Computer generated transcript

Warning!
The following transcript was generated automatically from the content and has not been checked or corrected manually.

okay? Yeah. All right. Yeah. Good morning, everyone. A very good morning to you all. It's 9. 20. I think we should get started. A very warm welcome to the second day off the globe meeting of a warm welcome to all of you who are in this room. I think there are about 100 of you And, of course, a very warm welcome to all those who are joining us online. I think that are about 400 people online. I've been good with the online people Are the online. Have it. Okay, so my name is how to come in a sign Me, a professor of gynecology at the University of Birmingham on is my pleasure to welcome you all. This is the Eighth Glow Conference. The first girl conference was in lyrical in 2012. So this is the 10th anniversary off globe around of applause for the 10. Now, the founding father off this conference is a gentleman who is amongst the audience today, right? It's his vision on it's his drive that actually brought this conference to life. So let's recognize his effort. Professor Andrew Weeks. Thank you. Now, why did undrawn you decide Teo gather a group of people. And again, um, we believed that we were more than the sum of parts, and we believed that if you were to stand together, we could reach a lot further. And I think what we really wanted to do and a thing Glow has been achieving this over the past decade or so is to create a community. The community was meant to be a UK based global health global women's health community. But I'm really delighted over the past few years. It's become a global community, and I think that is a massive achievement, and I think that deserves a round of applause. So I have a play for you. It is natural for us to sit next to our bottom buddies, right, and to kind of stick in that little group where we feel completely comfortable. That is completely natural. I do that too, right? But I think where you will have a really benefit in terms of coming to a conference like this is by speaking with someone that you haven't ever spoken to before, right, so break the mold, going to find somebody that you haven't spoken to before, and strike up a dialogue and you might find that there are some amazing, amazing outcomes from such a endeavor. So I heard you to not sit next to your boss. Somebody you said. Okay, that's my plea to you. Okay, great. So we had an amazing day yesterday. We had some really great presentations on to some really insightful discussions, and today is promising to be justice. Good. We have a great lineup off talks on discussions and workshops and so on. So, in fact, we have a freaking or lectures. Today we have to a panel discussions nine or presentations on three interactive workshops this afternoon. That's a lot to pack in into a day. But it would be an amazingly interesting and inside full day, as it was yesterday. So let's get going with the day on to carry us forward this morning, I have the honor privilege off introducing you to Professor Saeed, a cushy who is a friend and a comic. So is the heater works at the Department of Orangey at the University of Nairobi in Kenya. As I know, you have two more than two decades worth of clinical and research experience, and you have led and contributed too many clinical trials that have shaped practice in in Obs and Gynie. You are currently working, but that's on the motive trial and your energy. And bigger is benefiting us, the research community and the women at large. So it's my honor to invite you to chair this morning's session. Thank you. Good morning, everyone on. Good morning. Good afternoon. And a good even for those who are attending, is it my phone who are participating and attending online? And we welcome you all. I would like to start by thanking R E and Shaquille A on the organizing committee for giving me this opportunity to be here today on to be able to chair this very interesting session. Um, on. Azari said, we have a very, very interesting session. We have this morning talking about, uh, presentations on a procession this morning is on the engagement off funders, policymakers, patients and public involvement. Onda, uh, I would like to start off by introducing on a pill are from wh show. So she comes forward. A nice A medical doctor with a PhD in public health. She joined a huge about 20 years ago. Is a medical officer in the area off maternal and perinatal help. Her interests include the unprotected, increasing cesarean sections witnessed worldwide on UM, it's consequences. She is responsible for the research activities on this topic, including research in trends in equality is determinants guidelines and you'll for monitoring rates on optimizing Cesarean section for best maternal and very natal outcomes. So she's here to tell us more about what she's been doing. Um, ano you have actually 30 minutes. There's a slight error on the program. It says 9 30 to 10 30. But it's 9. 