Speaker: Melese Siyoum
Facilitator: Indri Astuti Purwanti
Back ground: Pelvic organ prolapse (POP) is a common condition that can significantly impact a woman’s quality of life. Pelvic floor muscle training (PFMT) is recommended as a first-line conservative treatment for prolapse, but evidence from low-resource settings is limited.
Objectives: This study aimed to assess midwife-led pelvic floor muscle training on prolapse symptoms and health-related quality of life (HRQoL) among women with mild to moderate prolapse in Ethiopia, 2024.
Methods: A community-based, parallel, two-arm cluster randomized controlled trial was conducted in Dale and Wonsho districts of Sidama Region, Ethiopia. Women with symptomatic POP stage I-III were randomized by cluster to receive either midwife-led PFMT plus lifestyle counseling (intervention group) or lifestyle counseling alone (control group). The primary outcomes were change in prolapse symptom score (POP-SS) and prolapse quality of life (P-QoL). Mixed-effects generalized linear model was used to determine the effect size at 99% confidence level.
Results: A total of 187 women were randomized (intervention = 89 and control = 98). At sixth month, the intervention group showed significantly greater improvements with a mean change difference of: -4.1 (99% CI: -5.38, -2.83) in prolapse symptoms; -11.48 (99% CI: -15.9, -7.1) in physical domain, -12.65 (99% CI: -19.3, -6.1) in psychological domain and -9.47 (99% CI: -15.5, -3.5) in personal relationship domain of P-QoL. A significantly higher number of women in the intervention group perceived their condition as ‘better’ after the intervention. Women with earlier stages of prolapse (stage I and II) experienced higher benefits compared to stage III.
Conclusions: A midwife-led PFMT combined with lifestyle counseling significantly improves prolapse symptoms and quality of life in mild to moderate POP. This strategy can be integrated into the existing maternal and reproductive health programs to address POP in low-income settings where access to trained specialist is limited.
Speakers: Pronita Raha, Joy Kemp and Judith McAra-Couper
Facilitator: Elisa Segoni
Development of midwife faculty is key for quality midwifery education but globally the quality and availability of programmes to develop midwife faculty is variable. In Bangladesh, where international-standard midwifery education is still new, faculty do not yet meet the ICM midwife teacher standard. Faculty are nurse-midwives, though the new generation of direct-entry midwives will soon take up positions in education. This presentation describes a peer-mentorship programme for midwifery faculty in Bangladesh, enabling them to teach the new curriculum through non-didactic pedagogical approaches in theory and practice settings.
In 2021, twenty national peer-mentors received online preparation by midwifery faculty from New Zealand. A series of national and local stakeholder briefings took place at key points throughout the programme, COVID-19 permitting. From 2022-2024 peer-mentors conducted in-person quarterly visits to midwifery education institutions in Bangladesh, providing mentorship to 370 midwifery faculty and monitoring the quality of midwifery education. A digital community of practice was created to connect faculty with the peer-mentors, with each other and with teaching resources. Baseline and endline data were collected using a checklist based on WHO midwifery educator competencies, then entered onto a digital dashboard; qualitative data were collected by survey questionnaire then analysed thematically.
A process evaluation of the programme in 2024 found that peer-mentorship had been effective in enabling faculty to implement the curriculum, to improve the learning environment and increase students’ exposure to midwife-led care models in practice. The programme may not be generalisable across all midwifery education institutions or outside of Bangladesh.
Speakers: Rowsan Ara, Joy Kemp and Farida Begum
Facilitator: Hayat Emam Mohammed Gommaa
In Bangladesh, as in many countries around the world, midwives regularly face workplace abuse, but few incidents are reported or resolved appropriately. Most midwives/nurses and students are unaware of their rights to a safe workplace or learning environment and freedom from abuse, violence, discrimination or degrading treatment and may not recognise abuse when it occurs. Therefore, in 2024, the Directorate General of Nursing and Midwifery in Bangladesh (DGNM), with support from the UK and UNFPA, developed a framework to safeguard midwives/nurses and students from workplace abuse, connect them with their workplace rights and establish a zero-tolerance approach to harassment.
A working group was formed to develop the framework, with representatives from policy level, practice, education, regulatory body, administration, professional associations and women’s groups. Expert advice was provided by a regional safeguarding specialist and the draft was validated at a national workshop. The framework consists of a survivor-focused standard operating procedure aligned with national laws and guidelines, a dedicated safeguarding cell within the DGNM, and a helpline and email address for reporting abuse. There are newly-defined reporting and investigation processes and the provision of medical, legal and psychosocial assistance as required. Faculty and nurse/midwife managers received training-of-trainers and national and divisional staff, midwives/nurses and students received orientation.
Next steps in 2025 will be final approval from the Ministry, launch and implementation of the framework with dissemination to all nurses and midwives, education institutions, students and service managers, through the DGNM, the Bangladesh Nursing and Midwifery Council and professional associations.
