Non-pneumatic Anti-shock Garment Research Articles

Use of nonpneumatic anti-shock garment and first response care bundle to improve maternal survival following obstetric hemorrhage in Migori County, Kenya

Background: Despite targeted efforts by the Ministry of Health and nongovernmental organizations, the maternal mortality ratio (MMR) was 673 in 100,000 live births in Migori County, Western Kenya. The first confidential investigation into maternal deaths was a detailed review of half of the maternal deaths reported across Kenya in 2014. Approximately 40% of maternal deaths were due to obstetric hemorrhage (OH), and 90% were attributed to substandard care. Objectives: To evaluate the use of a nonpneumatic anti-shock garment (NASG) and first response bundle in maternal survival following postpartum hemorrhage. Methods: An implementation team trained maternity care staff at 104 participating facilities (responsible for 85% of facility births for the county) to use the first-response bundle, NASG, and uterine balloon tamponade (UBT) combined with NASG for uterine atony. The study had two phases, beginning July 1, 2020, and ending September 30, 2021. Results: 63,580 deliveries were reported, giving an OH rate of 1.32%. Of 838 women with OH, 51.8% showed signs of hypovolemic shock (n=434). NASG was applied per protocol to 56.5% (n=267) of women and preventively to 146 (36.1%) of the 404 women with OH. For most women with OH who did not receive NASG, the provider stated that it was not necessary. In three cases, NASG was not applied due to lack of a trained provider, and in four cases, NASG was not available at the facility. The use of the complete first-response bundle increased from 37.3% to 42.3% over time. For tranexamic acid (TXA), 40.8% of eligible women who received TXA had received the other three interventions. 86 were managed with both the UBT and NASG (22.5%). Conclusion: This study demonstrated that the use of the NASG and PPH first-response bundle is feasible at tertiary and primary health facilities. The limitation to the use of a first-response PPH bundle is whether there is a local commitment to expand the availability of TXA.

Operational demonstration and process evaluation of non-pneumatic anti-shock garment (NASG) introduction to the public health system of Northern Province, Zambia

BackgroundA disproportionate burden of maternal deaths occurs in low- and middle-income countries (LMICs), and obstetric hemorrhage (OH) is a leading cause of excess mortality. In Zambia, most of maternal deaths are directly caused by OH. The Non-Pneumatic Anti-Shock Garment (NASG) is a first aid tool that uses compression to the abdomen and lower body to stop and reverse hypovolemic shock secondary to OH. We describe the process and experiences introducing the NASG into the Zambia public health system to encourage the development of national policies, clinical guidelines, and implementation plans that feature the NASG.MethodsWe conducted an observational study of NASG introduction to 143 public health facilities in Northern Province, Zambia, organizing observations into the five dimensions of the RE-AIM evaluation framework: reach, effectiveness, adoption, implementation, and maintenance. The NASG was introduced in August 2019, and the introduction was evaluated for 18 months. Data on healthcare worker training and mentorship, cases where NASG was used, and NASG availability and use during the study period were collected and analyzed.ResultsThe NASG was successfully introduced and integrated into the Zambia public health system, and appropriately used by healthcare workers when responding to cases of OH. Sixteen months after NASG introduction, NASGs were available and functional at 99% of study sites and 88% reported ever using a NASG. Of the 68 cases of recorded OH where a NASG was applied, 66 were confirmed as clinically appropriate, and among cases where shock index (SI) could be calculated, 59% had SI ≥ 0.9. Feedback from healthcare providers revealed that 97% thought introducing the NASG was a good decision, and 92% felt confident in their ability to apply the NASG after initial training. The RE-AIM average for this study was 0.65, suggesting a public health impact that is not equivocal, and that NASG introduction had a positive population-based effect.ConclusionsA successful NASG demonstration took place over the course of 18 months in the existing health system of Northern Province, Zambia, suggesting that incorporation of NASG into the standard of care for obstetric emergency in the Zambia public sector is feasible and can be maintained without external support.

