title: Use of uterine balloon tamponade for control of postpartum hemorrhage by community-based health providers in South Sudan.
abstract: OBJECTIVE
  To determine whether use of uterine balloon tamponade (UBT) for management of uncontrolled postpartum hemorrhage (PPH) by community-based providers in a resource-limited setting could be feasible, effective, and safe.
  
  
  METHODS
  In rural South Sudan, community providers were trained and equipped with a simple UBT device consisting of a catheter, condom, and syringe. Snowball sampling identified cases of UBT use since training. Semi-structured interviews were conducted among community providers, referral facility providers, patients, and patient family members. Interview transcripts were analyzed using qualitative methods.
  
  
  RESULTS
  Thirteen cases were identified and 24 interviews related to community-based UBT use were conducted. Qualitative analysis revealed several major themes. Community providers applied UBT in appropriate clinical situations. UBT was effective for controlling PPH, even among severely ill patients. Referral was difficult and lengthy owing to the austere setting, but simple UBT appeared to mitigate these challenges. Communities had some initial fears, yet ultimately embraced UBT. Equipment and supplies were largely maintained. There was universal satisfaction with UBT among patients, family members, and providers. One death occurred among the 13 cases, although it was probably not attributable to PPH.
  
  
  CONCLUSIONS
  Training and UBT device provision are simple, affordable, and effective for managing uncontrolled PPH in a resource-limited setting.
authors.affiliation: Division of Global Health and Human Rights, Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA 02114, USA. brett.d.nelson@gmail.com
authors.forename: Brett D
authors.initials: BD
authors.lastname: Nelson
authors.forename: Hanni
authors.initials: H
authors.lastname: Stoklosa
authors.forename: Roy
authors.initials: R
authors.lastname: Ahn
authors.forename: Melody J
authors.initials: MJ
authors.lastname: Eckardt
authors.forename: Emily K
authors.initials: EK
authors.lastname: Walton
authors.forename: Thomas F
authors.initials: TF
authors.lastname: Burke
mesh_terms: D003153:Community Health Services / Q000191:economics / Q000379:methods*; D003906:Developing Countries; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007407:Interviews as Topic; D017060:Patient Satisfaction; D006473:Postpartum Hemorrhage / Q000503:physiopathology / Q000628:therapy*; D011247:Pregnancy; D012017:Referral and Consultation; D012720:Severity of Illness Index; D013397:Sudan; D013997:Time Factors; D016896:Treatment Outcome; D058738:Uterine Balloon Tamponade / Q000009:adverse effects / Q000191:economics / Q000379:methods*