title: Positive effects of the non-pneumatic anti-shock garment on delays in accessing care for postpartum and postabortion hemorrhage in Egypt and Nigeria.
abstract: BACKGROUND
  We examined whether the non-pneumatic anti-shock garment (NASG) ameliorates the effects of delays in transport to and treatment at hospitals for women with postpartum hemorrhage (PPH) and postabortion hemorrhage (PAH) and investigated the effects of NASG use on timing of delivery of interventions in-hospital.
  
  
  METHODS
  Pre/post studies of the NASG were conducted at hospitals in Cairo (n = 349 women), Assuit (n = 274), Southern Nigeria (n = 57), and Northern Nigeria (n = 124). In post-hoc analyses, comparisons of delays were conducted using analysis of variance (ANOVA), and associations of delays with extreme adverse outcomes (EAO, mortality or severe morbidity) were examined using chi-square tests, odds ratios (ORs), and multivariate logistic regression.
  
  
  RESULTS
  Median minutes from hemorrhage start to study admission differed by site, ranging from 15 minutes in Cairo to 225 minutes in Northern Nigeria (p < 0.001). Median minutes from study admission to blood transfusion ranged from 30 minutes in Cairo to 209 minutes in Southern Nigeria (p < 0.001). Twenty percent of women with ≥60 minutes between hemorrhage start and study admission experienced an EAO without the NASG compared with only 6% with the NASG (χ(2) = 13.71, p < 0.001). In-hospital delays in receiving intravenous (IV) fluids and blood were more common in the NASG phase.
  
  
  CONCLUSIONS
  Women with PPH or PAH in Egypt and Nigeria often face delays in reaching emergency obstetrical care facilities and delays in receiving definitive therapies after arrival. Our results indicate that the NASG can reduce the impact of these delays. Stabilization does not replace treatment, however, and delays in fluid/blood administration with NASG use must be avoided.
authors.affiliation: University of California San Francisco, San Francisco, CA 94105, USA. janet.turan@ucsf.edu
authors.forename: Janet
authors.initials: J
authors.lastname: Turan
authors.forename: Oladosu
authors.initials: O
authors.lastname: Ojengbede
authors.forename: Mohamed
authors.initials: M
authors.lastname: Fathalla
authors.forename: Mohammed
authors.initials: M
authors.lastname: Mourad-Youssif
authors.forename: Imran O
authors.initials: IO
authors.lastname: Morhason-Bello
authors.forename: David
authors.initials: D
authors.lastname: Nsima
authors.forename: Jessica
authors.initials: J
authors.lastname: Morris
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Butrick
authors.forename: Hilarie
authors.initials: H
authors.lastname: Martin
authors.forename: Carol
authors.initials: C
authors.lastname: Camlin
authors.forename: Suellen
authors.initials: S
authors.lastname: Miller
mesh_terms: D000328:Adult; D001794:Blood Pressure / Q000502:physiology; D001803:Blood Transfusion / Q000592:standards; D004534:Egypt; D005260:Female; D005865:Gestational Age; D006297:Health Services Accessibility / Q000592:standards*; D006801:Humans; D009549:Nigeria; D007744:Obstetric Labor Complications / Q000517:prevention & control / Q000628:therapy; D009774:Obstetrics; D010298:Parity; D010343:Patient Admission / Q000592:standards; D010360:Patient Transfer; D006473:Postpartum Hemorrhage / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control / Q000628:therapy*; D011247:Pregnancy; D011481:Protective Clothing / Q000706:statistics & numerical data*; D012771:Shock, Hemorrhagic / Q000150:complications* / Q000453:epidemiology; D013997:Time Factors