title: A low-cost simulator for learning to manage postpartum hemorrhage in rural Africa.
abstract: BACKGROUND
  Postpartum hemorrhage (PPH) is the leading cause of maternal mortality in Africa and Asia. Despite an UN Millennium Development Goal to reduce maternal mortality rates, no significant effect has resulted to date, in large part because women in these areas give birth in rural communities with poor access to definitive care. Traditional birth attendants (TBAs) provide care for delivering mothers; however, they are neither trained nor equipped to recognize or manage PPH as a life-threatening emergent condition. The purpose of this study was to design and evaluate a low-cost, portable simulator for training TBAs and nurse midwives in the use of bimanual compression to manage PPH.
  
  
  METHODS
  Clinicians in USA and Ghana were consulted to develop the engineering specifications, including low cost, long lifetime, easy to use, portable, and high anatomic and procedural fidelity. Pugh charts were used to finalize the design from multiple concepts. The simulator was built and evaluated for validity by American and Ghanaian obstetricians, nurse midwives, midwifery students, and TBAs. The feasibility of the simulator for training illiterate learners was also assessed.
  
  
  RESULTS
  The simulator was evaluated to be an effective training platform with excellent fidelity and valid feedback mechanisms. It was demonstrated to be a feasible platform for training illiterate TBAs to perform bimanual compression.
  
  
  CONCLUSIONS
  The low cost, portable simulator developed for this project has the potential to reduce maternal mortality from PPH in the developing world. Research is ongoing in this application.
authors.affiliation: University of Michigan, Ann Arbor, MI 48109-5201, USA.
authors.forename: Joseph
authors.initials: J
authors.lastname: Perosky
authors.forename: Randolph
authors.initials: R
authors.lastname: Richter
authors.forename: Ofra
authors.initials: O
authors.lastname: Rybak
authors.forename: Florence
authors.initials: F
authors.lastname: Gans-Larty
authors.forename: Mabel Adu
authors.initials: MA
authors.lastname: Mensah
authors.forename: Abraham
authors.initials: A
authors.lastname: Danquah
authors.forename: Domitilla
authors.initials: D
authors.lastname: Debpuur
authors.forename: David
authors.initials: D
authors.lastname: Kolbilla
authors.forename: Anthony
authors.initials: A
authors.lastname: Ofosu
authors.forename: Frank
authors.initials: F
authors.lastname: Anderson
authors.forename: David
authors.initials: D
authors.lastname: Marzano
authors.forename: Pamela
authors.initials: P
authors.lastname: Andreatta
mesh_terms: D000349:Africa; D006801:Humans; D008348:Manikins; D008880:Midwifery / Q000193:education*; D006473:Postpartum Hemorrhage / Q000628:therapy*; D012424:Rural Population