 Thank you very much All right, so Mabel Kisawa Asafo We'll be presenting sickle cell management in pregnancy the role of the midwife in a teaching hospital Kumasi She is a nurse midwife specialist regional health director at Ghana Health Service a shanti Ghana All right Mabel All right. Yeah, that's it I have the handle Okay Right. Thank you very much. I'm very grateful to be here with you To present to you on the topic management Sorry sickle cell management in pregnancy the role of the midwife in a teaching hospital in Kumasi Yeah, we'll be looking at these outline for the presentation A bit objective research methods findings and conclusions Yeah sickle cell disease it's a mostly A disease that is common worldwide a genetic disease that is affecting a lot of population in the whole world and it has really Affected a lot of people formally it used to be known as a black disease but now Think the slice are just Moving from one place to the other need to go back Okay And Mabel if you'd like help with your slides, I'm happy to move them for you If you want to if you can see them well, and you're not comfortable moving them You could just say if you want me to move them. I'm happy to do that for you Okay, I think I'm on the introduction slide, but it has jammed to the objective Okay, so do you want me to just quickly move them back to the introduction slide? Okay Yes, please Okay, would you like this slide or this one? This is the methodology. What I see is the methodology. Okay, we've got on showing at the moment is introduction slide slide 15 That is what you see there, right? Yes, ma'am Okay all right so A central cell disease is the most common genetic disease in the whole world Which has affected a lot of populations And it has it comes with each one various complications affecting worldwide. It used to be a disease of blacks But because of migration now it has become a global disease And therefore everybody in the whole world is being affected And it is a disease that is inherited from both parents It's not that only one parent is affected. No for a person to be born with sickle cell disease it means that Both parents had a trait of a sort and a child young born child inherited trait from both parents and one person With sickle cell disease gets pregnant The person suffers a lot of complications and problems Among which are pre-term labor low birth weight, maternal death and then conditions such as hypertension in pregnancy and others Next slide But currently It is estimated that pregnancy in women with sickle cell disease in Africa Is very high. The mortality rate is very high And it stands between 7 and 12 percent However, those women with sickle cell disease when they also get pregnant It affects them so much that they stand a chance of dying 22 folds Compared with those without sickle cell disease I can hear some noise. I wonder what everybody's hearing me Can I go ahead? Use the microphones if you are Plug your microphone and make sure Okay The microphone is on. It's turned blue. Is that okay? Mabel, you're wonderful. You can keep going Okay Okay So People people with sickle cell disease when they get pregnant they stand a chance of dying 22 times more than those without sickle cell disease But currently a lot of research has also shown that if people Are managed with a multi multi disciplinary team It will help them to be able to improve Their condition and then the death rate By about 18 9 percent And therefore it is important that People with sickle cell disease when they get pregnant they are managed with multi disciplinary team Which includes the maid wife However, a lot of research conducted has been done in UK the developed countries US and other places and not much is done in Africa A lot that has been done in Africa also look at pregnancy outcome and others and little is Known about the midwives role in managing sickle cell disease in Ghana And that is why I chose to research to explore the midwives A role in managing sickle cell disease in Ghana So the method used was qualitative That is to be able to explore the views of the women Or the sorry the midwives who are managing these people So that we know exactly what they are doing with these women and senior midwives were chosen because Sickle cell disease is known to be a high-risk pregnancy and therefore all the women who are Uh Who reports with pregnancy should be nurse with people with expertise In midwifery and then obstetrics and therefore senior midwives were recruited And in-depth interviews were conducted with 17 senior midwives It was a purpose because of the high-risk nature And the fact that senior midwives expertise are supposed to manage them And then their data was analyzed using thematic analysis The objectives of the study Was to assess midwives knowledge regarding the obstetric management Of sickle cell disease and to describe the practices of the midwife in pre-conception care Of women with sickle cell disease and to also explore the care that they provide for these women during pregnancy labor and postpartum It was also to identify the challenges that they encounter whilst they are offering their services And also to determine how they can Improve on the services that they provide for these women So the findings where that's a lot of them were age between 30 And 60 so the lowest age was 31 and the highest age 59 They were midwives of senior level Ranging from midwifery officer. That is the mo to the highest level of dds Which is the deputy director of nursing services So they are all within the senior midwifery categories And there are also people who have had a lot of working experience And the least person with experience is six years with the highest being 30 The highest experience is 37 Yeah, they also were selected from workplaces antenatal clinics postnatal clinic antenatal world labor world and then all the Areas of midwifery services provision The teams 10 teams came out of the various findings Namely scope of midwifery practice Knowledge on managing sickle cell disease their competencies their practices during preconception practices in antenatal practices during labor Practices during postnatal and then whether they have any guideline That is guiding them in their management So on the scope of midwifery practice They shared their experiences or their knowledge on what they think is their scope of midwifery practice And one midwife