: AMTSL and misoprostol scale-up in Bangladesh: Professor Shah Monir Hossain, Bangladesh Ministry of Health & Dr. Abu Jamil Faisel, EngenderHealth
Multiple ways to scale-up PPH prevention in Ghana: Dr. Gloria Asare, Ghana Health Services
A national commitment to scaling up AMTSL: Mali’s experience: Dr. Binta Keita, Mali Ministry of Health
Taking PPH prevention to the community in Guatemala with oxytocin in Uniject: Dr. Jacqueline Lavidalie, Guatemala Ministry of Health
Midwifery education and AMTSL in Peru: Carmen Gamarra, Peruvian Midwifery School
AMTSL M&E: Indicator, supportive supervision, AMTSL tracking and HMIS: Niamh Darcy, RTI
Assisting the Senegalese MOH to integrate AMTSL into their Health System: Daren Trudeau, IntraHealth
HCI AMTSL scale-up and monitoring: Kathleen Hill, HCI
Oxytocin in Uniject: An “ease of use” study in Argentina: Fernando Althabe, IECS, Argentina
How research has informed practice: Innovations in scaling up PPH prevention in Ghana: Ezequiel Garcia Elorrio, IECS, Argentina
Efforts to help policy inform practice: Africa 2010: Doyin Oluwole, AED/Africa 2010
Midwives and the Third Stage of Labor: ICM’s role in policy and practice: Anne Hyre, ACNM
FIGO’s 10 year commitment to PPH prevention and treatment: Hamid Rushwan, FIGO
AMTSL and the newborn Democratic Republic of Congo: AXxess’s experience: Dr. Michel Mpunga, AXxes
Supply and logistics systems: What do we know from Strengthening Pharmaceutical Systems/MSH experience and survey data: Grace Adeya, MSH/SPS
The world of misoprostol: Strategies and success of Venture Strategies: Melodie Holden, Venture Strategies Innovations
Maternal Child Health Integrated Program (MCHIP) and PPH prevention and treatment: Koki Agarwal, Jhpiego
WHO: Guidelines, recommendations and the AMTSL multi-centre trial: Matthews Mathai, WHO
What does it take to save mothers’ lives?
Experts gather at PATH’s Washington, DC office to discuss innovative solutions to the world’s leading cause of maternal death
On Thursday, November 19, 2009, staff from the Prevention of Postpartum Hemorrhage Initiative (POPPHI) and partners from the field gathered in PATH’s DC office for a discussion of innovative solutions to prevent postpartum hemorrhage (PPH), the leading cause of mothers’ death worldwide. Joined by US government officials and global health advocates, the speakers from the WHO, Bangladesh, and Ghana shared their experiences with efforts to expand the use of active management of the third stage of labor (AMTSL) —a feasible and inexpensive intervention that has been proven to effectively prevent PPH—in developing countries where women are most in need. Full information on the event can be found here.

WHO Indicator Meeting – Prevention of postpartum hemorrhage/Active management of the third stage of labor (AMTSL) – November 17, 2009, PATH DC Office, Washington DC
On November 17, 2009, POPPHI in collaboration with World Health Organization’s – Making Pregnancy Safer department, held an initial meeting of experts to identify a standard indicator for PPH prevention that could be included in routine health information systems globally, and to develop a future road map for a global WHO recommendation on this topic. An overview and notes from the meeting can be found here.

Presentations:

Active Management of the Third Stage of Labor: Deborah Armbruster, PATH
Tracking the Use of AMTSL in a Teaching Hospital in Ghana: Prepared by Dr. Nelson Damale
AMTSL Indicator: what it is, how it was developed and its use in USAID-funded projects: Niamh Darcy, RTI International
Representatives of the Malian Association of obstetrics and gynecology (SOMAGO) and the Malian midwifery association (ASFM) sign a joint statement for the prevention of postpartum hemorrhage
Representatives of the Malian Association of obstetrics and gynecology (SOMAGO) and the Malian Midwifery Association (ASFM) developed a joint statement for the prevention of PPH and the rational use of uterotonic drugs during labor. This joint statement was presented on May 11, 2008, at the 11th international day of the midwife, accepted, and then signed by the President of the ASFM, Ms Dicko Fatoumata Maïga, and the Secretary General of the SOMAGO, Dr Youssouf Traoré.

