EBI-7-2-65

7-2 Final Project Milestone Two: Evidence-Based Interventions, Recommendations, and Implementation

Patricia Kamara

Southern New Hampshire University

September 27th, 2019

Evidence-Based Intervention

There are wide range of interventions developed to address the global health issue of high rate of maternal mortality in Haiti and these interventions have been effective in addressing the health issue to some extent. However, these interventions include;

Training traditional birth attendants: According to Bergstrom (2011) several childbirths in Haiti are supported by traditional birth attendants (TBAs) who gain their skills through apprenticeship and experience instead of going for formal training that is characterised as skilled birth attendants (these are nurses, midwives and doctors). The World Health Organisation has established wide range of programs to provide short-training and educational courses to TBA in order to educate them on how to respond to minor complications as well as identify major complications and refer them to appropriate professionals. According to WHO (2018), these training exercises provided to TBA have been able to minimise maternal mortality rates. On the other hand, Carroli (2017) revealed that there is insufficient strong evidence regarding the fact that training TBAs is an effective approach to minimise mortality rate in Haiti. However, the evidence available revealed that TBA-training improves the general knowledge among TBAs and may minimise infant mortality but does not have a significant effect on maternal mortality (Kidney, 2009). Furthermore, the study by Piper (2017), aimed at identifying the relationship between TBAs training and maternal mortality. Findings from the study identified that improved TBA training did not result to significant decrease in the rate of maternal mortality but led to a slight decrease in the new-borne mortality. Therefore, it was difficult to conclude that TBA training reduces maternal mortality due to several reasons such as lack of medical services to which to refer women with major complications, training that is insufficient to give TBAs the skills to perform life-saving interventions and barriers to learning resulting from lack of formal educations among TBAs.

Skilled birth attendants: The number of skilled-birth attendants have been increased in wide range of health facility to minimise maternal mortality (Levine, 2017). The available evidence on the use of skilled-birth attendance mainly dependence on non-experimental analysis and it is still not clear if or by how much it may minimise maternal mortality. Findings from the available studies revealed that increased in the number of skill-birth attendants has slightly reduced maternal mortality but not to a large extent (Levine, 2017). The challenges associated with the intervention of improving the number of skilled-birth attendants in health facility is inadequate supply of quality doctors and midwives, lack of health facilities to which to refer complicated issues and reluctance among women to make use of such services.

Clean delivery kits: According to WHO (2018), about 15% of maternal mortality were as a result of infections. Programs to provide clean delivery kits were implemented to minimise infections among women who are delivering at home and in health centres and among their infants. According to Graham (2017), a clean delivery kits should contain clean razors and cord ties for cutting umbilical cord, soap for washing vagina and hands, plastic sheets for creating a clean delivery surface and a pictorial instructions sheet for directing mothers and their attendants on how to make use of some other items contained in the kit. Therefore, findings from Graham (2017) identified that maintain a hygienic and clean delivery kits reduces infant and maternal infections and at the same time reduces infant and maternal mortality. The weakness of this intervention is that clean delivery kits may be contaminated and thus, gets mothers or infants inflected during the period of use.

Recommendation

Considering the high level of maternal mortality in Haiti, wide range of interventions has been developed to bring the rate to a minimal level. Although these interventions have been effective but can be improved to offer a better service to the Haitians. To improve the provided intervention, the following recommendations has been made:

· It is recommended that skilled care should be provided to mothers before, during and after childbirth. In addition, they should be encouraged to have various antenatal care visits where they should be attended to by skilled care workers. This service should be made free if possible or should be of low-cost because many Haitian women have no access to such services due to poverty.

· It was identified that most of the Haitian women in the rural areas were attended by unskilled birth attendant and this was the major reason for high maternal mortality within the region. Therefore, it is recommended for educational programs be developed to educated them. Some efforts should also be channelled to community mobilization as well as the prediction and prevention of pregnancy complications.

· The level of ignorance was also recognised as one of the major determinants of the high maternal mortality in Haiti, it is therefore recommended that access to basic and higher education for both boys and girls should be made available so as to promote a sustainable development within the country. In addition, the act of improving the level of education will affect the Haitian population positively in several ways such as reducing the level of poverty and at the same time increase gender equality as well as reduce maternal mortality.

Implementation

In order to effectively implement the recommendations to improve the developed interventions, the Haitian Governments needs to build more health facilities especially within the rural areas where such facility is lacking or minimal. In addition, the private and the public health facilities such ensure that they have a well-trained work attendant to attend to women before, during and after childbirths. The World Health Organisation and various other NGOs involved in public health should develop education programs to educate the public (especially women) on the importance of antenatal and regular hospital visits during and after pregnancy. Lastly, the childbirth attendants who are not well-trained should endeavour to attend the training programs developed by WHO to improve their knowledge and skills regarding childbirth and its associated complications.

The level of success of the developed intervention to address the issues of high maternal mortality in Haiti can be measured by comparing the rate of maternal mortality before and after the interventions were established. According to World Health Organisation (2017), the rate of maternal mortality in Haiti was identified to be decrease by 15% since the implementation of various interventions.

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