Post-Partum Haemorrhage (PPH) is among the leading causes of maternal mortality in Kenya, contributing to 34% of deaths.

PPH can be defined as excessive bleeding and loss of blood occurring shortly after giving birth, but it can also happen in the days and weeks after delivery. 

WHO defines PPH as losing more than 500 millilitres (ml) of blood 24 hours after vaginal birth, and more than 100 ml of blood after a caesarean (C-section) birth.

The condition can lead to shock and sometimes death due to a dangerous drop in blood pressure. 

Migori’s maternal mortality

Migori County is among the 15 counties in Kenya grappling with the issue of maternal deaths, with PPH being the leading direct cause of these deaths. 

In a bid to improve on maternal healthcare in Migori county, clinical health workers across the county have been trained on how haemorrhage management.

This was done though haemorrhage mentorship training programme, aimed at reducing maternal and infant deaths in the county.

Denis Ochieng the National Master Trainer on haemorrhage said that the mentorship package was rolled out by the national government to reduce maternal and infant mortality in the country.

A total of 32 clinical officers and nurses drawn across the county were trained in competent skills on how to use the Non-pneumatic Anti-shock Garment (NASG).

This a low-cost technology and a first aid mechanism that is meant to support and prevent Post-partum haemorrhage (PPH) in women during emergencies.

Ochieng noted that the haemorrhage mentorship programme was a practical-cantered approach aimed at training health workers to improve maternal care in the country.

“Initially we have been training and mentoring our clinical health workers through other models that were theoretically best with little impact in reducing maternal and infant mortality”, said Ochieng.

He emphasized that the programme will identify champion mentors to retrain other health workers across the county as well as improve the relationship between the champions and mentors.

Maternal healthcare and indicators

Migori County Nursing Officer Alice Munga noted that the county maternal indicators were comprehensively better with birth attendance standing at 90 percent in the 238 health facilities in the county.

Munga acknowledged that the county maternal death stood at around 392 per 100,000 live births occurrences.

However, she noted that more strategies were being put in place like the haemorrhage mentorship package to try and reduce maternal deaths.

Additionally, she encouraged pregnant women to adhere to the four pre-natal care attendances to help address any complications that may arise during the delivery period.

Migori County’s pre-natal care have four mandatory visits stood at 52 percent but with the haemorrhage mentorship programme the county aims to reach 70 percent.

Munga affirmed that mentored clinical officers and nurses will be haemorrhage Trainers of Trainers (ToTs) to help retrain other health workers in their respective healthcare facilities to help reduce the mortality rate.

Ferida Owendi, nurse-midwife and one of the mentorship beneficiaries said that it was a privilege to be mentored and promised to pass on the skills and knowledge to her peers at her training facility.

Owndi added that the haemorrhage programme skills will help to manage emergencies at the local hospitals before referrals are made to prevent unnecessary maternal deaths caused by PPH.

The training was organised through a partnership of Lwala Community Alliance (LCA).

LCA is a non-profit organisation that works to improve the health, education and well-being of communities in rural western Kenya.

The organization operates a health centre at Lwala that provides comprehensive primary healthcare services.

LCA has been at the forefront in helping the Migori health department in addressing the haemorrhage condition.

This has been aided through the Obstetric Haemorrhage Initiative (OHI) introduced by the organisation to county health facilities.

OHI is a bundle of protocols and tools that treat obstetric haemorrhage cases.

OHI relies on lifesaving supplies like uterotonics, tranexamic acid and the uterine balloon tamponade.

NASG garment is also one of the bundles of protocols and tools used to manage obstetric haemorrhage. 

The Organisation has so far distributed 985 garments to both public and private health facilities in the county as well as trained 322 ToTs.

Obstacles to better Maternal healthcare

However, staff attrition is also another challenge derailing the success of handling haemorrhage cases across the county facilities. 

This happens when a fully trained health provider resigns, retires or gets their contract terminated.

The evident slower progress and the uptake of the innovation in various local health facilities. At times it also lowers the morale of other staff.

Another challenge is poor referral services to a high-level hospital have been a big threat to saving the lives of patients.

This is heavily contributed to by poor road networks and the inaccessibility of facilities in remote areas, especially during the rainy season.

Finally lack of enough ambulances to ferry patients has also been a challenge, mostly when there is more than one case in one hospital.

When these are put in place, the rates will even reduce further.

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