30 10 on. We'll give you well a few minutes for you to have a discussion and respond to questions. So welcome, Anna. Thank you. Thank you very much. I'm delighted to be here in life for the first time in a long time. On to see that many of the faces in soon have really faces behind after after so much are meetings from some meetings. So thank you very much. Uh, Chocula and the organizer's for inviting w to go on this session. This is a fantastic and congratulations on the first day, which was great. I'm going to start since I see, this is art friendly environment, and you know art is welcome. I'm going to start with a sort of piece of art. These was published by them by the National Geographic in 2015, so it's a little bit old, but it shows how the world gives birth on. You know, you can see each circle is, um, country. The colors show the science fiction great in each country. So you know, you see that the darker reddish colors means it's an section rates higher on the blue ish colors. Show Countries Week Lower science fiction rates. It's worth bringing to the forefront. How you know, for example, we see the European countries that have kind of an orange color, meaning that you know cesarean sections. Rates are relatively high, but the size of the circles are relatively small. On the other side. You have also Saharan Africa. We very low science fiction rates or blueish colors, but large, um, circles. So it's it's very important to know that even in countries were science fiction rates are lower than they should be. Still very large. Uh, this proportionally large number off debts Sorry, know that's off the science sections are occurring, so there's no it can be the quality of care during the science. Fiction cannot be overstated if we don't want to go into higher levels of maternal mortality and morbidity and also features so on. The the world picture is not going to change in the next on the current decade, because projections have shown that from the 21% to science fiction rate, these are averages, so they hide a lot of the mask. Large difference is, but we'll go in 2030 will go to 29 or 30%. The interestingly, the less level of countries on there on then a high developed countries will have the same. Approximately the same to science fiction rate on the rate in low income countries will be at about 12%. So society in section is an integral part off compressive obstetric care on providing safe, high quality, respectful society section toe All women in need is priority for WD on To some extent, we know the interventions that are needed to achieve these. It isn't the know how that we tend to fail. We we need to work on the how do we implement the interventions that we know they work on. This is why in wh oh for currently, they sell it off. Emphasis or in many instances, there's emphasis on implementation. Research implementation research require a huge amount off engagement at country level. It's the engagement needed from the Ministry of Help. The policy makers, the partners implementing on it needs also ah, lot of work with the women's. Uh on doctors are health care providers to understand their needs on their concerns because it's only by addressing their needs and concerns that we will be able to to implement. So in my talk, I'm just going to go through some examples of, um, priorities and activities that dot So, um, is, um, I've okay ting on I'm gonna do anything for, um topics. Evidence based interventions to optimize outcomes. Reliable data on monitoring for decision making, quality of medicines on women's view. So the importance of the experience on satisfaction of women I'm just saying extent I realize that the room is full of the mutual collaborators. Actually, you know, many of the studies that definitely is prioritizing are conducted by, you know, the ice and coordinators in the room, so it's the today will be kind of almost like a summary off. What? You know what was told yesterday. But let's start with the evidence based interventions. So it's take stop with maternal infections, which is David, uh, David strained so material infections are unimportant. Coast of maternal debts is the third costs. Um maternal debts. About 10% of maternal deaths are due to sepsis on almost all of them in low and middle income countries. These represents 35% maternal deaths on many of them occur after ah society in section on. Also, most of these maternal infections are preventable by the provision of high quality care. In 2017. Recognizing the burden on the need for action, they won't have assembly, which is the highest body for health policy setting, which is comprised by 194 member states countries. The ministries of health off the off 19, 194 countries so they won't have assembly adopted. A resolution on sepsis is with ah to improve the prevention, diagnosis and management off sepsis. Uh, recent, uh, shin means a reception is ah, the policy framework that commits countries to action on one direction. Obviously easier said in a meeting room like that done on. You know, obviously countries are struggling to implement on again it's implementation research. What is needed here on this is where you know Dave it's research on to develop and test on effect effective strategies to prevent the take untried and management tunnel sepsis is is, um I start very important research for W two with three interventional domains that he explained yesterday so I would not talk much about it. They had hygiene, the infection prevention and management implementing that mutual, um, evidence based intervention, including the prophylactic antibiotic prophylactic in high risk women on promoting safe surgical procedures In the case of the science fiction and then