Abstract
BackgroundObstetric hemorrhage (OH) remains one of the leading causes of maternal mortality, particularly in rural Africa. Tanzania has a high maternal mortality ratio, and approximately 80% of the population accesses health care lower level facilities, unable to provide Comprehensive Emergency Obstetric Care (CEmOC). The non-pneumatic anti-shock garment (NASG) has been demonstrated to reduce mortality as it buys time for women in shock to be transported to or to overcome delays at referral facilities.MethodsThis report describes one component of an ongoing maternal health improvement project, Empower, implemented in 280 facilities in four regions in rural Tanzania. The NASG along with a Closed User Group (CUG) mobile phone network were implemented within the overall EmOC project. Simulation trainings, repeated trainings, and close hands-on supportive supervision via site visits and via the CUG network were the training/learning methods. Data collection was conducted via the CUG network, with a limited data collection form, which also included free text options for project improvement. One-to-one interviews were also conducted. Outcome Indicators included appropriate use of NASG for women with hypovolemic shock We also compared baseline case fatality rates (CFR) from OH with endline CFRs.Data were analyzed using cohort study Risk Ratio (RR). Qualitative data analysis was conducted by content analysis.ResultsOf the 1713 women with OH, 419 (24.5%) met project hypovolemic shock criteria, the NASG was applied to 70.8% (n = 297), indicating high acceptability and utilization. CFR at baseline (1.70) compared to CFR at endline (0.76) showed a temporal association of a 67% reduced risk for women during the project period (RR: 0.33, 95% CI = .19, .60). Qualitative feedback was used to make course corrections during the project to enhance training and implementation.ConclusionsThis implementation project with 280 facilities and over 1000 providers supported via CUG demonstrated that NASG can have high uptake and appropriate use for hypovolemic shock secondary to OH. With the proper implementation strategies, NASG utilization can be high and should be associated with decreased mortality among mothers at risk of death from obstetric hemorrhage.
Highlights
Obstetric hemorrhage (OH) remains one of the leading causes of maternal mortality, in rural Africa
OH can lead to shock, a state in which the body’s vital organs lack enough oxygen, which leads to organ failure and death
In Tanzania women die from bleeding and shock due to long distances from emergency health services, Comprehensive Emergency Obstetric Care (CEmOC). One way this problem has been addressed is with the use of a lightweight, cost-efficient compression garment, the non-pneumatic anti-shock garment (NASG), which stabilizes women who have lost excessive blood, allowing them to survive delays in travelling to or receiving care at CEmOC facilities
Summary
Obstetric hemorrhage (OH) remains one of the leading causes of maternal mortality, in rural Africa. This low-technology, easy to apply, circumferential pressure device, is made of stretchy compression neoprene and closes tightly with Velcro, reversing shock, restoring vital signs, and decreasing blood loss in the pelvis and uterus [5] This first aid device buys valuable time, to enable transfer from rural and lower level facilities, and during the often-long delays for blood transfusions or surgeries that can occur, even in tertiary and university teaching hospitals in LRCs. Morbidity and mortality outcomes using the NASG have been positively compared to outcomes with standard treatment of shock/hemorrhage in women with a variety of OH etiologies, and the NASG was found to be effective in decreasing blood loss by over 50% [6–9].
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