Utilization of non-pneumatic anti-shock garment for treating obstetric hemorrhage and associated factors among obstetric care providers in Ethiopia: A systematic review and meta-analysis

Background The non-pneumatic anti-shock garment (NASG) is a life-saving device that can help to avoid delays and prevent further complications in the case of obstetric hemorrhage. Although there are many fragmented primary studies on the NASG utilization in Ethiopia, the pooled utilization rate is unknown. In addition, a disagreement was observed among those studies while reporting the associated factors. Therefore, this study was intended to determine the pooled level of NASG utilization and its associated factors among obstetric care providers in Ethiopia. Methods A total of 51 studies were retrieved from PubMed, Google Scholar, the African Journal of Online, direct open-access journals, and Ethiopian universities’ institutional repositories. This study was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. The quality of studies was evaluated using the modified Newcastle-Ottawa quality assessment tool. The data were extracted by two authors independently using Microsoft Excel and analyzed by Stata version 11. A random-effects model was applied to calculate the pooled level of NASG utilization and its associated factors. The PROSPERO registration number for the review is CRD42023414043. Result A total of 8 studies comprising 2,575 study participants were involved in this meta-analysis. The pooled utilization rate of NASG was found to be 39.56%. Having NASG training (pooled odds ratio (OR) = 3.99, 95%CI = 2.35, 6.77), good knowledge about NASG (OR = 2.92, 95%CI = 2.04, 4.17), a positive attitude towards NASG (OR = 3.17, 95%CI = 2.10, 4.79), and having ≥ 2 NASGs in the health facility (OR = 10.59, 95%CI = 6.59, 17.01) were significantly associated with NASG utilization. Conclusion Utilization of NASG for the treatment of obstetric hemorrhage was low in Ethiopia. To increase its utilization, Ministry of Health should improve the accessibility of NASG at each health facility and increase the Health professionals’ knowledge and attitude through in-service and pre-service training.

Non-pneumatic anti-shock garment (NASG) and balloon tamponade decrease maternal mortality and morbidity from Obstetrics Haemorrhage: A prospective observational study

Obstetric haemorrhage is the leading cause of maternal mortality and morbidity worldwide. A prospective observational study was conducted among 132 women admitted, booked/referred, at tertiary care centre with Obstetric Haemorrhage for 2 years period. Of these 71 patients had received Non-pneumatic antishock garment and / or Uterine Balloon Tamponade (Group 1) and 61 didn’t receive any (Group 2). Both groups were observed for its outcome. The socio-demographic parameters and obstetric characteristics among both groups were comparable. However, there were differences in their outcomes and complications. Surgical interventions were more among group 2 as compared to group 1, B-lynch/Modified B-lynch (8.4% vs. 1.6%), Stepwise devascularisation (2.8% vs. 1.6%) and Obstetric hysterectomy (7.0% vs. 3.2%). There was significantly more blood loss in Group 2 than group 1. Duration of hospital stay was significantly shorter (9.8±2.7 days) in Group 1 as compared to Group 2 (12.7±3.6). The shock index after intervention was significantly smaller (0.7±0.1) in Group 1 in comparison to Group 2 (0.8±0.1) and Group 1 required significantly less number of blood and blood products as compared to group 2. 19.7% required ICU admission in group 1 and 24.6% in Group 2. There was no mortality in group 1 and 3 patients died in group 2. NASG and UBT is both life-saving and cost effective and can become the first defence against Obstetric Haemorrhage.

Utilization of non-pneumatic anti-shock garment for the management of obstetric hemorrhage among healthcare providers in north Shewa zone, Ethiopia.

Global maternal deaths have either increased or stagnated tragically. Obstetric hemorrhage (OH) remains the major cause of maternal deaths. Non-Pneumatic Anti-Shock Garment (NASG) has several positive results in the management of obstetric hemorrhage in resource-limited settings where getting definitive treatments are difficult and limited. Therefore, this study aimed to assess the proportion and factors associated with the utilization of NASG for the management of obstetric hemorrhage among healthcare providers in the North Shewa zone, Ethiopia. A cross-sectional study was conducted at health facilities of the north Shewa zone, Ethiopia from June 10th-30th/2021. A simple random sampling (SRS) technique was employed among 360 healthcare providers. Data were collected using a pretested self-administered questionnaire. EpiData version 4.6 and SPSS 25 were used for data entry and analysis, respectively. Binary logistic regression analyses were undertaken to identify associated factors with the outcome variable. The level of significance was decided at a value of p of <0.05. The utilization of NASG for the management of obstetric hemorrhage among healthcare providers was 39% (95%CI: 34-45). Healthcare providers who received training on NASG (AOR = 3.3; 95%CI: 1.46-7.48), availability of NASG in the health facility (AOR = 9.17; 95%CI: 5.10-16.46), diploma (AOR = 2.63; 95%CI: 1.39-3.68), bachelor degree (AOR = 7.89; 95%CI: 3.1-16.29) and those healthcare providers who have a positive attitude toward utilization of NASG (AOR = 1.63; 95%CI: 1.14-2.82) were variables positively associated with the utilization of NASG. In this study, almost two-fifths of healthcare providers used NASG for the management of obstetrics hemorrhage. Arranging educational opportunities and continuous professional development training for healthcare providers, providing in-service and refresher training, and making it available at health facilities may help healthcare providers to effectively use the device, thereby reducing maternal morbidity and mortality.

