Fighting Burundi's Number One Cause of Maternal Mortality: Postpartum Hemorrhage

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After giving birth, a mother suffering from postpartum hemorrhage (PPH) can die within two hours if she doesn’t receive proper treatment. In Burundi, postpartum hemorrhage is the leading cause of maternal death. But it can be stopped in its tracks if the proper care is available.

And that’s exactly why Burundi’s Ministry of Health, concerned by the significant number of maternal deaths, partnered with Pathfinder International to introduce an approach to tackling the problem—Clinical and Community Action to Address Postpartum Hemorrhage plus the other major causes of maternal death (CCA/PPH+).

NASG being used in Burundi

To better address postpartum hemorrhage, the program incorporates several elements of prevention, early detection, treatment and community-awareness building, including the use of the non-pneumatic anti-shock garment (NASG) to resuscitate and stabilize women already in shock and facing death until comprehensive care for PPH can be obtained.

Use of the non-pneumatic anti-shock garment was previously unknown in Burundi, so its introduction was not easy. Policymakers still needed to be convinced, as well as OB-GYN specialists. The garment’s appearance itself was strange to many health providers. The advocacy for this approach started at the national level with the Ministry of Health and the national referral hospital. 

Sadly, only a day after the first advocacy meeting in the national referral hospital, a woman died because of postpartum hemorrhage. 

PPH training in Burundi

Although the woman’s death was absolutely tragic, the immediacy contributed to the understanding of the importance and urgency on the part of stakeholders that the CCA/PPH+ strategy, including use of non-pneumatic anti-shock garments, should be introduced as soon as possible. Pathfinder was asked to support the hospital and other health facilities by integrating the NASG into emergency obstetric care and providing training on its proper use.

The national referral hospital served as a starting point for rolling out training of service providers throughout Burundi. In total, 23 health facilities (20 health centers and 3 district hospitals) benefited from training and 30 non-pneumatic anti-shock garments were provided.

In the district hospital of Kayanza, one of the health facilities supported by the program, hospital staff had often complained of delays in pregnant women reaching the hospital when experiencing obstetric complications and shock due to post-partum hemorrhage.

Only a month after the CCA/PPH+ approach was introduced in the hospital, results could already be seen. Lives were being saved.

The NASG has dramatically shown its importance as a lifesaving element in the approach to address PPH.Mrs. Lea Nibigira, one of the trainers, welcomed the Pathfinder team to visit the maternity ward. She went straight to the bed of a woman whose life had been saved by the use of a NASG. Lea was pleased to present the happy results of this woman’s experience and survival.

Her story: When the pregnant woman arrived at hospital, she had been carried on a hammock over a long distance and was bleeding very heavily.  Following a quick exam, she went into deep shock with no detectable blood pressure. The non-pneumatic anti-shock garment was rapidly applied by trained staff and her blood pressure levels improved. The medical team rushed her to the operating room for a quick cesarean section. The NASG was kept on during the operation and the mother was saved.

Lea was excited to tell the story and expressed her deep pleasure with the efficacy of the NASG saying, “I’m sure this mother is still alive because of the NASG.” She is happy that the garment has been introduced in the Kayanza district and sincerely hopes the CCA/PPH+ strategy can be scaled up into other districts for the wellbeing of women and their families.

Overall, the non-pneumatic anti-shock garment has dramatically shown its importance as a lifesaving element in the approach to address postpartum hemorrhage. Government officials appreciate the overall strategy and its complement to the reinforcement of other aspects of emergency obstetric care and major causes of maternal death. They already have integrated the NASG into the list of materials/equipment to be available in health facilities.

"We are optimistic that by integrating this strategy through prevention, recognition, treatment and community-awareness building, this adoption will be a major step forward in significantly reducing maternal deaths throughout the country," Ellen Israel, Pathfinder's Senior Technical Advisor for Women's Health and Rights, said.

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