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Integrated Approach for PPH and Newborn Infection Prevention in Madagascar

This project aims to reduce maternal and newborn mortality by implementing an integrated community-level approach for prevention of postpartum hemorrhage and newborn infection in Madagascar. It includes training community health workers and distributing uterotonic and chlorhexidine for home births.

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Integrated Approach for PPH and Newborn Infection Prevention in Madagascar

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  1. Integrated Community-level Approach for Prevention of Postpartum Hemorrhage and Newborn Infection in Madagascar Eliane Razafimandimby, MPH Maternal and Child Survival Program/Jhpiego, Madagascar

  2. Population est. 21 millions

  3. Madagascar : Trends in Health Indicators

  4. Only 35% of population lives within 5 Kms of a primary health care facility (CSB)

  5. The Project in Vohemar • Goal : Contribute to reducing Maternal and Newborn Mortality • 157 “communes” in the District of Vohemar (Population : 169,000) • 300 CHWs enrolled and trained by Jhpiego/MCHIP and JSI/Mahefa

  6. Objectives of the Project • To determine acceptability and feasibility of administration of a uterotonic (misoprostol) and chlorhexidine 7,1% (CHX) for home births through a community-based and facility-supported distribution scheme Photo :JSI/Mahefa

  7. Photo : MCHIP

  8. Project Approach Photos :Jhpiego/MCHIP • Trained Community Health Worker distributes products during home visits to pregnant women at 32+ weeks • Measures taken to follow correct use

  9. Results Number of women from Jan-July 2014 1872 98% use 99% satisfaction

  10. ANC Visits Increased in Program Areas Source: SDSP Vohemar, BDD GESIS.

  11. Facility Births Increased in Program Areas

  12. Results “If youuse AroFoitra, thereis no badsmellingafter the fall-out of the umbilicus. ” “Before, I used to bleed a lot aftergivingbirth and when the CHW told me thatthereis a drug to preventhemorrhage I was happy, I usedit and I thinkthatFamonjyisreally a good medicationthatsaveslives.” Photos :Jhpiego/MCHIP

  13. Conclusions • An integrated program resulted in high and correct use of the uterotonic and CHX for cord care   • Acceptability of self-administered misoprostol for PPH prevention,and for CHX for cord care was high • Integrated approach : helped shift the focus on a MNH package/strategy to accelerate reduction in maternal and newborn deaths

  14. The way forward… • The MoHhas recently approved the use of misoprostol at community level • MCSP is supporting the TWG in the scaling up of Miso and CHX • Tools/training materials developed under MCHIP • Update of CHW training curricula to include Misoprostol, CHX and MNH interventions at community level.

  15. MisaotraTompoko ! Photo: JSI Mahefa

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