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.
Speaker: Rizka Ayu Setyani
Facilitator: Adetoro Adegoke
Maternal and child health is a critical public health priority in Indonesia; however, fragmented healthcare delivery and inequitable access to services continue to hinder optimal outcomes. This study evaluates the effectiveness of an integrated primary health service model in improving maternal and child health outcomes, focusing on midwives as central agents connecting healthcare systems, communities, and families.
A mixed-methods approach was employed across 10 primary healthcare facilities in urban and rural Indonesia. Quantitative data from patient records and service utilization statistics were analyzed, complemented by qualitative insights from interviews and focus group discussions with midwives, healthcare workers, and families.
The findings revealed a significant increase in antenatal and postnatal care visits (p 0.05) and improved continuity of care, including timely referrals and follow-ups. Midwives reported strengthened collaboration with community health workers and local facilities, while families highlighted better access to culturally responsive and holistic care. The introduction of digital tools further streamlined coordination and reduced delays in service delivery.
These results demonstrate that integrated primary health services can strengthen maternal and child healthcare systems, with midwives playing a pivotal role in bridging gaps and fostering trust. Scaling such models nationwide could enhance Safe Motherhood initiatives and accelerate progress toward achieving the Sustainable Development Goals.