the better sepsis management, This is the station. If I'm not, if I'm correct a toe to improve the identification on the treatment abscesses. Also, you know, recognizing as we said yesterday, that tree training is not sufficient, but some type of training is necessary. W Toe has being working on developing training models, standardizing training models for infection prevention and control on. They are now developing the lab, a new model, which is the Model five for society in section on also interactive practical resources for trainers. So to be able to go beyond the self paced course that it exists in the future we're page now on. I think David will be using these models Indian in them. A trial. Let's move to a certain postpartum hemorrhage following society In section postpartum hemorrhage is also the first got off off maternal mortality on, obviously, as postpartum hemorrhage is very prevalent after after cesarean section aunt, it's very easily preventable. Or most of the dates can be prevented by using in utero, tonic, prophylactic uterus on IC in the third stage of labor. And this is what wh your recommends So but in terms. So let me just bring here the summary of the W two recommendations in all that you tonics are recommended by W two. Oh, in the case, if you know they have in the country or in the setting, there is a cold chain, a reliable coaching on oxytocin east. They won the first choice, but when there is no when they have in settings where they have a fragile cold chain, then you know the the oxytocin seeing so the the carpet that heat stable carpet. Oh, zing is recommended that what happens for postpartum hemorrhage treatment? So in there? No, they're no trials for a heat stable carpet toes ng in ah, two in postpartum hemorrhage treatment and therefore w o cannot recommend him Stable carpet. Oh, sing for for treatment. What happens that the benefit off having the the heat stable carpet So sing for for preventing because you don't need a cold chain you cannot apply to the post partum hemorrhage, So it's still treatment. So still, countries need to bring forth their coach change to be able to have the oxytocin in for treatment. So for w two Oh, I'm for the appropriate use off heat stable carpet. Oh, sing. It's very important to conduct a randomized controlled trial to assess safety. Untried mint off hit a stable carpet. Oh, sing for, um, for treatment. Sorry. Safety and effectiveness. So moving on these also the motive which is here. We have also the leaders on We heard from Fernando Tablet yesterday also the important trial and also they were conducted with in this trial on cesarean section or postpartum hemorrhage. For instance, I in section with the intent to agree on an Optima definition for postpartum following science section methods for the tech team. Uh, they they loved difference, respond management and also to agree on a threshold for action. Okay, um, moving away from from trials into evidence synthesis off off evidence based interventions that are, you know, for society and section for the for the 4% of surgical procedure, um, it's important to mop the interventions that work on they don't work on also too much the gaps. What are the interventions that are necessary to try or two test on a trip in Went in Argentina is working also in collaboration with Chocula and Birmingham. In mapping these interventions on, they have divided in interventions prior to admission in hospital interventions, interventions active. The church are no clinical interventions or crosscutting on just not to go through them in detail. But, you know, they quit a few number of interventions with thinning hospital interventions just to mention, for example, juice to watch talking yesterday about the, you know, conducting a randomized controlled trial on uterine searchers interrupted versus continues asking, asking searcher, you know large number of interventions that need to be mapping on Consolidated in terms off after this charge went to resume physical activity or went to resume intercourse or what is the length of hospitalist A The optimal in on Leslie in the non clinical interventions? Maybe just to mention the safety, the surgical safety checklist that it's it's also going to be part of this is safe a trial. And okay, moving. Um, sorry. What we done to the next? A reliable data on monitoring for decision making here from 2. 20 from 2015. Wh oh, does not recommend any more any ideal or optimal cesarean section great at the national level or at a population level on, uh, it recommends that all women in need glasses Sorry. In section on independently off the striving to achieve any sorry specific, um, hum rate monitor also, um, recommends to use the drops in classifications to monitor, assess and compare society and section rate. So it's not like we don't need to monitor. We do need to monitor, but not with the with the national level or a listen, uh, for for clinical decisions on, I think everybody knows what the ropes and acidic a shin is, um on to promote the use. Um, I'm further understanding off the classifications. Double it. So long last year. The rap song Classifications platform, which is a a free, um, platform. It's hospital based on it aims to promote a quality of care by improving understanding off society and section rates according to the ropes, um, groups. So the platform