Tag Archives: WHO

The perfect union: ISUOG and WHO partner for global women’s health

ISUOG Outreach is committed to ensuring that every woman throughout the world has a quality ultrasound scan – and that is evidently assured via training and quality education. With such a mandate, it is with no surprise that the the World Health Organization (WHO) finds an ally in ISUOG Outreach, with whom it has been working as a close partner in the Partnership for Maternal Newborn and Child Health. Recently, the two organizations joined forces to support the WHO Action trails (a multi-site randomized trial of antenatal corticosteroid use for women at risk of imminent preterm birth in hospitals in low-resource countries ) where ISUOG Outreach recruited two of its volunteers to provide training accordingly. Reporting from the field are ISUOG Outreach Trainers Dr. Lynn Coppola (USA) and Dr. Sandhya Maranna (Australia) who share their experiences taking part in the Action Trails in multiple countries – from India to Kenya.

“The ISUOG Outreach is supporting the World Health Organization (WHO) for the ACTION Trails (Antenatal CorticosTeroids for Improving Outcomes in Preterm Newborns) which will be conducted in a total of 28 sites spanning 5 countries.  The study is designed to address current concerns regarding the efficacy and safety of antenatal corticosteroid use in low-resource settings.  Accurate gestational age assessment will be an important component of the study, and the WHO has thus provided an ultrasound machine for each of 28 sites.  ISUOG Outreach trainers are providing the associated fetal biometry training.  Thus far, training has been conducted in India, Bangladesh, Pakistan, and Kenya.  Training in Nigeria is scheduled to occur in May.  Here are some of the highlights!

India:  Sandhya Maranna, an ISUOG Outreach Trainer with academic and clinical background in medicine, radiology and ultrasound, collaborated with WHO as a temporary adviser in the trials.  She trained ten obstetricians and gynaecologists in a 2400-bed tertiary, referral research and teaching hospital in Belgaum in Southern India. ‘Train-the-trainer’ model was employed to standardise protocol with estimating gestational age or patient recruitment into the trials. She and Dr Lynn Coppola will be continuing their collaboration with the quality assurance of the ultrasound component of the project.

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Dr. Sandhya Maranna observing training in India (Image courtesy of Dr. S. Maranna)

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Teaching hospital in Belgaum, India (Image courtesy of Dr. S. Maranna)

Bangladesh: Training sessions (both didactic and practical) were conducted in both Dhaka and Sylhet, with approximately 10-12 trainees at each site.  ISUOG training materials and Dr. Alfred Abuhamad’s eBook entitled Ultrasound in Obstetrics and Gynecology: A Practical Approach were the primary didactic materials used.  As common with all sites, the trainees in Bangladesh had a wide range of prior experience with fetal ultrasound.  Due to their excitement to participate in the study and to improve their personal ultrasound skills, it was fun and amazingly rewarding to facilitate their learning process. Their enthusiasm to work together as a group and to help each other was obvious.  This picture is of Dr. Maritza Gonzalez (MFM fellow, University of Arizona Health Sciences Center) as she works with some of the trainees in Sylhet.  In the other picture, you can see that the love for selfies shows no national boundaries!  Dr. Saima Sultana and Dr. Salahuddin Ahmed were gracious and kind hosts.

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Training in Bangladesh (Image courtesy of Dr. L. Coppola)

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Dr. Lynn Coppola and the trainees in Bangladesh (Image courtesy of Dr. L. Coppola)

Pakistan:  Approximately 10 trainees from 2 sites met at Aga Khan University in Karachi for the training.  As evidenced by the fact that some trainees even travelled for 8 hours by overnight train, they showed great dedication to preparing their site for the ACTION trial.  Some attendees were motivated enough to even attend the didactic sessions for a second time when conducted in Hyderabad!  Although some of the trainees had prior ultrasound experience, this was the first time that others had ever received formal ultrasound training.  The improvement in their skills, the evolution of their questions, and their expressions of appreciation were all a great reward.  The group picture shows our Pakistan ultrasound trainees, accompanied by local ACTION trial leaders Dr. Shabina Arif, Dr. Farrukh Raza, and Dr. Sajid Soofi.