Bamako(Mali), May 11th, 2008: Ms Dicko Fatoumata Maïga (President of the ASFM) and Dr Youssouf Traoré (Executive Secretary of SOMAGO) signing the joint statement for the prevention of postpartum haemorrhage and the rational use of uterotonic drugs. (Photo courtesy of Dr Bruno Carbonne, FIGO)

Skilled birth attendants in the regions of Mopti and Koulikoro, Mali, expand the use of AMTSL using a mixed learning approach
The National Department of Health in Mali is testing the feasibility of using a mixed learning approach to train skilled birth attendants to apply AMTSL. Training activities are decentralized to the district level and providers complete the didactic portion of the course using a self-paced curriculum and then are guided through clinical by the district trainers. Funding for the project was provided by USAID/Mali and technical assistance has been provided by the USAID projects POPPHI, Capacity, ATN, PKC, and SPS.

Representatives of POPPHI/IntraHealth International, Inc., and DPM/SPS with AMTSL point persons in the Djenné District in the Mopti Region of Mali. (Photo courtesy of Dr Daouda Touré, DPM/SPS)

POPPHI initiates and works with partners to expand the use of AMTSL in Mali

Final Evaluation of Matrones Study Underway in Mali. The Capacity Project’s Perle Combary recently assisted in the data analysis and writing of a final evaluation on a study of the role of matrones in the active management of the third stage of labor (AMTSL), a recommended practice to prevent postpartum hemorrhage. The preliminary results of the study—a collaborative effort among the Capacity Project, Prevention of Postpartum Hemorrhage Initiative (POPPHI), Assistance Technique Nationale and Keneya Ciwara Project—suggest that matrones are able to perform AMTSL with the same levels of success and competency as other qualified health-worker cadres. If this initial analysis is confirmed, it will demonstrate the benefits of expanding the role of matrones to improve alignment of maternal health needs with available human resources.Currently, 60% of all births in Mali are attended by matrones; their sanctioned use of AMTSL by the Ministry of Health would assist a very large population across the country.

Democratic Republic of Congo: Integrated maternal and newborn care training package

Newborn in DRC that benefited from integrated essential maternal and newborn care (photo courtesy of Dr Marie Claude Mbuyi, AXxes/USAID)

The USAID projects AXxes/DRC, BASICS, and POPPHI joined together to develop a training package for integrated maternal and newborn care that included newborn survival, clinical decision-making, maternal care during pregnancy that influences newborn survival, prevention of postpartum hemorrhage, active management of the third stage of labor, immediate care of the newborn, monitoring the postpartum woman and newborn during the first six hours after delivery of the placenta, postpartum care for the woman and newborn, newborn resuscitation, care for breastfeeding problems related to the woman, care for the low birthweight baby, and care for minor and major infections of the newborn. Learning activities include interactive classroom sessions, individual learning exercises, demonstrations on anatomic models, and four days of clinical practice. The training package was pre-tested during training of national trainers in July 2008 and received extremely positive feedback from participants about both the training methodology and the content. (Training activities will be rolled out by the Ministry of Health with the financial and technical assistance of the USAID AXxes project.) Follow-up cascade training will be done by those recently trained in Kinshasa and be done on a provincial, district, and ultimately community level. Those trained include AXxes project personnel, Medical School faculty and experts from the DRC Ministry of Health all of whom will branch out and ultimately bring this level of expertise and capacity to hospitals and clinics throughout the country.