Knowledge, Utilization, and Associated Factors of Nonpneumatic Antishock Garments for Management of Postpartum Hemorrhage among Maternity Ward Health Care Professionals in South Wollo Zone Health Facilities, Ethiopia, 2021: A Cross-Sectional Study Design.

In 2017, approximately, 810 women died every day from preventable causes related to pregnancy and childbirth around the world. Obstetric hemorrhage, specifically postpartum hemorrhage, is the leading cause of preventable maternal mortality in the world. New strategies and technologies are needed to reduce the global public health epidemic of maternal mortality. However, nonpneumatic antishock garments were recently introduced and incorporated into teaching curriculums as a management modality for postpartum hemorrhage in Ethiopia. Therefore, this study assessed the knowledge, utilization and associated factors of nonpneumatic antishock garment among maternity ward healthcare professionals in the selected South Wollo zone health facilities, North West Ethiopia. An institutional-based cross-sectional study design was conducted from February 1 to April 30, 2021. A consecutive sampling technique was employed to collect the data. A self-administered semistructured English version questionnaire was used to collect the data. EPI-Info and SPSS were used for data entry and analysis, respectively. Bivariable and multivariable logistic regression analyses were used to analyze the association of nonpneumatic antishock garment utilization with independent variables. A total of 244 maternity ward health care professionals participated. One hundred forty-six (59.8%) had a good knowledge of nonpneumatic antishock garments. About 110 (45.1%) of the participants have ever used it for the management of postpartum hemorrhage. Those having one nonpneumatic antishock garment (AOR = 2.7, 95% CI: 1.3, 5.5), two or more nonpneumatic antishock garments (AOR = 14.1, 5.7, 35.0), good knowledge (AOR = 5.2, 2.5, 10.7), and positive attitude (AOR = 2.5, 1.1, 5.7) and those who were receiving training (AOR = 2.2, 1.1, 4.4) at 95% CI were significantly associated with utilization of nonpneumatic antishock garments. The knowledge and utilization of nonpneumatic antishock garments for the management of postpartum hemorrhage were low. Those having more nonpneumatic antishock garments, good knowledge, and a positive attitude and those who received training were found to be significantly associated with nonpneumatic antishock garment utilization. The provision of training and availability of nonpneumatic antishock garments are the key actions to be taken to increase the utilization of nonpneumatic antishock garments.

Utilization of Nonpneumatic Antishock Garment and Associated Factors among Obstetric Care Providers in Public Hospitals of Sidama Region, Hawassa, Ethiopia, 2022.

Nonpneumatic antishock garment is one of the newly emerging technology advances that reduce blood loss which is caused by obstetric hemorrhage and help women survive during delays to get definitive care. Over 80% of maternal mortality due to hemorrhagic shock may have been prevented if a nonpneumatic antishock garment had been utilized by an obstetric care provider. However, to the current knowledge, the utilization of nonpneumatic antishock garments is low and even no single study was conducted in the study area. Hence, we found that it is necessary to assess the magnitude and factors affecting the utilization of antishock garments among obstetric care providers in public hospitals of the Sidama region, Ethiopia, 2022. A facility-based cross-sectional study design was employed among 403 obstetric care providers from June 15 to July 15, 2022. A two-stage sampling technique was applied; the data was collected by 5 trained BSc midwives using pretested and structured self-administered questionnaires. Data was entered into EpiData Manager version 4.6 and exported to Statistical Package for Social Sciences (SPSS) version 26 software. Bivariate and multivariable logistic regression analyses were used. A total of 394 (97.8%) health professionals participated in this study. Overall, 30.71% (95% CI: 26.4%, 35%) of the obstetric care providers had utilized nonpneumatic antishock garments for the management of postpartum hemorrhage. Training on the antishock garment (AOR = 4.183, 95% CI: 2.167, 8.075, p < 0.00), tertiary hospital (AOR = 0.355, 95% CI: 0.132, 0.952, p < 0.04), having protocol in the facility (AOR = 2.758, 95% CI: 1.269, 5.996), availability of NASG in the facility (AOR = 4.6, 95% CI: 1.603, 13.24), good knowledge (AOR = 2.506, 95% CI: 1.26, 4.984), and positive attitude (AOR = 2.381, 95% CI: 1.189, 4.766) were significantly associated factors. Conclusion and Recommendation. We found that less than one-third of the study participants have used the antishock garment in the management of postpartum hemorrhage in the current study. In addition to enhancing in-service and ongoing professional development training, it is preferable to insure the availability and accessibility of antishock in the facilities in order to close the knowledge and attitude gap among obstetric care providers.