indicated That the midwife is supposed to care for the pregnant women From the beginning of pregnancy on to delivery After delivery the midwife takes care of the woman for such ways Before handing her over to the committee healthness Another also indicated the role of the midwife is not limited to pregnancy alone It extends to the men as well because in family planning we include them Our practice also involve adolescent health antenatal and postnatal So we're just giving out the knowledge about what they know to be the scope of the midwife Another also indicated recently island of critical care nursing which we now do as midwife For about three to four years ago the obstetric and gynecology now have our own intensive care unit So midwives are being trained in critical care nursing And I also know of anesthesia which midwives can also train So they think that the ups and gunning units within the hospital has now started training midwives In intensive care and then they can also go into critical care nursing as well to expand their scope On the knowledge in managing psychosocial disease Generally midwives had a fair idea about what psychosocial disease is and they express their views And the science and symptoms that are associated with it. So one indicated that it is hereditary They have types such as SS, AS, AC, depending on the electrophoresis That determine the type an individual has There are some features that when seen can determine if the person has psychosocial disease Their teeth is prominent. The forehead is bulge They have jaundice and fingernails are like drumsticks They have crisis severe joint pain and jaundice. That is a midwife sharing her experience Another also said in psychosocial disease Instead of the normal cells, they have psychosocial shape of their red blood cell They have crisis joint and bodily pain They are bound to take folic acid and other supplements They are advised to visit their clinic regularly. That is also another person sharing experience And then on the competencies of the midwives in managing psychosocial disease We try to find out how their Pre-service and in-service trainings have prepared them to be able to manage people with psychosocial disease And on pre-service training One indicated that it has prepared me adequately. At least I have the skill to manage the clients And if there is any emergency, I will be able to manage it But some of them also said they were not taught How to manage women with psychosocial disease during their pre-service training as one said in fact During my time of training, there was not much done on caring for women with psychosocial disease in pregnancy For in-service training or after school What they go through in terms of training They indicated as one said I have not had any other training in psychosocial disease on the job Another also said no not even a workshop. In fact, they don't organize workshop for us But we have been told that since this place is a new unit They will organize training for us in diabetes psychosocial disease and all the medical Conditions in pregnancy that training has not come on yet. Yes, there was another there was a A unit in the confanacea teaching hospital where I conducted a study Which is known as the frito-maternal Unit where they manage medical conditions including those with psychosocial disease So they said that that unit has just come up and they have promised to train them However, that training has not yet come on On their practices in pre-conception care Almost all the medias indicated that there was no program for pre-conception care in the teaching hospital As they indicated one said in confanacea, we don't do pre-natal care The frito-maternal medicine for statistics and gyne is now trying to look at that aspect of care But for now there is nothing like that. I have been there for seven years and have not provided pre-conception care to mothers We just start with antinatal clinic when they come That somebody's experience another also said we do not do pre-conception care here We only see them when they come on admission Then what they are finding is they are practices during antinatal care They also mentioned what they do during antinatal care provision one indicated that we give them anti-tetanol injection Some of them are allergic to SP. SP is a anti-malaria prophylaxis called sulfadoxin Pyramidamine which is given to them to as a prophylaxis against malaria So we give them mosquito nets to prevent malaria. We educate on diet fluids fruits and fibers. We do liver heart checks WBC has wide blood cell Full blood count FBC urea and creatinine They do that once at the reporting and when they are 36 weeks of gestation The another also indicated midwives do not do much Apart from checking their blood pressure weight and height Usually if The one sitting at the registration table. We have specific indicators. We look out for example those with high blood pressures resource negative mothers Mothered with HIV and those with sickle cell disease are given priority care We usually group them and allow them to see the specialist doctor So that is another person's view of how much they do or how much care they provide for women with sickle cell disease in pregnancy For their practices during labor and delivery Midwives again share their experiences on how much they do or how much Efforts or work the service they provide for them As one said we see to it that the mother has an IV line that is intravenous line We administer normal C line and call the doctor We also check the vital signs We do vaginal examination Monitor patients using the pathograph If the person is Due for delivery We deliver them and continue with infusion We offer prescribed trial model Another also said at labor pain management is number one Oxygen is also kept at their side and we make sure we hydrate them When they get to second stage at times we speed the stage by either giving episiotomy and encourage them to push Or we do vacuum aspiration for them Finding out on their practices during postnatal Again, they also share their experiences on how they do for them for postnatal care One said we nurse them differently from the usual postoperative care We give to the other patients who don't have the disease What we do is that we give them more fluids Like hydration unlike the normal patient who don't have the disease When they come And we give them the infusion