Bangladesh: A New POPPHI Project “Scale-Up” Country

We are pleased to announce that Bangladesh has recently become a POPPHI Project “scale-up” country. Activities were launched in Bangladesh in August 2006 at the National Stakeholders’ Meeting on Scale-Up of Postpartum Hemorrhage. Based on recommendations from this meeting, objectives and a number of PPH activities were identified. Bangladesh is moving forward to implement these activities:

Provide technical assistance to local organizations and professional associations and support a national assessment of AMTSL services.
Work as the secretariat of the national taskforce on prevention of PPH.
Review and adapt POPPHI program materials for use and dissemination in Bangladesh.
Promote knowledge and use of AMTSL in 3 districts which are located near 3 private hospitals where POPPHI partner EngenderHealth is currently implementing other safe motherhood programs (with potential expansion to at least 9 other Districts in the next year).
Provide technical assistance and advocacy to make uterotonic drugs/devices (oxytocin and misoprostol) available at lower levels and include misoprostol in the AMTSL protocol with specific indication.
Advocate to include AMTSL and prevention of PPH in the graduate and post graduate curricula of medical schools and colleges in the next year through the PPH Task Force.
Set up an AMTSL Center of Excellence.
Past POPPHI Events
Postpartum Hemorrhage Working Group meeting, April 6 2009 , PATH

This meeting brought together leading researchers, program managers, clinicians, and pharmaceutical management people to share current data and information, identify research priorities, and assist POPPHI and US Agency for International Development (USAID) to set programmatic priorities.

See Presentations:

Africa 2010: Contribution to PPH prevention and treatment in Africa: Doyin Oluwole and Holly Stewart, AED
Misoprostol for PPH: Current evidence and future directions: Jill Durocher, Gynuity Health Projects
Pathfinder continuum of care for addressing PPH:Dr. Abdelhadi Eltahir, Pathfinder Infernational
Turning Research into Practice: Implementing large-scale PPH/misoprostol programs: Melodie Holden, Venture Strategies for health and Development and Temple Cooley, PSI
Theories of Postpartum Bleeding in Rural Bangladesh: Implications for Community Health Intervention: Lynn Sibley, Emory University
Spot-light on Preventing Postpartum Hemorrhage USAID Support: Lily Kak, USAID
Non-pneumatic anti-shock garment (NASG) POPPHI 2009 Update : Suellen Miller, UCSF, Presented by Carinne Meyer, UCSF
POPPHI – WGI presentations – FIGO: Arulkumaran Sabaratnam, FIGO
Maternal Health Task Force: Joseph Ruminjo, EngenderHealth
PPH Prevention: Where are we now and what is next?: Linda L. Wright, NICHD, NIH, DHHS
WHO PPH updates 2009
See Task Force meeting minutes:

Community based Task Force
First Intervention Task Force
Training Task Force
Uterotonic Drugs and Devices Task Force
Latin American and Caribbean Regional Conference: Reducing Maternal Mortality through the Prevention of Postpartum Hemorrhage: Research to Evidence-Based Practice, March 31- April 3, Managua, Nicaragua

POPPHI, with the support of the USAID LAC Bureau, collaborated with PAHO, URC, LLC, and others, to hold a very successful Latin American and Caribbean (LAC) Regional Conference on evidence-based postpartum hemorrhage prevention strategies and best practices. International and regional experts shared research findings, PPH reduction strategies, and information on early treatment of PPH. There were participants from 12 LAC countries including ministry of health representatives, obstetrician / gynecologists, midwives, along with members and directors of professional associations.

Los Presentaciones: mas se publicarán en breve/ Presentations: more will be posted soon..

OMS-2006-HPP Recomendación: André B.Lalonde, MD Vicepresidente ejecutivo The Society of Obstetricians and Gynaecologists of Canada
Colaboración entre organizaciones profesionales ICM & FIGO: André B.Lalonde, MD Vicepresidente ejecutivo The Society of Obstetricians and Gynaecologists of Canada
Una escandalosa negación de la evidencia: Uso del manejo activo de la tercera etapa del partoen 8 países financiados por USAID: Benin, Etiopía, Tanzania, Indonesia, El Salvador, Honduras, Nicaragua, y Guatemala: Presentado por C. Stanton en nombre del grupo de estudio MATEP
Iniciativa para la Prevención de la Hemorragia Post parto (POPPHI): Deborah Armbruster, Directora de POPPHI
Nicaragua: Mejoramiento y Expansión de la Aplicación del Manejo Activo del Tercer Periodo del Parto (MATEP): Dr. Wilmer Beteta, MINSA Direccion de Epidemiologia
Los uterotónicos en la prevención y el tratamiento de la hemorragia uterina posparto: Jane Briggs y Beth Yeager, Management Sciences for Health (MSH)
Oxitocina en Uniject Panorámica y actividades actuales: Steve Brooke, Commercialization Advisor Uniject Applications Teams Leader, Program for Appropriate Technology in Health (PATH)
Pinzamiento tardío del cordón umbilical: Una revisión de la evidencia: Camila M. Chaparro, Ph.D. Organización Panamericana de la Salud Washington, D.C
Situacion del Manejo Activo de Tercer Periodo del Parto en la Region de Centroamerica 2006-2007: Douglas Jarquin, Jose Angel Portillo, Walter Omar Linares Pacheco, Jesus Octavio Vallecillo Paredes, COMIN-FECASOG
Cobertura de los medios de la conferencia, más pronto/ Media coverage of the conference, more coming soon..