Predictors of time to recovery from postpartum hemorrhage in Debre Markos comprehensive specialized hospital, Northwest, Ethiopia, 2020/21

BackgroundPostpartum hemorrhage is one of the leading causes of maternal deaths worldwide. Early recovery is a performance indicator and better health outcome of patients with postpartum hemorrhage. Therefore, this study aimed to assess time to recovery from postpartum hemorrhage and its predictors in Debre Markos Comprehensive Specialized Hospital, Ethiopia, 2020.MethodsA retrospective follow-up study was conducted among 302 women who were diagnosed with postpartum hemorrhage from January 1, 2016 to December 31, 2020 at Debre Markos Comprehensive Specialized Hospital. Consecutive sampling technique was employed. To show the statistical significant difference between each group of variables, log rank test was used. Kaplan Meier analysis to estimate time to recovery and cox proportional-hazard regression analysis to determine independent predictors were carried out cautiously. Adjusted hazard ratio used to determine the strength of association.ResultThe median recovery time from postpartum hemorrhage was 13 h with range of (10 to 17 h). Blood transfusion (AHR: 1.8, 95% CI (1.39, 2.57)), NASG utilization (AHR: 6.5, 95% CI (4.58, 9.42)) fluid resuscitation (AHR 2.9, 95% CI (1.48, 5.54)), active management of third stage of labor (AHR: 1.7, 95% CI (1.18, 2.45)) and history of antenatal care follow-up (AHR: 2.6, 95% CI (1.91, 3.56)) were the predictors, which shorten the recovery time. Comorbidities like anemia at the time of admission (AHR: 0.62 95% CI (0.44, 0.89)), retroviral infection (AHR: 0.33, 95% CI (0.16, 0.67)) and Hepatitis B-Virus infection (AHR: 0.52, 95% CI (0.32, 0.82)) delay the recovery rate from postpartum hemorrhage.ConclusionMothers in North-West Ethiopia stays morbid from postpartum hemorrhage for more than half a day. Their recovery time was affected by Non-Pneumatic Anti-Shock Garment utilization, implementation of emergency management components like blood transfusion and fluid resuscitation, history of antenatal care follow up, and being comorbid with viral infections. Non-pneumatic anti-shock garment application to every mother with postpartum hemorrhage and implementation of proper emergency management approach are vital for rapid recovery from postpartum hemorrhage.

Factors Influencing Utilisation of Non-Pneumatic Anti-Shock Garment in The Management of Postpartum Haemorrhage Among Midwives in Ekiti State

Postpartum haemorrhage (PPH) is one of the leading causes of death among women especially in developing nations which can be managed through the use of non-pneumatic anti-shock garment (NASG). This study was aimed at evaluating the Utilization of NASG in the management of PPH among midwives in Ekiti State. This study adopted an embedded mixed method design. Purposive sampling technique was used to select six health facilities in Ekiti State and a total of 164 midwives participated in the quantitative study and 11 midwives in the qualitative study. Data were collected using self- structured questionnaire and interview guide. Results from the study shows that Midwives mean age was 37 ± 7.64, more than half 65.9% had (NASG) in their facilities, 54.3% have applied NASG on their patients, this corroborates with the result of the interview where majority showed adequate utilization, occasional utilization and awaiting approval for utilization. It was observed that Midwives’ don’t utilize NASG as a result of availability of other methods of controlling PPH 88.8%, non-availability of the garment 53%t, and Inaccessibility to NASG 48.8%, 36,4% indicated staff training challenge and alternative to NASG utilization 36.4% as the major factors influencing the utilization, this also corroborate with the result from the key informant interview, It was noted that the utilization of NASG was influenced by its availability as the p value gotten was 0.01 which is lesser than 0.05. Conclusively, the utilization of NASG for the management of PPH was on the average.

