Provider experiences with uterine balloon tamponade for uncontrolled postpartum hemorrhage in health facilities in Kenya.
OBJECTIVE
To understand provider perceptions and experiences following training in the use of a condom-catheter uterine balloon tamponade (UBT) as second-line treatment for uncontrolled postpartum hemorrhage (PPH) in health facilities in Kenya.


METHODS
As part of a qualitative study, interviews of facility-based providers who had managed PPH following comprehensive PPH training were conducted between February and April 2014. Facilities were purposively sampled to represent a range of experience with UBT, facility size, and geography. Interviews continued until thematic saturation was achieved. Interview transcripts were analyzed for themes.


RESULTS
Overall, 68 providers from 29 facilities were interviewed, of whom 31 reported experience with UBT placement (25 midwives, 2 clinical officers, 4 medical officers). Qualitative analysis revealed several major themes. Providers used UBT appropriately within the PPH algorithm, although the timing and clinical severity of patients varied. UBT was most commonly used when bleeding was unresponsive to uterotonics, hysterectomy was unavailable, and referral times long. Providers reported that bleeding was arrested following UBT use in all except one patient, who had a suspected coagulopathy. Most providers described UBT as technically easy to use, although three described initial balloon displacement.


CONCLUSIONS
UBT has been readily accepted by providers at all levels of training and is being incorporated into the existing PPH management algorithm in Kenya.
Division of Global Health and Human Rights, Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA. Electronic address: abirami_natarajan@hms.harvard.edu.
Abirami
A
Natarajan
Division of Global Health and Human Rights, Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA.
Jean
J
Chavez
Division of Global Health and Human Rights, Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
Roy
R
Ahn
Division of Global Health and Human Rights, Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
Brett D
BD
Nelson
Division of Global Health and Human Rights, Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA.
Melody
M
Eckardt
Kenya Medical and Education Trust, Kisumu, Kenya.
Liddy
L
Dulo
Kenya Medical and Education Trust, Kisumu, Kenya.
Emmaculate
E
Achieng
Kenya Medical and Education Trust, Kisumu, Kenya.
Monica
M
Oguttu
Division of Global Health and Human Rights, Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA.
Kristina
K
Tester
Division of Global Health and Human Rights, Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
Thomas F
TF
Burke
D000328:Adult; D001291:Attitude of Health Personnel; D036861:Delivery, Obstetric / Q000193:education*; D005260:Female; D006268:Health Facilities; D006282:Health Personnel / Q000193:education / Q000523:psychology*; D006801:Humans; D007630:Kenya; D008875:Middle Aged; D006473:Postpartum Hemorrhage / Q000628:therapy*; D011247:Pregnancy; D036301:Qualitative Research; D016896:Treatment Outcome; D058738:Uterine Balloon Tamponade / Q000295:instrumentation / Q000523:psychology*
Feasibility studies; Kenya; Maternal mortality; Postpartum hemorrhage; Uterine balloon tamponade