157072 A new tool for saving women's lives in Nigeria: The potential of the Non-pneumatic Anti-Shock Garment (NASG)

Monday, November 5, 2007: 8:50 PM

Janet Turan, PhD, MPH , Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, CA
Suellen Miller, PhD, CNM , OB/GYN and Reproductive Sciences, University of California, San Francisco, San Francisco, CA
Elizabeth Butrick, MPH, MSW , Obstetrics, Gynecology and Reproductive Sciences, Univeristy of California, San Francisco, San Francisco, CA
Oladosu Ojengbede, MD , Obstetrics and Gynecology, University College Hospital, Ibadan, Nigeria
I. Oludare Morhason Bello, MD , Obstetrics and Gynecology, University College Hospital, Ibadan, Nigeria
Mohammed Awwal, MD , Obstetrics and Gynecology, Murtallah Mohamed Speciality Hospital, Kano, Nigeria
Hadiza Galadanci, MD , Obstetrics and Gynecology, Aminu Kano Teaching Hospital, Kano, Nigeria
Aminu Isyaku Mohammed, MD , Obstetrics and Gynecology, Aminu Kano Teaching Hospital, Kano, Nigeria
Titi Aina, MD , Obstetrics and Gynecology, University College Hospital, Ibadan, Nigeria
Akin Akinwuntan, MD , Obstetrics and Gynecology, University College Hospital, Ibadan, Nigeria
Hilarie Martin , OB/GYN and Reproductive Sciences, University of California, San Francisco, San Francisco, CA
Obstetric hemorrhage is a major cause of maternal death and disability in Nigeria. We are conducting a pilot project on use of the non-pneumatic anti-shock garment (NASG) for saving women's lives. Findings will inform a national scale-up of this intervention. This analysis of pre-post data from six hospitals was conducted to examine the effects of NASG use on blood loss, acute morbidity, and mortality in women with hypovolemic shock due to obstetric hemorrhage (N=188).

During the pre-intervention period, all eligible women received standard treatment (n=99); during the intervention, women received standard treatment plus the NASG. Women in the NASG group tended to be in worse condition initially, with significantly higher estimated initial blood loss and a higher proportion with very poor vital signs (23.2% pre versus 55.7% NASG, 2=20,72, p=.000). Despite this, outcomes were better for women in the NASG group. They had significantly less blood loss after study admission (median 230 mL versus 600 mL, median difference -400 mL, 95% CI -250 - -520), and 86% fewer mortalities (2=4.13, p=.067). Among survivors, three women in the pre group and one woman in the NASG group experienced acute morbidity.

These results suggest that the NASG may make an important contribution to reducing maternal mortality and morbidity from obstetric hemorrhage in low-resource settings. Besides directly saving lives, we anticipate that the NASG scale-up process will serve as a focal point for safe motherhood activities in Nigeria and will be an agenda-setting device for promoting global political priority for safe motherhood.

Learning Objectives:
By the end of this session, participants should be able to: Describe the importance of obstetric hemorrhage as a cause of maternal mortality and morbidity in low-resource settings. Identify the potential contribution of the non-pneumatic anti-shock garment (NASG) to reducing death and disability from obstetric hemorrhage. Explain how the NASG project will promote political priority for safe motherhood in Nigeria.

Keywords: Safe Mother Program, International MCH

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.