title: Provider experience of uterine balloon tamponade for the management of postpartum hemorrhage in Sierra Leone.
abstract: OBJECTIVE
  To understand healthcare providers' experience of incorporating uterine balloon tamponade (UBT) into the national postpartum hemorrhage (PPH) clinical pathway after UBT training.
  
  
  METHODS
  In a qualitative study, semi-structured interviews were undertaken with healthcare providers from 50 centers in Freetown, Sierra Leone, between May and June 2014. All eligible healthcare providers (undergone UBT training, actively conducted deliveries, and treated cases of PPH since UBT training) on duty at the time of center visit were interviewed.
  
  
  RESULTS
  Sixty-one providers at 47 facilities were interviewed. Bleeding was controlled in 28 (93%) of 30 cases of UBT device placement. Participants reported that UBT devices were easy to insert with only minor challenges, and enabled providers to manage most cases of uncontrolled PPH at their own facility and to refer others in a stable condition. Reported barriers to optimal UBT use included insufficient training and practical experience, and a scarcity of preassembled UBT devices. Facilitators of UBT use included widespread acceptance of UBT, comprehensive and enthusiastic training, and ready availability of UBT devices.
  
  
  CONCLUSIONS
  UBT-used either as a primary endpoint or en route to obtaining advanced care-has been well accepted and integrated into the national PPH pathway by providers in health facilities in Freetown.
authors.affiliation: 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.
authors.forename: Abirami
authors.initials: A
authors.lastname: Natarajan
authors.affiliation: Division of Global Health and Human Rights, Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Kamara
authors.affiliation: Division of Global Health and Human Rights, Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
authors.forename: Roy
authors.initials: R
authors.lastname: Ahn
authors.affiliation: Division of Global Health and Human Rights, Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
authors.forename: Brett D
authors.initials: BD
authors.lastname: Nelson
authors.affiliation: Division of Global Health and Human Rights, Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Melody J
authors.initials: MJ
authors.lastname: Eckardt
authors.affiliation: Division of Global Health and Human Rights, Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
authors.forename: Anne Marie
authors.initials: AM
authors.lastname: Williams
authors.affiliation: Ministry of Health and Sanitation, Division of Reproductive Health, Freetown, Sierra Leone.
authors.forename: Samuel A
authors.initials: SA
authors.lastname: Kargbo
authors.affiliation: Division of Global Health and Human Rights, Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
authors.forename: Thomas F
authors.initials: TF
authors.lastname: Burke
mesh_terms: D000293:Adolescent; D000328:Adult; D019091:Critical Pathways; D019468:Disease Management; D005260:Female; D006282:Health Personnel / Q000193:education*; D006801:Humans; D007407:Interviews as Topic; D008428:Maternal Mortality; D006473:Postpartum Hemorrhage / Q000628:therapy*; D011247:Pregnancy; D036301:Qualitative Research; D012807:Sierra Leone; D058738:Uterine Balloon Tamponade / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: Clinical pathway; Feasibility studies; Maternal mortality; Postpartum hemorrhage; Sierra Leone; Uterine balloon tamponade