Estrella de Panamá:http://www.estrelladepanama.com/web/main/ver.php?idnews=22283826

La Jornada net:http://www.lajornadanet.com/diario/archivo/2008/abril/020408-7.html

WINNER:http://www.winnernet.org/esp/portal_pub/noticias/noticia.php?noticiaID=4701

Radio La Primerisima:http://www.radiolaprimerisima.com/noticias/general/27009

Postpartum Hemorrhage Working Group meeting, March 20, 2008, PATH

See Presentations:

AMTSL and ENC at birth: Goldy Mazia & Indira Narayanan BASICS
Pilot Study: The safety and feasibility of midwifery assistants (Matrones) using active management of the third stage of labour (AMSTL): Susheela Engelbrecht, POPPHI, Sara Stratton, IntraHealth
Essential “nutrition-related” delivery care practices for short- and long-term infant and maternal health and nutrition: AMTSL and the newborn – an immediate postpartum care package: new directions and collaborative efforts: Camila M Chaparro, Pan American Health Organization
Use of oxytocin and misoprostol for induction or augmentation of labor in low-resource settings: Ann Lovold, Cynthia Stanton, Department of Population, Family and Reproductive Health The Johns Hopkins Bloomberg School of Public Health Baltimore, Maryland
POPPHI NASG Update:Suellen Miller, CNM, PhD Associate Professor Dept Ob/Gyn & Reproductive Sciences UCSF
Misoprostol for PPH: An Update on Gynuity’s collaborative body of research: Jill Durocher, Jennifer Blum, Gynuity Health Projects
Research to evaluate components of AMTSL: POPPHI/USAID/WHO Istanbul, Turkey, 4-5 December 2007:Metin Gulmezoglu, WHO
Oxytocin in Uniject – March 2008 Update: Steve Brooke, Commercialization Advisor Uniject Applications Teams Leader, PATH
Long-Term Community Use of Misoprostol Kigoma, Tanzania:Ndola Prata University of California, Berkeley Venture Strategies for Health and Development
Task Force meeting minutes coming soon…..

Expert meeting on Labor Induction and Augmentation March 19, 2008, PATH

POPPHI hosted an expert meeting on labor induction and augmentation which brought together WHO, UNICEF, USAID, NIH, Gynuity, academic researchers and experts from the field to review data on labor induction and augmentation, to address the potential improper administration of uterotonic drugs and to explore the current data in order to determine what further efforts should be made and look at next steps. Data was presented from an extensive literature review on the topic of labor induction and augmentation for developed and developing countries by Dr. C. Stanton and A. Lovold, Johns Hopkins Bloomberg School of Public Health. The group of experts concluded that sufficient evidence exists to justify moving ahead in three areas: 1) development of context-specific guidelines for induction and augmentation, citing minimum criteria for staffing and equipment; 2) rigorous investigation of the maternal/perinatal effects of the present use of induction and augmentation in facility and home-based births and 3) ensuring community awareness of the devastating effects of the improper use of these drugs on mothers and babies.