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Dr. Coppola with the trainees in Pakistan (Image courtesy of Dr. L. Coppola)

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Hands-on training in Pakistan (Image courtesy of Dr. L. Coppola)

Kenya: Training was conducted at the Reproductive Health Unit of Thika Level 5 Hospital and was attended by approximately 15 providers, representing 4 study sites.   Local flooding from an unusually wet rainy season significantly delayed our arrival on the first day, but the weather subsequently improved.  Again, the dedication of the trainees to the trial and to improving their personal ultrasound skills was readily apparent.  The trainees were tireless in their desire to spend time on the ultrasound machines and to stretch the practical sessions for as long as possible.  They additionally created a short list of extra questions for didactic review on the last day.  Also on the last day, we had a small bit of excitement and practised “speed scanning” for one patient as she was apparently in active labor and we were not in physical proximity to the maternity ward.  Dr. Joshua Vogel (WHO) and Dr. Zahida Qureshi (University of Nairobi) were in attendance to support the training process and to encourage the trainees to share their new skills with others when they return to their home study sites.

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Group picture in Kenya (Image courtesy of Dr. L. Coppola)

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Dr. Coppola going over a scan with trainees (Image courtesy of Dr. L. Coppola)

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Trainees scanning in Kenya (Image courtesy of Dr. L. Coppola)

Participation in the ISUOG Outreach program has been an amazingly rewarding experience for me.  While writing this blog and thinking about my most favorite memories, these are the benefits that I continue to treasure the most:

  • Making a small contribution to an important international efficacy and safety trial
  • Witnessing a clear international dedication to maternal and child health
  • Strengthening obstetric ultrasound capacity at various sites by “training the trainers” (a benefit that will extend beyond the actual WHO ACTION trial)
  • Meeting new friends and establishing opportunities for future collaborations

 In gratitude to ISUOG Outreach (and to Sandhya Maranna for contribution of the India portion of this blog submission)

Lynn Coppola, MD, MPH
Assistant Professor OBGYN, Maternal-Fetal Medicine
University of Arizona College of Medicine

 

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WHO Meeting in London: maternal health in the post-2015 agenda

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ISUOG participated as an active observer during the WHO-PMNCH Board meeting in London, chaired by Graça Machel, former First Lady of South Africa and Mozambique.

As a member of WHO’s Partnership for Maternal and Newborn Child Health, ISUOG participated in their Annual Board Meeting on Monday 20 April 2015, at the RCOG headquarters in London.

Chaired by former South Africa/Mozambique First Lady, Graça Machel (who is also the widow of Nelson Mandela) the energy in the room was electric with discussions on strategies to improve women’s health and focused on identifying priorities for maternal and child health for the post-2015 Sustainable Development Goals (SDG) agenda. However, identifying these priorities became a real challenge for the board which tried to agree on what these should be and at the same time recognise the needs of all nations. This stems from the common issue of data and feedback monitoring which proved to be inconsistent over the years and there is now a lack of concrete and inconsistent reporting on what the main issues are in various countries.

ISUOG is a proud to partner with PMNCH and our presence at this meeting helped address the importance of providing doctors with quality education and training so that they can deliver effective obstetric and gynecological care to women all over the world.

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Amina Mahamad of Nigeria, UN’s Advisor to Maternal and Child Health for the Post-2015 agenda, responds to why educating doctors is crucial in saving the lives of countless women.