Utilization of non-pneumatic anti-shock garment and associated factors for postpartum hemorrhage management among obstetric care providers in public health facilities of southern Ethiopia, 2020.

Delays in care have been recognized as a significant contributor to maternal mortality in low-resource settings. The non-pneumatic antishock garment is a low-cost first-aid device that can help women with obstetric haemorrhage survive these delays without long-term adverse effects. Extending professionals skills and the establishment of new technologies in basic healthcare facilities could harvest the enhancements in maternal outcomes necessary to meet the sustainable development goals. Thus, this study aims to assess utilization of non-pneumatic anti-shock garment to control complications of post-partum hemorrhage and associated factors among obstetric care providers in public health institutions of Southern Ethiopia, 2020. A facility-based cross-sectional study was conducted among 412 obstetric health care providers from March 15 -June 30, 2020. A simple random sampling method was used to select the study participants. The data were collected through a pre-tested interviewer-administered questionnaire. A binary logistic regression model was used to identify determinants for the utilization of non-pneumatic antishock garment. STATA version 16 was used for data analysis. A P-value of < 0.05 was used to declare statistical significance. Overall, 48.5% (95%CI: 43.73, 53.48%) of the obstetric care providers had utilized Non pneumatic antishock garment for management of complications from postpartum hemorrhage. Training on Non pneumatic antishock garment (AOR = 2.92; 95% CI: 1.74, 4.92), working at hospital (AOR = 1.81; 95% CI: 1.04, 3.16), good knowledge about NASG (AOR = 1.997; 95%CI: 1.16, 3.42) and disagreed and neutral attitude on Non pneumatic antishock garment (AOR = 0.41; 95%CI: 0.24, 0.68), and (AOR = 0.39; 95% CI: 0.21, 0.73), respectively were significantly associated with obstetric care provider's utilization of Non-pneumatic antishock garment. In the current study, roughly half of the providers are using Non-pneumatic antishock garment for preventing complications from postpartum hemorrhage. Strategies and program initiatives should focus on strengthening in-service and continuous professional development training, thereby filling the knowledge and attitude gap among obstetric care providers. Health centers should be targeted in future programs for accessibility and utilization of non-pneumatic antishock garment.

Knowledge and Utilisation of Anti-Shock Garment Among Midwives of Adeoyo Maternity Teaching Hospital, Ibadan, Nigeria

Background and Aim: Postpartum Haemorrhage (PPH) is a leading cause of maternal mortality, yet it is one of the few obstetric complications, with proven and effective interventions. Non-Pneumatic Anti Shock Garment (NASG) is a high-quality, simple technology and low-cost first-aid device that reverses hypovolemic shock. While evidence has shown that this simple technology is effective in reducing PPH, the level of knowledge and utilisation is unclear. This underscored the need to assess the knowledge and utilisation of the NASG as a measure of controlling postpartum haemorrhage in Adeoyo Maternity Teaching Hospital, Yemetu, Ibadan. Methods: This study adopted a descriptive cross-sectional research design and questionnaires were used to gather data from the midwives. The convenience sampling technique was used to recruit one hundred and forty-four (144) midwives into the study. Data were analysed using version 21.0 of Statistical Package for Social Sciences (SPSS) using Chi-square. Results: The findings of this study revealed that although 97.9% of participants responded that they had seen NASG before, only about half (47.1%) could describe what it looked like. While 96.4% claimed that they knew how to use the NASG, only 73.7% of them actually use it each time there was PPH. No significant association was found between knowledge and utilisation of the equipment (p=.298). Factors associated with non-usage include non-availability, inexperience, lack of skilled personnel, and poor attitude. Conclusion: There was a good level of utilisation of the Non-Pneumatic Anti-Shock Garment for the management of postpartum haemorrhage, but only a few of the midwives were able to correctly describe it and not all were using it. Hence, refresher courses are hereby advocated to further improve NASG usage.

Applying the RE-AIM framework in a process evaluation of the introduction of the Non-Pneumatic Anti-Shock Garment in a rural district of Zimbabwe.