postoperative day one or even six hours postoperative They are given steps of water or tea and then we discontinue the fluids But with the circle cell after the surgery we continue with hydration even if they start the steps of water So they were trying to Distinguish between the care they provide for Women with circle cell disease and those who don't have circle cell disease as even the more fluids Than those who don't have circle cell disease Another also said for postpartum for postnatal care They go for immunizations for the babies and seek family planning counseling for the mother Finally enough most of the people I have talked to Do not want to go for the second time at all because The experience is so bad If they know their spouse's genotype or not the baby should be screened and seek medical intervention Personal hygiene cuts across Pray pregnancy through to after delivery their medication should also be taken Yeah, so this is also another person who was expressing her view that They have to be taken some people because of the experience they have had in giving birth They just don't want to embark on any pregnancy again So to find out about whether they have any guideline that is Helping them to provide services The indicated that they don't have any specific guideline for providing services As they indicated that no there was nothing like that The little training I had In my pre-service is what I was using to manage them I have not seen any protocol since I started working here Another also said I have not seen any protocol We normally manage by the instructions of the doctors So that is the guidelines of protocol for management And then those who felt there could be a protocol also shared that well I know that there may be One just that they have not been posted or displayed on the walls for us to see And that is a bit funny because if there's a protocol and it's not accessible then I don't know who will use that protocol for management So on the challenges the midwives face in managing sequester disease Again, they express their view about the kind of challenges they go through As one said the first one is that we don't have enough machines Like the common pulse or zimita We had to complain for long before we had some We give oxygen without knowing the percentage which is not good enough We have a lot of challenges When they are in crisis we want them to be on a monitor And that means pushing her to the ICU that is intensive care unit If every world had a monitor it would be good Means that walls have no monitors It is only at the intensive care units that monitors are So if a patient is in crisis and you need to put the person on monitor You have to push the person to the intensive care unit for that particular kind of care And as I said it is not enough It is not sorry it is not everyone who have knowledge in managing pregnant women With a circles cell disease So the protocol should be made available on the world's end clinic So that if a midwife is alone on the world She can refer to that for management The only thing I know is relieving pain If a patient is in pain I can set up normal C-line with tramadol for her Apart from that I can do education too That is all so they should make a protocol available That is the kind of direction for managing women with circles cell disease So in concluding on the findings It was identified that midwives had inadequate knowledge about circles cell disease in general And in managing women with circles cell disease They were not playing their role as coordinators in managing circles cell disease in pregnancy Thus it is indicated that in normal pregnancies midwives play lead roles But when it comes to risk pregnancies they have to coordinate the role Among a multidisciplinary team There is no established multidisciplinary team for managing circles cell disease That was found at the facility And then the study has also revealed that circles cell disease in pregnancy is a high risk Therefore the women should be managed by a team of specialized healthcare professionals including midwives The midwives play a coordinator role within the team to ensure that The women and babies are cared for adequately So the recommendations are that The midwifery career column should include genetic conditions and genetic counseling And the T-witters should ensure that the topics cover all genetic conditions including circles cell disease It is also recommended for the training schools that Or after school that they should be continuous in-service training when they come out of from school The clinical side should also have in-service training for the midwives to be able to update them On the new things that are occurring in circles cell disease There should be effective management in Effective management is best than when there is guidelines for practice So it is also recommended for the clinic the hospital That is the Konfanochi hospital to be able to come up with a guiding protocol for managing women with circles cell disease Then the multidisciplinary team that is also a standard and recommended That every facility should ensure that they use Should also be established in the facility so that the midwife can play is coordinator rule And then the reproductive and Child health directorates of the Ghana Health Service Also in collaboration with the non-communicable disease unit should come up with a strategy and standard protocol for managing circles cell disease Which could be used as an in-service training material for new entrants the non-communicable disease Is now in control of circles cell disease in Ghana So when it comes to policies for circles cell disease It has been pushed under the non-communicable disease control unit And therefore if they collaborate with the Ghana Health Service, they'll be able to come up with protocol for management Break conception care must be taken seriously by the Konfanochi teaching hospital and the clients should be monitored and followed up To receive the care there should be increased community awareness Of circles cell disease and its complications so that couples will also take informed decisions for a better life So that brings me to the end of the presentation Acknowledgement to all the midwives that were used for the presentation The other people who supported with this research And everybody including you listening to me today. Thank you very much Thank you