What will facilitate global cheering off data in the form off the ropes and acidic a shin were Why? So If you want to, you have your data for your hospital In the format of the rough simplification, the platform will allow you to enter your data. You're 20 numbers on outcome save you one on will generate different tables on graphs entrance for you, but you can also contact. You can also look for other hospitals. Data on you can contact them on on establish dialogue. That is evidence base. And that can be you know, that can be data driven on Understand. For example, you can contact somebody who has a science fiction rating drops and group one, for example, of less than 10%. If you're 6 30% you may want to, you know, check with them. What were they doing? You know you can do that through the platform. You don't. You know there's no need to have very official interactions through countries. You can actually do that yourself. So the wraps intensification. It's just the starting point on it. It gives you groups of women that are more, um, a genius, but actually doesn't say anything about the Y On this is very important. We need to understand why we conduct the society in the society in sections What happened with them? Why? So it's a story. Clean the problem with them? Why the understanding the reasons is because you know the categories off the Y r no mortuary exclusive. So there's overlapping. And it's very difficult to, uh, to compare between countries or between hospitals, given that overlapping also categories are not totally inclusive. Exhaustive. So unless you add another group of that is you know the other where everybody with everything feeds on. Therefore, you know, this is also hard to compare. Then it has a longer produce ability, meaning that different physicians are different. Obstetricians will classifier will decide on a on the same women will assign a different reason for for the indication. So this is also, you know, um, in pets comparisons on Leslie. They're not, um, perspective categories. You can only classify are women. Once you have decided on, you know, she's giving birth and you've done the science section on you have decided what was their reason on is very hard to take action on be, you know, Perspectively, if you cannot classify them before before hum. So this is the challenge that we have a head in terms of, ah, designing or identifying Ah ah, useful classifications for the reasons. And this is where Shaquille, a beer me home and the sea safe group are going to come This's trial off the study has not started is being is being inside face with the objective to develop, implement on evaluate a multifaceted intervention that you know names is safe targeting healthcare professional spread and women are health systems to reduce maternal, maternal and prenatal mortality and morbidity following science sections in low and middle income countries on um, we weigh heard yesterday about the three components. Try to understand the see why why, this is science sections are conducted also, um, improving that techniques. The interpretive interventions aren't also avoiding unnecessary science sections. So we're looking forward to start working on this, right? Shocking. Then just again Marrion mentioning the quality project on just 11 word are the This is important. This is ongoing. So this is half way through. This is a definite your priority. Also on this is to implement non clinical interventions toe optimize cesarean section in four countries which are Argentina, Vietnam working a fast so on Thailand. This is a multi country study on this is in recognition off the increasing, um, weight off the non clinical reasons for deciding on a society in section. So that way we can forget that there are more and more, you know, they increase is, you know, in countries where we have 50% of science fiction rates, there are no clinical indications that, you know, rich that high moving there next to the quality of medicines. This is a very interesting and neglected topic the, uh, systemat review in 2000 on quality off medicines for life threatening maternal conditions. Um noted that or, you know, focusing on a low and middle income countries. Found 34 studies in 40 countries with 3159 samples that were analyzed on you know, we saw you've seen the graph for oxytocic on for Mr Prestol. Almost 40% of the samples where, um were on So whereas for in the middle, we have gone between where 75%. So if we are giving this is a strongly important because if we are giving so much funding on so much effort to implementation research to make the oxytocic there to prevent perspective hemorrhage on, we don't have good quality of suggesting. Then we're wasting our time is like, you know, building a story in Poland. Putting no water is really you know, these grateful So that Metro has been working prioritizing with UNICEF and, um, FDA on guidelines and tools to to improve the quality of supported oxidizing another another medicines, but really, in the cold chain on now, you know the priority that were working Well, they're working with our country's toe on implementation research on adopting the stools toe, improve the quality of medicines, um, on day and working with regulatory agencies, etcetera. Lastly on. So he's already calling me at last but not least, the women's voice. You you may be familiar