UTILIZATION OF ANTI-SHOCK GARMENT IN PREVENTION OF POSTPARTUM HAEMORRHAGE AMONG STUDENT-MIDWIVES IN SELECTED SCHOOLS IN LAGOS AND OYO STATES
CHAPTER ONE
1.0 INTRODUCTION
1.1 Background of the study
Postpartum haemorrhage (PPH), according to World Health Organization (2003), is defined as vaginal bleeding over 500ml after vaginal delivery and excess 1000ml after caesarean delivery.
PPH is the most common cause of obstetric haemorrhage and one of the five leading causes of maternal mortality in developed and developing countries (WHO, 2003).
Over 500,000 women die annually from complications of pregnancy and childbirth, of which the majority die from haemorrhage and shock, which can be prevented (Miller, Ojengbede, Tura, Butrick & Hensleigh, 2007). Obstetric haemorrhage can be managed in developed countries with uterotonic medications, blood transfusions and surgery. It is often fatal in developing countries where many births occur at homes without skilled attendance and limited access to high-quality, comprehensive emergency obstetric care. In many cases, limited access to definite treatment with blood transfusion results from “no blood” in the blood bank.
Anti-shock Garment (ASG) is a new technology and method to reduce death from obstetric haemorrhage (Hensleigh, 2002). ASG is a generic term for any compression device that shunts blood from the extremities to the core organs, heart, lungs and brain, thus reversing shock (Hensleigh, 2002).
According to Miller (2009), ASG is a “life wrap”, “wet suit” to the rescue. It is an essential first-aid device that can keep a mother alive until she is treated for PPH.
PPH is the single largest cause of maternal death worldwide. Developing improved strategies for managing PPH is essential to reduce these unnecessary deaths. It is, therefore, important to spread the promising news of the potential of ASG(s) in reducing maternal death.
This research study presents the result of the level of utilization of Anti-shock Garments to prevent postpartum haemorrhage among student-midwives in selected schools in Lagos and Oyo States.
1.2 Statement of Problem
Africa has the highest maternal mortality ratio, with an estimated average of 800 deaths per every 100,000 births, of which Nigeria ranked second among the three countries with the highest maternal death rate, with India being first and Afghanistan third (Aboderin, 2012).
PPH is responsible for around 25% of maternal mortality worldwide (WHO, 2007), reaching as high as 60% in some countries. One woman dies every minute due to pregnancy and childbirth complications worldwide. The leading cause of maternal mortality is obstetric haemorrhage (Miller, Hamza & Bray, 2006).
A woman can bleed to death in 2 hours or less, and in rural areas, where hospitals may be days away, leaves little hope for women suffering from haemorrhages (Karla, Christine, Alberto & Sivellen, 2010). The dread is of concern because this complication is often preventable.
The use of Non-pneumatic anti-shock garments as part of the standard management of PPH has demonstrated promising outcomes for women in low-resource settings where health care providers are limited, sustaining women’s lives before definitive treatment (Miller, Ojengbede & Turan, 2009).
This research study aimed to assess the level of utilization of anti-shock Garment in the prevention of postpartum haemorrhage among student-midwives.
1.3 Objectives of the Study
The study aims to investigate the extent of utilization of ASG(s) in the prevention of PPH by student–midwives in their various training schools.
The specific objectives of the study are:
- To assess the knowledge of student-midwives on PPH.
- To elicit the knowledge of student–midwives on Anti-Shock garments.
- To assess the level of utilization of ASG(s) in preventing PPH.
- To identify the extent of practical skills (application and removal) of student midwives in Non-pneumatic anti-shocks garment (NASG)
- To outline the benefit of NASG in the management of PPH.
1.4 Significance of the Study
The significance of the study was to assess the level of utilization of NASG in the prevention of PPH.
Postpartum haemorrhage is the single largest cause of maternal death worldwide. Maternal mortality and morbidity adversely affect the health and welfare of children, families and communities because of the death of “women”, the backbone of any nation. This research will help to reduce maternal mortality.
Maternal mortality is the leading cause of death for women of reproductive age in Asia and Latin America. It is the second leading cause of death for women in Africa (Morris, Meyer, Fathalla, Youssif, Al-Hussaini, Camlin & Miller, 2011). These deaths are largely preventable with skilled attendance and comprehensive emergency obstetric care.
Non–pneumatic Anti-shock Garment is recommended as part of advances in preventing and treating haemorrhages and has reduced maternal mortality and morbidity by over 50% (Miller et al., 2010).
The first-aid use of NASG in managing PPH to resuscitate and stabilize women with hypovolemic shock until definitive treatment is obtained. In most tertiary health facilities in Nigeria, the use of NASG would be of great relief, a buying time until definite management.
This study will preserve the lives of women and serve as a training ground for the utilization of ASG(s) among student–midwives. It will also help achieve the fifth-millennium development goal by 2015.
1.5 Research Questions
- To what extent do student-midwives know about PPH?
- How much do student-midwives know about ASG?
- To what extent is the practical use of NASG in preventing PPH in the training institution?
- What are the practical steps in the application of NASG?
- What are the importance and benefits of NASG in the management of PPH
1.6 Hypothesis
There is no significant relationship between knowledge and the utilization of ASG(s).
1.7 Scope of the Study
This study was conducted among student–midwives of academic sessions 2011/ 2013 and 2012/ 2014 in three selected schools – school of midwifery, Lagos University Teaching Hospital; Eleyele and Catholic Hospital, Oluyoro, Ibadan to determine the level of utilization of ASG in the prevention and management of PPH.
1.8 Limitation of the Study
The study was limited to “female” students due to the schools’ peculiarity and limited time frame due to the course of the study and the small sample size. This research was then extended to the new student midwives to increase the sample size.
1.9 Operational Definition of Terms
UTILIZATION –The practical use includes the prompt and correct application
ANTI–SHOCK GARMENTS – These are light-weight compression devices comprising segments applied to the lower extremities, pelvic and abdomen to resuscitate severe bleeding quickly.
PREVENTION – This is the act of stopping an event from happening. In this study, it is the act of stopping bleeding.
POSTPARTUM HAEMORRHAGE – Vaginal bleeding above 1000 ml after caesarean delivery and 500ml after vaginal delivery.
STUDENT MIDWIVES – Registered Nurses undergo midwifery training and education for 18 months in academic sessions, 2011/2013 and 2012/2014 in selected Schools of Midwifery.
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