The Non-Pneumatic Anti-Shock Garment (NASG) is a first aid tool that can halt and reverse hypovolemic shock secondary to obstetric hemorrhage. The World Health Organization recommended the NASG for use as a temporizing measure in 2012, but uptake of the recommendation has been slow, partially because operational experience is limited. The study is a process evaluation of the introduction of NASG in a public sector health facility network in rural Zimbabwe utilizing an adapted RE-AIM, categorizing observations into the domains of: reach, effectiveness, adoption, implementation and maintenance. The location of the study was Hurungwe district, where staff members of 34 health facilities at primary (31), secondary (2) and tertiary (1) levels of care participated. We found that all facilities became skilled in using the NASG, and that the NASG was used in 10 of 11 instances of severe hemorrhage. In the cases of hypovolemic shock where the NASG was used, there were no maternal deaths and no extreme adverse outcomes related to obstetric hemorrhage in the study period. Among the 10 NASG uses, the garment was used correctly in each case. Fidelity to processes was high, especially in regard to training and cascading skills, but revisions of the NASG rotation and replacement operating procedures were required to keep clean garments stocked. Clinical documentation was also a key challenge. NASG introduction dovetailed very well with pre-existing systems for obstetric emergency response, and improved clinical outcomes. Scale-up of the NASG in the Zimbabwean public health system can be undertaken with careful attention to mentorship, drills, documentation and logistics.

Utilization of Non-pneumatic Anti-shock Garment and Associated Factors among Health Care Professionals at Public Hospitals of Addis Ababa, Ethiopia, 2021

Background: Non-pneumatic anti-shock garments (NASGs) are simple systems that use lower body counter pressure to reverse hypovolemic shock and reduce blood loss caused by obstetric hemorrhage. Each year, obstetric hemorrhage (OH) causes more than a quarter of all maternal deaths worldwide. One of these promising advances is the use of non-pneumatic anti-shock garments (NASGs). Despite this, NASG treatment is only used in a few cases to prevent postpartum hemorrhage, save the mother’s life, and studies on its utilization and associated factors are not widely available. Objective: To assess the utilization of non-pneumatic anti-shock garments and associated factors among health care professionals at public hospitals in Addis Ababa, Ethiopia 2021. Method: An institution-based cross-sectional study design and quantitative data collection methods were conducted from March 31 to April 15/2021. A total of 388 randomly selected healthcare professionals working in the maternity health care unit at a public hospital in Addis Ababa were included. The data were cleaned and coded then entered into EPI data version 3 and exported to SPSS version 25 for further analysis. Logistic regression was used to identify factors associated with NASG utilization. Variables were first analyzed with Bivariate (p<0.2) and then multivariate logic regression model and considered statistically significant at a P-value of <0.05. The adjusted odds ratio with a 95% CI interval was used to determine the degree and direction of the association between covariates and the outcome variable. Results: A total of 377 (97.1%) health professionals participated in this study. In this study, the prevalence of NASG Utilization was 39.3% which was low. The study indicated that the female participant were 3 times more likely to use NASG 2.568 (1.198-5.502), being (General Practitioner) 88% less likely than midwives AOR=.95% CI. 122 (.025-.705), being not trained on non-pneumatic anti-shock garments, Not aware of the existence of the NASG in the facility, and the lack of non-pneumatic anti-shock garments have a positive association. Conclusion and Recommendation: There was a lower rate of NASG utilization (39.3%) among healthcare professionals for the management of obstetric hemorrhage. Training and increasing the availability of NASG are important.

Clinical study of Non-pneumatic anti shock garment (NASG) in patients with post-partum haemorrhage at a tertiary hospital

Clinical study of Non-pneumatic anti shock garment (NASG) in patients with post-partum haemorrhage at a tertiary hospital

Utilization Rate and Factors Associated with Non-Utilization of Non-Pneumatic Anti-Shock Garment in the Management of Obstetric Hemorrhage in Public Health Care Facilities of Northern Ethiopia: A Cross-Sectional Study.