Highlighting the importance of ensuring all OB/GYN’s are empowered with quality education in training, Amina Mahamad of Nigeria, who serves as the UN’s Advisor to Maternal and Child Health for the Post-2015 agenda, shared her own experience as a mother. When giving birth to her four children in Nigeria, she was found subject to squalid conditions and dealt with doctors who were not sure exactly how to manage the childbirth. She highlighted that it is indeed time for countries to invest in education and resources for their health practitioners to help prevent maternal mortality. She mentioned as well her own cousin, who died of pre-eclampsia, which was not diagnosed until it was too late, despite having been to all her routine check-ups. Her message was clear; all mothers should be given the assurance and ease of mind that their doctor is fully capable of delivering their baby safely and this only comes through quality education for our doctors.

The agenda for the Sustainable Development goals aim to incorporate the needs of both the developing and developed world; and, it is clear that many more conversations will be needed to ensure that the goals fulfil the health requirements of women and children globally. ISUOG is very proud to be part of this process and looks forward to progress in the years to come.

Beyond 2015: the continued relevance of maternal mortality

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Image from ISUOG Outreach – Ghana 2010

Gesù Antonio Báez is ISUOG’s International Development Officer. He coordinates and is responsible for all development projects, in particular for the coordination of the ISUOG Outreach Program. He contributes regularly to the ISUOG Outreach Blog. To inquiry about Outreach, reach him at outreach@isuog.org

December 2015 will technically mark the end of the current Millennium Development Goals for 2015 and multiple organisations and NGO’s are running at frantic pace to continue to work towards fulfilling what those goals were set out to accomplish while governments are providing their last reports and findings to demonstrate whether they have met their goals for 2015 or not.

The Millennium Development Goals (or MDG’s as they are commonly called) were a list of eight specific goals designated and agreed to by the United Nations in 2000 that were aimed at cutting poverty and related factors in half by 2015. Among those eight goals were number four and five which primarily focused on the need to reduce levels of maternal and neonatal mortality rates in under development countries. But after 2015, should the topic on improving maternal and neonatal health come off the priority list?

At present, talks on the Post 2015 Sustainable Development Goals are underway with countless stakeholders and NGO representatives invited to the United Nations and relevant UN agencies to help identify them. A new initiative carried out by the NGO “Red Elephant” is underway in collaboration with the UN to carry out surveys in various regions to ask the global audience which items they should view as a top priority to begin working on- items such as adolescent rights, women’s empowerment, gender equality, and many more. And at ISUOG’s 25th World Congress which will take place in Montréal of this year, the topic of global maternal mortality will be a major focus. But will maternal mortality still be relevant for the new global goals going forward? Or will new priorities take precedence.

Clearly, there have been achievements, such as in China. According to the WHO, 97 women died per 100,000 live births in China in 1990. By 2013, the number reduced to 31 and this achievement was highlighted at ISUOG 10th International Symposium in Beijing last year.

India, however, is a different matter. At present, India is not anticipated to reach their goal for halving maternal mortality rates by 2015. Though significant progress has been made in certain Indian states, such as Kerala (which has also hosted a number of ISUOG Approved Courses), other states – particularly in the north such as Uttar Pradesh – have been improving at a slower rate. With this, it only carries more importance into why ISUOG is hosting its 11th International Symposium this year in New Delhi and stresses the importance of its presence in that particular region of the world.

Other countries such as Papua New Guinea have barely made any improvement since the MDG’s creation in 2000. In fact, it’s only doubled which makes it the worst place to give birth in the pacific region.

And in the wake of the current crises in Syria where refugees are giving birth within tents that are exposed to harsh environmental conditions, the need for maternal morality reduction is growing more urgent than ever before.  Maternal mortality must continue to always be a priority in all global agendas and ISUOG Outreach endeavors to ensure that it is through its education endeavors. Educating OB/GYN practitioners in ultrasound technology is vital for them to identify preventable causes of maternal mortality and in the long run, this can only help to reduce rates. But prioritizing maternal health globally is crucial for there to be reduction in the long term.

– Gesu Antonio Baez

 

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Infographic courtesy of the World Health Organization (WHO)