By introducing and evaluating an ultra-low-cost uterine balloon tamponade package in underserved areas of Africa, we are working to reduce maternal mortality and morbidity due to postpartum hemorrhage.
Uterine balloon Tamponade for postpartum hemorrhage
Postpartum hemorrhage (PPH) is the most common cause of maternal morbidity and mortality in developing countries. More than 30 percent of all maternal deaths worldwide are attributable to PPH, accounting for approximately 130,000 deaths and 2.6 million disabled women every year. The vast majority of cases of PPH occur in low-and middle-income countries.
At the Division of Global Health and Human Rights, we have developed an effective Uterine Balloon Tamponade (UBT) implementation package that can be assembled from components readily available in developing countries. The ultra low-cost (less than $5) uterine balloon kit consists of a condom tied to a Foley catheter and inflated with clean water through a syringe and one-way valve. Uterine balloon tamponade is standard of care in the United States, but the manufactured medical balloons used in US hospitals are single-use and can cost over $300 apiece. The condom balloon provides an ultra-affordable alternative using components available in even the most resource-poor healthcare settings. In areas where surgical and pharmaceutical interventions are not available, the uterine condom balloon device has been shown to stop bleeding effectively and allow time for the mother to be transported to a higher-level health facility.
MGH has successfully completed implementation and research activities related to UBT use in both South Sudan and Kenya. In 2010 and 2011, our MGH team rolled out the UBT package to over 870 frontline health workers (FHWs) in South Sudan; most of the providers were non-literate and had little formal health training. We subsequently conducted a rigorous case study on the use of UBT in a limited region of Eastern Equatoria state, in South Sudan, and documented 13 cases of UBT use, all of which were successfully placed by our trainees. Despite significant barriers such as lack of literacy, FHWs correctly identified uncontrolled PPH, properly placed the balloon, arrested the bleeding, and subsequently referred the women to higher-level facilities. In Kenya, beginning in August 2012, and in partnership with the Ministry of Health, PATH, Unicef, and others, we began implementing our UBT device by training 46 health providers from 12 health facilities as a Phase I pilot. In the first 11 months, 26 UBTs were placed. Many of these women were either unconscious or in altered mental states due to the severity of their hemorrhage. However, bleeding was rapidly controlled in each of the hemorrhaging women. None of the women died or became disabled. In response to the Phase I pilot, the Kenyan Ministry of Health has formally integrated our package into the national policy for PPH.
Our Division has recently been awarded a $2 million USAID Saving Lives at Birth (SLAB) transition-to-scale grant to deploy and evaluate our ultra-low-cost UBT system in 350 facilities in South Sudan and Kenya over the next four years. Our program will employ cell phone-based tracking of UBT use, which will allow us to accurately document women’s health outcomes after treatment at these facilities. We will also collaborate closely with our local and international partner organizations to identify options for building a compelling business model for commercializing UBT.
For additional information watch the following videos:
"Saving women's lives across Africa"
"Dr. Richard Olunga's testimonial"
"Midwives stories from Africa"
"Scaling up uterine balloon tamponade system in Kenya and South Sudan"
The Division of Global Health and Human Rights has championed the use of various low-cost, high yield medical technologies in underserved areas of Africa, and our UBT work is a continuation of these efforts. Some examples of past technologies implemented by the Division include:
- Pulse oximetry
- Oxygen concentrators
- Ambubags for resuscitation