BackgroundObstetric hemorrhage (OH) causes more than 25% of the maternal deaths across the world annually. A significant number of these deaths can essentially be prevented with a skilled birth attendant and having all-inclusive emergency obstetric care technologies. One of these promising technologies is to utilize non-pneumatic anti-shock garment (NASG). Despite this fact, there are limited studies on the utilization of NASG in Ethiopia.ObjectiveThe aim of this study was to assess the utilization rate and factors associated with non-utilization of NASG in the management of obstetric hemorrhage in public healthcare facilities of Northern Ethiopia.MethodsAn institution-based cross-sectional study was conducted from December 2017 to February 2018 involving 338 randomly selected healthcare providers working in the maternity healthcare facilities. Data were collected using pre-tested and self-administered questionnaires. Data were entered and analyzed using STATA version 14.0 statistical software package. The result was displayed using descriptive, bivariate, and multivariable logistic regression analysis to identify independent predictors of non-utilization of NASG at a P-value≤0.05.ResultsAbout 121 (35.80%; 95% CI=30.68–41.16%) of the health workers did not utilize NASG, and 217 (64.20%; 95% CI=58.84–69.32%) utilized NASG. Being females, with adjusted odds ratio (AOR)=2.21 (95% CI=1.06–4.63), use of NASG in previous works to manage OH, with AOR=0.1 (95% CI=0.02–0.48), having perceived skill to use the garment in the facility, with AOR=0.10 (95% CI=0.01–0.79), were significantly associated with the non-utilization of NASG.ConclusionThere was a lower rate of NASG utilization among the healthcare providers for the management of obstetric hemorrhage. Being a male care provider, having no experience of using NASG to manage PPH, and having perceived skill to use the garment in the healthcare facility were significantly associated factors for the non-utilization of the NASG. Due emphasis should be given to the utilization of NASG to manage obstetric hemorrhage by addressing the identified modifiable factors for non-utilization of NASG by healthcare workers.

Knowledge and utilization of non-pneumatic anti-shock garment for the management of postpartum hemorrhage among Midwives in government hospitals in Ogun State, Nigeria

Objective: To assess the knowledge and determine the level of utilization of Non-Pneumatic Anti-Shock Garment (NASG) for the management of PPH among Midwives. Method: The study employed a descriptive cross-sectional study design, using a validated self-administered questionnaire. A total of 198 randomly selected midwives across three health facilities in Ogun State participated in the study. A 10-point knowledge scale was used to assess the knowledge of midwives on NASG. Descriptive statistics were used to determine the level of utilization of NASG among midwives, while Chi-square statistics were used to determine the relationship between the dependent and independent variables of interest at p&lt;0.05 level of significance. Results: Most (88.9%) of the respondents were female with a mean age of 40.2±5.6years. Most (48.5%) had a BNS degree. The majority (74.7%) of the respondents were aware of NASG. Close to a half (49.3%) of the respondents had fair knowledge scores, 34.5% had good knowledge scores, while 16.2% had poor knowledge scores. Only 22.7% of the respondents had ever used NASG in the management of PPH; 77.3% never used it before. Also, 67.2% of the respondents reported NASG was not available in their facilities. There was a significant influence of knowledge of NASG on the utilization among midwives (X2=37.151, P&lt;0.05, df=2). Conclusion: This study demonstrated that midwives in healthcare facilities were aware, but did not have good knowledge of NASG. The utilization of the garment for the management of PPH was also very poor, probably due to suboptimal knowledge and non-availability of the garment.

Cost-effectiveness of postpartum haemorrhage first response bundle and non-surgical interventions for refractory postpartum haemorrhage in India: an ex-ante modelling study

BackgroundPostpartum haemorrhage (PPH) is the leading cause of maternal mortality worldwide and India accounts for approximately 19% of global maternal deaths, with PPH as the leading cause. In recent years, care bundles have been shown to increase adherence to clinical guidelines and improve patient outcomes. The objective of this study was to develop a PPH cost-effectiveness model to estimate the potential health impact and cost-effectiveness of a quality improvement programme for PPH management featuring a first response bundle and a set of refractory PPH interventions in health facilities in Uttar Pradesh, India. MethodsWe used a decision tree model to compare the status quo delivery of PPH care in Uttar Pradesh with two scenarios in which recommended bundles for PPH management were optimally applied. Status quo PPH care includes intravenous fluids, uterotonics, and uterine massage delivered with a setting-specific probability that increases with the level of health facility. In the strengthened PPH care scenario, status quo interventions are combined with tranexamic acid in a first response bundle which is used in all PPH cases, plus manual placenta removal and suturing when indicated. In the enhanced PPH care scenario, PPH care is further enhanced through implementation of non-surgical interventions for managing refractory PPH (including uterine balloon tamponade, aortic compression, and non-pneumatic anti-shock garment). For each scenario, we conducted a Monte Carlo simulation of cohorts of 1 million women delivering at home, subcentres, primary-health clinics, community-health centres, and district hospitals. The results were scaled to represent the annual number of deliveries in Uttar Pradesh and their distribution across health facilities. The main outcomes were PPH cases, PPH deaths, and PPH surgical procedures. FindingsCompared with status quo, perfect implementation of enhanced PPH care was predicted to reduce PPH-related maternal mortality in intervention facilities by 98%, from 10·7 to 0·3 per 100 000 deliveries, averting 450 deaths per year in Uttar Pradesh. Although enhanced PPH care would increase annual costs associated with the active management of the third stage of labour and non-surgical PPH management by US$190 000 and $300 000, respectively, service delivery costs were reduced by $1·42 million per year. Strengthened PPH care was predicted to prevent PPH deaths and reduce service delivery costs compared with status quo, but to have only 66% of the health impact and 63% of the cost-savings compared with enhanced PPH care. The upfront programme implementation costs and persistence of change in PPH management after implementation are uncertain. If enhanced PPH care were implemented with up to $2300 per facility, and the change in PPH management persisted for at least 2 years, the programme is estimated to be cost-effective (<0·5 GDP per capita per life year gained). InterpretationImplementation of an enhanced PPH care programme, including the first response bundle and non-surgical refractory PPH interventions, is likely to be cost-effective and life-saving in Uttar Pradesh, India. Moreover, enhanced PPH care is likely to generate more health impact and cost-savings compared with strengthened PPH care because of the greater reduction in number of surgeries needed. FundingBill & Melinda Gates Foundation

