title: An inexpensive device to treat postpartum hemorrhage: a preliminary proof of concept study of health provider opinion and training in Nepal.
abstract: BACKGROUND
  Obstetric hemorrhage remains the leading cause of maternal mortality in resource limited areas. An inexpensive pneumatic anti-shock garment was devised of bicycle tubes and tailored cloth which can be prepared from local materials in resource-limited settings. The main purposes of this study were: 1) to determine acceptability of the device by nurses and midwives and obtain suggestions for making the device more suitable for use in their particular work environments, 2) to determine whether a three hour training course provided adequate instruction in the use of this device for the application of circumferential abdominal pelvic pressure, and 3) determine production capability and cost in a resource-limited country.
  
  
  METHODS
  Fifty-eight nurse and midwife participants took part in three sessions over eight months in Nepal. Correct device placement was assessed on non-pregnant participants using ultrasound measurement of distal aortic flow before and after device inflation, and analyzed using confidence intervals. Participants were surveyed to determine acceptability of the device, obtain suggestions for improvement, and to collect data on clinical use.
  
  
  RESULTS
  Device placement achieved flow decreases with a mean of 39% (95% CI 25%-53%, p < 0.001) in the first session, 28% (95% CI 21%-33%, P < 0.001) after four months and 29% (95% CI 24%-34%, p < 0.001) at 8 months. All nurses and midwives thought the device would be acceptable for use in obstetric hemorrhage and that they could make, clean, and apply it. They quickly learned to apply the device, remembered how to apply it, and were willing and able to use the device clinically. Ten providers used the device, each on one patient, to treat obstetric hemorrhage after routine measures had failed; bleeding stopped promptly in all ten, two of whom were transported to the hospital. Production of devices in Kathmandu using local tailors and supplies cost approximately $40 per device, in a limited production setting.
  
  
  CONCLUSIONS
  Preliminary data suggest that an inexpensive, easily-made device is potentially an appropriate addition to current obstetric hemorrhage treatment in resource-limited areas and that further study is warranted.
authors.forename: Nancy L
authors.initials: NL
authors.lastname: Kerr
authors.affiliation: Department of Emergency Medicine, University of New Mexico, MSC 11 6025, 1 University of New Mexico, Mexico 87131, USA. mhauswald@salud.unm.edu.
authors.forename: Mark
authors.initials: M
authors.lastname: Hauswald
authors.forename: Suman Raj
authors.initials: SR
authors.lastname: Tamrakar
authors.forename: David A
authors.initials: DA
authors.lastname: Wachter
authors.forename: Gillian M
authors.initials: GM
authors.lastname: Baty
mesh_terms: D003362:Cost-Benefit Analysis; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D006282:Health Personnel / Q000193:education*; D006489:Hemostatic Techniques / Q000191:economics / Q000295:instrumentation*; D006801:Humans; D008880:Midwifery / Q000193:education*; D009390:Nepal; D006473:Postpartum Hemorrhage / Q000628:therapy*; D011247:Pregnancy; D012189:Retrospective Studies