UBT: Innovative device saving lives of mothers in Kagera region

28Oct 2018
James Kandoya
Guardian On Sunday
UBT: Innovative device saving lives of mothers in Kagera region

A YEAR ago, Abela Beihoki was eagerly waiting to give birth to her third child in Karagwe district, Kagera region.

Abela Beihoki (R), who suffered from PPH while giving birth to her child, Lameck Layson. PHOTO: Correspondent

She did not expect she would leave the hospital safely back to her home place with her baby after she suffered excessive bleeding after delivering her child.

Thanks to the hospital she had gone to, Nyakahanga Hospital, its staff had undergone training funded by the Human Development Innovation Fund (HDIF`s) Every Second Matters for Mothers and Babies–Uterine Balloon Tamponade (ESM-UBT) project, trained in preventing bleeding in mothers after delivery.

UBT is an innovative life-saving device introduced by Jhpiego to manage uncontrolled bleeding in mothers after giving birth and can save up to 80 per cent of these cases if placed by trained skilled birth attendants in health facilities.

 “After I delivered my child, I almost fell unconscious,” she said.

She said she was so terrified that she thought she was dying due to the painful experiences she went through.

The mother of three said at the hospital doctors and the healthcare team unsuccessfully tried to stop bleeding using alternative methods recommended by the ministry of health according to guidelines for post-partum haemorrhage (PPH) management.

Luckily enough, the team initiated the use of the newly introduced UBT, saving her life by inserting the device into her private parts to stop the bleeding.

Beihoki is one among a number of women who suffered uncontrolled bleeding after giving birth to a child.

PPH currently accounts for about 39 per cent of causes of maternal deaths where 70 to 75 per cent is due to atomic uterus or the failure of the uterus to contract after delivery.

Dr Furaha Kahindo, who was part of Beihoki’s health care team, was trained by a Jhpiego partner, a Massachusetts General Hospital (MGH) through a partnership with the government of Tanzania on UBT insertion.

Funded by the HDIF, through ESM-UBT, all 85 health facilities in Mara and Kagera regions were trained on providing the service to expectant mothers after delivery since July 2016.

Before the training, emergency obstetric care was only available in less than half of the potential health facilities, 39 out of the 85 health centres in Mara and Kagera regions.

Dr Kihindo said Beihoki’s condition after delivering her third child worsened so much so that she was admitted on arrival and could have lost the life had the technology not been present.

“Based on the previous experience with PPH management using traditional methods such as intrauterine massage, she could have lost her life,” the doctor said.

According to Dr Kihindo, the only option that remained in saving her life was to remove her uterus, though that would mean she would not be able to conceive again in life.

Dr Kihindo is among providers of the UBT services in the country and has also been effectively coaching and mentoring other healthcare providers so as to reduce maternal mortality.

Despite efforts to reduce maternal and child mortality, the country has still unacceptably high rate of 556/100,000 live births.

PPH remains one of the main contributors to the high MMR, accounting for about two in five of all maternal deaths.

She clarified that ESM-UBT is not currently part of the national protocol for management of PPH, but has the potential to contribute to the reduction of preventable maternal deaths.

It is composed of a condom affixed to a Foley catheter, inflated with clean water through a syringe and one-way stopcock to achieve tamponade and arrest of bleeding.

 This innovation is ultra-low-cost ($5 per kit), simple, protocolised, easy to teach and learn, and can be utilised by healthcare providers of various cadres including nurses, nurse-midwives, clinical officers and doctors.

Its simplicity and cost-effectiveness allows usage at lower levels of HFs including primary health clinics by frontline healthcare workers. 

The principal investigator working with Jhpiego Dr Dunstan Bishanga suggested that the government can adopt the new technology of using UBT to reduce uterine blood loss after it proved successfully in Mara and Kagera regions.

In a pilot project, the use of (UBT) was introduced in Mara and Kagera regions in 2015 which had high cases of maternal deaths.

The researcher said the technology could help to limit uterine blood loss during delivery, thus saving lives.

He clarified that (PPH) was one of the leading causes of maternal mortality in developing countries, contributing to 40 per cent of all reported maternal deaths in the country.

“The technology can readily be implemented by providers with minimal training in any health facility,” he said while presenting a cross-section study on ‘Improvement in the active management of the third stage of labour for the prevention of Postpartum Hemorrhage (PPH)in Tanzania.’

“The study is aimed at assessing the feasibility of implementing the UBT package at multiple health facilities, skills priorities,” he said.

“It can reduce uterine blood loss by more than 80 per cent if placed by skilled attendants at health facilities. It is disruptive solution for PPH and it must be part of the national guidelines,” he added.

The medical expert added that the technology could be applied in all government hospitals and health facilities countrywide because it was low cost and easy to practice.

UBT technology has already been in use in Sierra Leone, Kenya, Ghana and Senegal where it has proved excellent, with few cases of PPH being reported

“We request that this intervention be also introduced at even lower level health facilities (including dispensaries). It is not a complicated procedure hence it can be done even at that level.” He said.

Expressing government concern, after the Dissemination Workshop, the Director of Health Services (DHS) in the President’s Office, Regional Administration and Local Government (TAMISEMI) Dr Ntuli Kapologwe said the government would soon adopt the use of UBT technology to limit uterine blood loss during delivery and thus help to save lives.

He said through the UBT technology, pregnant women are assured of their lives and that will also improve health services in hospitals and health centres.

During the 2018/2019 financial budget, the government will set aside enough funds to procure units to implement the technology in various health facilities in the country.

He said the findings will also be presented to regional and district medical officers’ (RMOs and DMOs) meetings next month where directives will be issued.

When contacted, the Chief Medical Officer(CMO) Prof Mohamed Kambi said the government will adopt the uterine Balloon Tamponade(UBT) to reduce Postpartum Hemorrhage(PPH)-uterine blood loss in women when deliver

He said it was aware of the new invention and so far it was working on it to self confident.

“We as a government are aware of the UBT recently findings showcasing the success of their invention that if used to delivery mothers there was a possibility of reducing Postpartum Hemorrhage (PPH) – the uterine blood loss which causes 80 per cent in maternal mortality,” he said.

CMO added that after the government was working on it to be self confident on it, then it will be adopted in all hospitals and dispensaries countrywide.

“We thank Jhpiego for their efforts to introduce the new innovation, which is new in our country. Our response to adopt it will come later after self approving it” he said.

According to the findings, when used UBT can reduce by up to 80 per cent to control PPH, which was a major cause of maternal mortality.

It is now estimated that PPH accounts for up to 40 per cent of maternal deaths occurring in the country.

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