183440 Kyrgyz Republic makes strides toward MDGs in Maternal and Neonatal Health

Tuesday, October 28, 2008: 11:18 AM

Nazgul Abazbekova, MD , Maternal and Reproductive Health Coordinator, ZdravPlus Project, Bishkek, Kyrgyzstan
Gita Pillai, PhD, MPH , Regional Deputy Director & Regional Director, Maternal and Child Health, ZdravPlus Project, Almaty, Kazakhstan
Barton Smith, MD , Family Medicine Consultant, ZdravPlus Project, Bishkek, Kyrgyzstan
Anara Eshkhodjaeva, MD , Maternal and Child Health Department, Ministry of Health, Bishkek, Kyrgyzstan
Vera Zlidar, MHS , Monitoring and Evaluation Consultant, ZdravPlus Project, Almaty, Kazakhstan
Stelian Hodorogea, MD , Consultant, WHO-Certified Obstetrician Trainer, ZdravPlus Project, Almaty, Kazakhstan
Background: For Kyrgyzstan, demographers project zero percentage chance of achieving millennium development goals for maternal and infant mortality (Lancet, 2007). However, an implementation strategy involving capacity building of providers and empowerment of people is spreading from district to district and resulting in outcomes strongly associated with maternal and newborn survival. The actions of providers and supporting organizations complemented by political support to achieve MDGs presents a determined effort to challenge projections of underachievement, and to improve health outcomes for Kyrgyz women and infants. Our presentation will use quantitative and qualitative data as well as photos, to present how the joint efforts of government and non-government organizations are making progress improving active management of the 3rd stage of delivery, post partum contraceptive acceptance, and newborn warm chain and infection control. Client interviews and hospital records are used to analyze and present the shifts in clinical practice and patient outcomes.

Design/Methods: This presentation uses data collected before (n=753 births) and 12 months after the initiation of strategy (n=551 births) to improve effective perinatal care according to WHO standards. Indicators of performance are based on a review of women's charts and post partum client interviews. The design involves: - Pre-Intervention baseline assessments using client records and client interviews and observations. - Intervention focused on competency-based clinical training and 6- monthly followup mentoring emphasizing clinical observation, demonstration, and practice at hospital and primary care levels. - Post-Intervention assessment of provider and client practices using client records, client interviews, and observation, 8 to 12 months after strategy initiation.

Results/Outcomes: The strategy resulted in an: Increase in active management of the third stage of labor (52% to 90%; p<.001), and a corresponding reduction in post partum hemorrhage (2.9% to 1.3%; p=.056), which is associated with reducing maternal mortality. Improvement in newborn warm chain and infection control, and a corresponding decrease in newborn hypothermia (28.5% to 1.1%; p<.001), which is associated with reducing newborn mortality. Increase in postpartum contraceptive counseling (43% to 70%; p<.001); and method acceptance (8.4% to 63%; p<.001), which is associated with reducing mortality risks associated with unplanned pregnancy and abortion.

Conclusion: Providers implementing effective perinatal care strategies in accordance with WHO standards of evidence based care are improving the quality of clinical practices associated with reductions in maternal and newborn mortality. This approach has been scaled up to 40% of all maternities in the country and holds promise of progress toward national MDGs.

Learning Objectives:
Participants will learn implementation and scale-up strategies to achieve improvements in clinical practices associated with mortality reduction that may be successful in their own countries.

Keywords: Maternal and Child Health, Quality Improvement

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: Dr. Nazgul Abazbekova has been the Kyrgyz Maternal and Reproductive Health Coordinator for ZdravPlus Project since 2002. With this role she has been responsible for implementing evidence-based maternal and neonatal care practices for nearly 20 clinics throughout the country. Before joining the ZdravPlus she taught students at the Kyrgyz State Medical Institute Department of Obstetrician & Gynecology and as a obstetrician-gynecologist in a Public clinic. Dr. Abazbekova received her medical degree from the Kyrgyz State Medical Institute and completed her internship in Obstetrics at the Bishkek City Perinatal Center.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.