153348 Overcoming delays in childbirth due to hemorrhage: A qualitative study of the Non-pneumatic Anti-Shock Garment (NASG) in Nigeria

Monday, November 5, 2007: 8:30 PM

Adeoti Oshinowo , School of Medicine, Stanford University, Stanford, CA
Hadiza Galadanci, MD , Obstetrics and Gynecology, Aminu Kano Teaching Hospital, Kano, Nigeria
Mohammed Awwal, MD , Obstetrics and Gynecology, Murtallah Mohamed Speciality Hospital, Kano, Nigeria
Oladosu Ojengbede, MD , Obstetrics and Gynecology, University College Hospital, Ibadan, Nigeria
Lyndsay McDonough, MPH , School of Public Health, Tulane University, New Orleans, LA
Elizabeth Butrick, MPH, MSW , Obstetrics, Gynecology and Reproductive Sciences, Univeristy of California, San Francisco, San Francisco, CA
Suellen Miller, PhD, CNM , OB/GYN and Reproductive Sciences, University of California, San Francisco, San Francisco, CA
Background: Obstetric hemorrhage (OH) is the leading cause of maternal mortality due to delays in obtaining Emergency Obstetric Care. Women die during transports to facilities or while awaiting appropriate care in facilities. One strategy for decreasing MMR from OH is a first aid device, the Non-pneumatic Anti-Shock Garment (NASG), a low technology compression suit. The NASG is being pilot tested in Kano, Nigeria.

Objectives: To understand provider, patient and family perceptions of the NASG in order to enhance its acceptability and decrease delays in application.

Methods: 10 focus groups of 134 health care providers (doctors, nurse-midwives, nurses, and staff) and 6 in-depth, individual interviews of patients who survived severe OH and shock and/or their family members, were conducted and analyzed using grounded theory.

Results and conclusions: Providers agreed that the NASG was easy to use, improved management of OH, but was difficult to fold correctly, and was not always the first thing providers would think of to apply in frantic emergency situations. Patients generally accept the NASG, but those who received less information about it before it was applied (they were unconscious at the time of application) who wake up in it are confused and uncomfortable with it; some try to remove it. There are clear policy implications from this study. As a new device, more training in pre-service education may help incorporate the NASG into providers' emergency response algorithm. Ante-natal and community education activities may help women and family members learn about the NASG as a life-saving device, not something to fear.

Learning Objectives:
Learning objectives: 1. Recognize obstacles to implementing a new technology to reduce maternal mortality associated with obstetric hemorrhage in Nigeria. 2. List training methods that will enhance providers incorporating a new technology into their emergency response algorithm. 3. List community outreach activities that can be conducted to improve families understanding of a new device to keep women alive during transport to emergency obstetrical care.

Keywords: Intervention, Patient Perspective

Presenting author's disclosure statement:

Any relevant financial relationships? No
Any institutionally-contracted trials related to this submission?

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.