Utilization of non-pneumatic anti-shock garment and associated factors for postpartum hemorrhage management among health care professionals\u2019 in public hospitals of Jimma zone, south-West Ethiopia, 2019

BackgroundNon- pneumatic anti-shock garment is a unique, life -saving first -aid device made of neoprene and velcro, which is used for treatment of women with postpartum hemorrhage. Maternal mortality in the world still very high and postpartum hemorrhage is the leading cause of maternal mortality worldwide.ObjectiveThis study was aimed to assess the utilization of non-pneumatic anti-shock garment and associated factors for postpartum hemorrhage management.MethodsFacility based cross-sectional studies design both quantitative and qualitative data collection methods were employed among 210 health care professionals and 10 key informants respectively. Bivariable and multivariable logistic regression was done to identify factors associated with non-pneumatic anti-shock garment utilization. Qualitative data was transcribed, translated and triangulated with quantitative findings.ResultsSeventy six (36.2%) of the respondents used non-pneumatic anti-shock garment in their hospitals for management of post-partum hemorrhage. Having good knowledge [(AOR = 3.96, 95% CI: (1.67, 9.407)], having positive attitude [(AOR = 3.54, 95% CI: (1.37, 9.13)], attending training [AOR = 13.156, 95% CI: (4.81, 36.00], having two and above non-pneumatic anti-shock garment at their hospitals [AOR = 8.7, 95% CI: (2.89, 26.20)] were significantly associated with utilization of non-pneumatic anti-shock garment. … “I didn’t use non-pneumatic anti-shock garment for the management of postpartum hemorrhage complication before because I have no training and experience how to use it.”ConclusionThe utilization of non-pneumatic anti-shock garment for the management of postpartum hemorrhage was low. Having positive attitude, having good knowledge and training on non-pneumatic anti-shock garment were statically associated with its use. The health care professionals that involved in the maternity service should be trained on how to use this important garment in the management of postpartum hemorrhage.

Differences in Life‐Saving Obstetric Hemorrhage Treatments for Women with Abortion Versus Nonabortion Etiologies in Tanzania

Complications from unsafe abortion are among the major causes of preventable maternal morbidity and mortality, which may be compounded by delays and disparities in treatment. We conducted a secondary analysis of women with symptoms of hypovolemic shock secondary to severe obstetric hemorrhage in Tanzania. We compared receipt of three lifesaving interventions among women with abortions versus other maternal hemorrhage etiologies. Interventions included: non-pneumatic anti-shock garment (NASG) (N = 393), blood transfusion (N = 249), and referral to a higher-capacity facility (N = 131). After controlling for severity of disease and other confounders, women with abortion-related hemorrhage and shock had 78percent decreased odds of receiving NASG (p < 0.001) and 77percent decreased odds of receiving a blood transfusion (p < 0.001) compared to women with hemorrhage and shock from other etiologies. Our findings suggest that, in Tanzania, women with abortion-related hemorrhage received lower quality of care than women with other hemorrhage etiologies.

Application of Non Pneumatic Anti- Shock Garment (NASG) in 100 patients of postpartum haemorrhage: analysis of causes, management and outcome in a tertiary centre of south Rajasthan

Application of Non Pneumatic Anti- Shock Garment (NASG) in 100 patients of postpartum haemorrhage: analysis of causes, management and outcome in a tertiary centre of south Rajasthan