Use of oxytocin and misoprostol for induction or augmentation of labor in low-resource settings: A working paper review: Ann Lovold, BHSc, RM, MP, Cynthia Stanton, PhD, Department of Population, Family and Reproductive Health, The Johns Hopkins Bloomberg School of Public Health

Postpartum Hemorrhage Working Group meeting, March 26, 2007, PATH

Presentations:

Oxytocin in Uniject – March 2007 Update: Steve Brooke, Commercialization Advisor, PATH

WHO Recommendations for the Prevention of Postpartum Haemorrhage Results from a WHO Technical Consultation– October 18-20, 2006: Panel Presentation: M.E. Stanton, USAID; R. Derman, University of Missouri/Kansas City; H. Sangvhi, JHPIEGO; D. Armbruster, POPPHI/PATH

Second International Confederation of Midwives Conference: Workshop on the Active Management of the Third Stage, March 11-13, 2007, Mar del Plata, Argentina

PAHO, with support from USAID, sponsored this conference and invited POPPHI to run a workshop on AMTSL as one of the advocacy and skills building workshops within the conference. See the Workshop Report.

Presentation:

Manejo Activo del Tercer Periodo del Parto – Gloria Metcalfe, Consultant, PATH

Launch of Scale-Up Activities in Mali, February 12, 15, and 22, 2007, Bamako, Mopti, and Koulikoro, Mali

Photo in Mali

Lily Kak, USAID, Deborah Armbruster, POPPHI, Susheela Engelbrecht, POPPHI, Gilles Perreault, FIGO at the national launch in Bamako, Mali

Mali training participants

Participants in the national training of trainers in Mali, February 2007

The national meeting to launch prevention of postpartum hemorrhage (PPH) activities was held February 12, 2007 to present current evidence and data on prevention of PPH interventions, present the Mali country situation, and devise an action plan/strategy to scale up these activities with specific roles for meeting participants, partners, and collaborators. This was followed by regional meetings in Mopti and Koulikoro. The success of the launches was largely due to the collaborative efforts and evident motivation/enthusiasm of all partners involved – the Ministry of Health, Rational Pharmaceutical Management Plus (RPM Plus), IntraHealth International, Abt Associates, POPPHI, and Care International. The launch included speakers from RPM Plus, the International Federation of Gynecology and Obstetrics (FIGO), the Society of Obstetricians and Gynecologists of Mali, and the Association of Midwives of Mali, in addition to speakers, or their representatives, that were present at the regional launches.

Practical Guidance to the Field on the use, storage, and management of uterotonics meeting, March 21, 2006, PATH

This meeting brought together World Health Organization (WHO) (Essential Drug division and Making Pregnancy Safer department), United States Pharmacopeia (USP), International Dispensary Association (IDA), USAID, manufacturers of oxytocin, and program implementers to provide practical guidance to the field on the use, storage, and management of oxytocics, particularly focused on oxytocin as the first line drug for use in postpartum hemorrhage prevention and treatment. A primary issue addressed was the research data indicating that oxytocin can be stored out of refrigeration for up to 3 months at up to 30 degrees Celsius. A synopsis of the meeting will be posted on this website in the near future.

Presentations:

Essential Drugs for Public Health Programs: Ideal Overlap of Regulated Product and Public Health Environments, Steve Brooke, Commercialization Advisor, PATH

Oxytocin: Storage, Labeling and Monograph Issues, Larry Callahan, Scientist, Department of Standards Development, USP

Promoting the use of oxytocin for the prevention of PPH, Hans Hogerzeil, Director, Medicines Policy and Standards, WHO

Simulation study stability Oxytocics, Michiel de Goeje, Technical Pharmacist, Quality Affairs Department, IDA

Postpartum Hemorrhage Working Group meeting, March 20, 2006, PATH

Presentations:

Global Network for Women’s and Children’s Health Research, Pierre Buekens, Dean, School of Public Health and Tropical Medicine, Tulane University, (presentation not available, related article posted)

GIRMMAHP Initiative, Albert Figueras, GIRMMAHP Coordinator, Fundació Institut Català de Farmacologia Barcelona

European Project on obstetric Hemorrhage Reduction: Attitudes, Trial, and Early warning System, Kathy Herschderfer, Secretary General, International Confederation of Midwives (ICM)

Reducing deaths from postpartum haemorrhage, Justus Hofmeyr, Head, Department of Obstetrics and Gynaecology, Eastern Cape Department of Health, University of the Witwatersrand/Fort Hare