Acceptance of a New Technology for Management of Obstetric Hemorrhage: A Qualitative Study From Rural Mexico

Berdichevsky, Karla; Tucker, Christine; Martínez, A M; Miller, Suellen

doi:10.1080/07399330903518491

Cited by 7 publications

(3 citation statements)

References 18 publications

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“…Consistent with previous work on the NASG and new technology introduction, this paper finds that its use is influenced by the setting and backgrounds of the providers involved. We found that initial resistance to the NASG was usually overcome through trainings and after witnessing real cases with the NASG, similar to what Berdichevsky et al term “doubting” [ 29 ].…”

Section: Discussionsupporting

confidence: 68%

Barriers and Facilitators to Scaling Up the Non-Pneumatic Anti-Shock Garment for Treating Obstetric Hemorrhage: A Qualitative Study

et al. 2016

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BackgroundObstetric hemorrhage (OH), which includes hemorrhage from multiple etiologies during pregnancy, childbirth, or postpartum, is the leading cause of maternal mortality and accounts for one-quarter of global maternal deaths. The Non-pneumatic Anti-Shock Garment (NASG) is a first-aid device for obstetric hemorrhage that can be applied for post-partum/post miscarriage and for ectopic pregnancies to buy time for a woman to reach a health care facility for definitive treatment. Despite successful field trials, and endorsement by safe motherhood organizations and the World Health Organization (WHO), scale-up has been slow in some countries. This qualitative study explores contextual factors affecting uptake.MethodsFrom March 2013 to April 2013, we conducted 13 key informant interviews across four countries with a large burden of maternal mortality that had achieved varying success in scaling up the NASG: Ethiopia, India, Nigeria, and Zimbabwe. These key informants were health providers or program specialists working with the NASG. We applied a health policy analysis framework to organize the results. The framework has five domains: attributes of the intervention, attributes of the implementers, delivery strategy, attributes of the adopting community, the socio-political context, and the research context.ResultsThe interviews from our study found that relevant facilitators for scale-up are the simplicity of the device, local and international champions, well-developed training sessions, recommendations by WHO and the International Federation of Gynecology and Obstetrics, and dissemination of NASG clinical trial results. Barriers to scaling up the NASG included limited health infrastructure, relatively high upfront cost of the NASG, initial resistance by providers and policy makers, lack of in-country champions or policy makers advocating for NASG implementation, inadequate return and exchange programs, and lack of political will.ConclusionsThere was a continuum of uptake ranging in both speed and scale. Ethiopia while not the first country to use the NASG has the most rapid scale-up, followed by Nigeria, then India, and finally Zimbabwe. Increasing the coverage of the NASG will require collaboration with local NASG champions, greater NASG awareness among clinicians and policymakers, as well as stronger political will and advocacy.

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Section: Discussionsupporting

confidence: 68%

Barriers and Facilitators to Scaling Up the Non-Pneumatic Anti-Shock Garment for Treating Obstetric Hemorrhage: A Qualitative Study

et al. 2016

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“…We believe some of this variation may have been due to differences in health-care provider beliefs and practices. One previous qualitative study in Mexico demonstrated varying levels of NASG acceptance among health-care providers ranging from complete acceptance and utilization to total rejection in which providers were unwilling to use the device (Berdichevsky et al 2010). Further, while there is little information available regarding specific demographic characteristics of the four regions involved, differences in literacy and education, population growth, economic activity, culture, religion, and education could impact abortion stigma among providers and the quality of care received by women with abortion-related hemorrhage.…”

Section: Discussionmentioning

confidence: 99%

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

Smith¹,

Therrien²,

Harley³

et al. 2019

Studies in Family Planning

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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 abortionrelated hemorrhage and shock had 78 percent decreased odds of receiving NASG (p < 0.001) and 77 percent 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 abortionrelated hemorrhage received lower quality of care than women with other hemorrhage etiologies.

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“…In five quasi-experimental, non-randomized studies, NASG intervention at tertiary facilities was associated with reduced odds of death for women with hypovolemic shock secondary to obstetric hemorrhage [ 10 ]. Lastly a qualitative study in rural areas in Mexico suggested positive responses on acceptability of health personel to NASG [ 11 ]. Fostered by the observational trends of effect on NASG use for improving maternal health conditions.…”

Section: Introductionmentioning

confidence: 99%

Non-pneumatic anti-shock garment for improving maternal survival following severe postpartum haemorrhage: a systematic review

et al. 2015

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IntroductionWomen with postpartum haemorrhage (PPH) in developing countries often present in critical condition when treatment might be insufficient to save lives. Few studies have shown that application of non-pneumatic anti-shock garment (NASG) could improve maternal survival.MethodsA systematic review of the literature explored the effect of NASG use compared with standard care for treating PPH. Medline, EMBASE and PubMed were searched. Methodological quality was assessed following the criteria suggested by the Cochrane Effective Practice and Organization of Care Group. Guidelines on Meta-analysis of Observational Studies in Epidemiology were used for reporting the results. Mantel-Haenszel methods for meta-analysis of risk ratios were used.ResultsSix out 31 studies met the inclusion criteria; only one cluster randomized controlled trial (c-RCT). Among observational studies, NASG fared better than standard care regarding maternal mortality reduction (Relative Risk (RR) 0.52 (95% Confidence interval (CI) 0.36 to 0.77)). A non-significant reduction of maternal mortality risk was observed in the c-RCT (RR: 0.43 (95% CI: 0.14 to 1.33)). No difference was observed between NASG use and standard care on use of blood products. Severe maternal outcomes were used as proxy for maternal death with similar pattern corroborating the trend towards beneficial effects associated with NASG.ConclusionNASG is a temporizing alternative measure in PPH management that shows a trend to reduce PPH-related deaths and severe morbidities. In settings where delays in PPH management are common, particularly where constraints to offer blood products and definitive treatment exist, use of NASG is an intervention that should be considered as a policy option while the standard conditions for care are being optimized.

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Acceptance of a New Technology for Management of Obstetric Hemorrhage: A Qualitative Study From Rural Mexico

Cited by 7 publications

References 18 publications

Barriers and Facilitators to Scaling Up the Non-Pneumatic Anti-Shock Garment for Treating Obstetric Hemorrhage: A Qualitative Study

Barriers and Facilitators to Scaling Up the Non-Pneumatic Anti-Shock Garment for Treating Obstetric Hemorrhage: A Qualitative Study

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

Non-pneumatic anti-shock garment for improving maternal survival following severe postpartum haemorrhage: a systematic review

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