title: Provider experiences with improvised uterine balloon tamponade for the management of uncontrolled postpartum hemorrhage in Kenya.
abstract: OBJECTIVE
  To understand healthcare providers' experiences with improvised uterine balloon tamponade (UBT) for the management of uncontrolled postpartum hemorrhage (PPH).
  
  
  METHODS
  In a qualitative descriptive study, in-depth semi-structured interviews were conducted between November 2014 and June 2015 among Kenyan healthcare providers who had previous experience with improvising a UBT device. Interviews were conducted, audio-recorded, and transcribed.
  
  
  RESULTS
  Overall, 29 healthcare providers (14 nurse-midwifes, 7 medical officers, 7 obstetricians, and 1 clinical officer) were interviewed. Providers perceived improvised UBT as valuable for managing uncontrolled PPH. Reported benefits included effectiveness in arresting hemorrhage and averting hysterectomy, and ease of use by providers of all levels of training. Providers used various materials to construct an improvised UBT. Challenges to improvising UBT-e.g. searching for materials during an emergency, procuring male condoms, and inserting fluid via a small syringe-were reported to lead to delays in care. Providers described their introduction to improvised UBT through both formal and informal sources. There was universal enthusiasm for widespread standardized training.
  
  
  CONCLUSIONS
  Improvised UBT seems to be a valuable second-line treatment for uncontrolled PPH that can be used by providers of all levels. UBT might be optimized by integrating a standard package across the health system.
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; Harvard Medical School, Boston, MA, USA.
authors.forename: Anna
authors.initials: A
authors.lastname: Alaska Pendleton
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: Roy
authors.initials: R
authors.lastname: Ahn
authors.affiliation: Kisumu Medical Education Trust, Kisumu, Kenya.
authors.forename: Monica
authors.initials: M
authors.lastname: Oguttu
authors.affiliation: Kisumu Medical Education Trust, Kisumu, Kenya.
authors.forename: Lidu
authors.initials: L
authors.lastname: Dulo
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: Thomas F
authors.initials: TF
authors.lastname: Burke
mesh_terms: D017280:Condoms / Q000706:statistics & numerical data*; D019468:Disease Management; D005260:Female; D006282:Health Personnel; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects*; D007630:Kenya; D008428:Maternal Mortality; D011183:Postoperative Complications / Q000628:therapy*; D006473:Postpartum Hemorrhage / Q000628:therapy*; D036301:Qualitative Research; D058738:Uterine Balloon Tamponade / Q000295:instrumentation*
keywords: Kenya; Maternal health; Maternal hemorrhage; Maternal mortality; Postpartum hemorrhage; Uterine balloon tamponade