with wh of you framework on quality of care. This framework posits that within the structure of the health system on the on the facilities, the process is off care actually in influence the outcome and a half, you know, I have an important influence in outcome. These process off care can be further understood by the professional care itself on the experience of care on Historically, the professional care has actually, you know, gotten all their research and all the interest, Whereas the experience of care has been a little bit neglected. This is usually understood because the tools that we have to measure experience of care are not so develop. But it is very important to move into that aside think we're doing because experience of care, influence directly in India, really in the satisfaction of women on system at reviews have shown that positive experience of care is associated with medical effectiveness on women's safety or patient safety. So it's very important on for the future, then is priority toe identify and to work on the scale to addressing this subjectivity to the best possible on also to start working on interventions to improve the experience of care on satisfaction on If so, he allows me just, you know, some very key message is science fiction. Grades are increasing or white and 90% of the society a core in low and middle income countries to a breeder stand. We know the interventions that can improve the situation on the gap. Still reminds in identifying the strategies toe. Implement those effective interventions on to sustain that. The reps and pacification is recommended as a start important to him to improve understanding. But we need a pacification for indications I used for what, uh, the quality of medicines to prevent and treat maternal life. Threatening condition is crucial, and it's a neglected challenge in law and we'll income countries. Research is needed to improve this unless Li uh, the experience and the satisfaction with care are crucial for a positive clinical outcomes on research is needed to address the subjectivity. Unwto identify interventions to improve experience of care. Thank you very much. Thank you very much for the very, very interesting presentation on a um you've taken us through that very interesting map off how the world gives birth. Talked about evidence based interventions reliable data and monitoring the quality of medicines on the quality of care for women and women's, um, health issues. Um, so I think in the interest of time, let's open it up for discussion. May be ready to start and see if they have any questions from our online participants. Yes, we have a question from Wendy Gram online. Who said is the ratio HRP doing any assessment of the uptake of the various tools manuals, guidance there produced and especially of particular modes of presentation like online learning or a tools are taken up with greater frequency. I know. Maybe you should just remain here. Yes. The future is, um, at least trying to make an assessment of the tools years on, uh, pieces. Not just now. You know, we started a few years ago because it's an important indicator to document how these guidelines and tools are use is not easy, but yes, we are. They rejoice. Strain. Okay, um, maybe they move here and then go back to the online platform. Any body with comments. Questions? Yes. Saadi's a mike. Please have these, uh, please use the my brother online, then. Thank you very much for your presentation? Um, yes. The literature is doing a lot of, you know, print work in trying to see that, you know, interventions tried such a situation implementation, science and so on. But how far is you know, wh you're really trying to see off course what implementations and's is how are the interventions implemented within the country? So how far they trying to ensure? You know, countries stick to, you know, whatever they decide at the end of the temperatures up, sustainability is a role issue in most off this, you know, even the intervention, even the implementation recent sustainability scale up. You know, I really issues within the country. Given Nigeria's an example, you do an excellent, you know, research funded by doubling at you and then good findings. And at the end of the day, you don't really see the intervention being skilled up and so steamed. Thank you. Thank you. That's absolutely good. Eyes the interventions working on living. Um, we are a little is, you know, there. There's no magic one to change it, but the insurance on researchers are trying to, um, built in the studies. The sustainability. Um um, aspect on, for example, this is why in one of my first it's lights, I said that in implementation research, you really need to engage with ministers of health on bolus e makers from the very, very beginning from US areas. But it's never too early to engage with them because you know you need You need all that time to work with them on the resources needed on the changes needed to make it a sustainable. It's possible and we also support us, you know, and it's just under s. So it's not like that mutual. This is standard practice process evaluations in the within the studies on the research to try to understand what are they throughout the study, where the barriers, what are they in? What places has worked on why? I mean, what places hasn't worked on why to help build also the stools or is understanding at the local level. But there is no, you know, I'm sorry. There's no much you want to, but there's a lot of ah awareness of this problem on trying to build in the possibility from the very, very thank you and Andrew Weeks. Thanks, Dan Appear that was fantastic on the I very much welcome the way in which wh show, in a sense is has moved away from just doing randomized trials into implementation research. And I think often we knew from randomized trials what could work in a perfect situation. But actually there was. There was that knowledge gap into interaction. What does work? One of the problems I see that as we move forward, is that so many of the guidelines are completely focused on randomized trial evidence on systematic reviews on doffed in to the exclusion of all the implantation research, which is so critical on I wonder if there's any moves that you know it. W h 02 go to sort of cock rain plus or systematic reviews where you've got the baseline from randomized trial evidence. But actually, there's a whole lot more added in. And it's not just the Lexapro it opinion, which is a bit really. That's something a little bit more robust for the implementation science evidence. Thank you, Thank you. I have a little moves is moving. He's aware of all these off all these evidence. This the evidence that it's not coming exclusively for one of my control trials. In fact, in the guidelines. They you know, we moved from 10, 20 years ago. It was exclusively around the much controlled trials. Now they have the qualitative component which, you know, includes values cost on all these disability acceptability. All these things are also included on our have. Even I'm not saying even more weight, but I really, really waiting. Ah, who would have thought, You know, 20 years ago that that evidence you know, on acceptability or on experience of women would actually, you know, be important. So this is already happening. The last the last few guidelines in maternal health. So in in where I work, they are already including these qualitative aspects on I think, you know, the interventional, the intervention research, the results from the intervention of research will be joining that par. But people are really more and more stronger. Process evaluations are included there because from implementation research is the process evaluation or is, you know, two greatest in the process of elevation. They want that can tell you why things are not working in some places or on why it's working in some in some other places. So when you have 10 hospitals in 10 countries. Somehow, when I work, some are not going to work. So it's critical to understand, you know, just not to have, you know, a number. Okay, this is my my Rachel. My son Already risk about to say to see at the Lakers on learn from them. So guidelines can be more Taylor into some health systems or some other health systems. We're in the way. Thank you very much. And, uh, do we have anything on line one last one? No. Fine. So I, um Okay, process the last one. Then we need to move on process. You'll make it concise, please. Thank you so much. But the morning give one. My name is post. Once again, I'm saying the constant off maternal sepsis, which is coming up and it's actually made your Questran. But I'm off the view, like in the country. I'm coming floor. There is a lot of Celophan education on. Then you find that most of those pregnant mothers on uh, yeah, you may end up develops. That's it's probably they have been practicing. So from indication during pregnancy off which the medications Ah, they were misused on this can alter their efficacy so I don't know that they are tailing this way. Subject cases that are coming up to a little toe aren't micro be resistance, which is also a higher concerned that maybe affecting the efficacy of the medications that I used to make it as conditions. In addition to remain so, cases that conditions that may implicate for the course off sepsis. Then there's another constant is about the increased things by, I think going to, uh, check the price. If the health professional ms we'd be that where the scales the necessary skills achy they can find that one was trained like productive a general bridge. But But what? I'm see that most of those brush because they're similar fate as I remember to put it over there by C is then what'll happen? But that's my breakfast. Trailed. It was not practicing the skill are saying that they're going to They're world of the prizes increpitus I'm out of here at the workers as fun as a potentially school son. Thank you so much. Thank you about your thinking toe. So, uh, would you like to respond to anything? I think those are comments that are very right. I recognize sepsis is an issue, but the whole issue off self medication, which maybe antibiotics, maybe others is, is quite a wide field. And then, of course, we discussed a lot yesterday about Cesarean section that you know when it should be done to the right person. And yes, whether we need to have all breach, you know, presentations delivered by cesarean. And then you say you increase your cesarean section. Great. What? You lose your skin. So it it's something that will be to be discussed that much wider and who has been discussed yesterday and the discussions will go on. So I think thank you very much.