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By introducing and evaluating a postpartum hemorrhage package with ultra-low-cost uterine balloon tamponade embedded in underserved areas of Africa, we are working to reduce maternal mortality and morbidity due to postpartum hemorrhage.
As of March 18, 2016, 280 UBTs have been placed in critically ill, hemorrhaging women and death and disability has been averted in 264.
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 Postpartum Hemorrhage Implementation Package with Uterine Balloon Tamponade (ESM-UBT) 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 (see picture). 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 $400 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.
MGH has successfully completed implementation and research activities related to ESM-UBT use in South Sudan, Sierra Leone, Senegal, Nepal, and Kenya. In 2010 and 2011, our MGH team rolled out the ESM-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 uptake of ESM-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 ESM-UBT package 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.
In July of 2013, our Division was awarded a $2 million USAID Saving Lives at Birth (SLAB) transition-to-scale grant to deploy and evaluate our ultra-low-cost ESM-UBT package in 300 facilities in Kenya and 50 facilities in Sierra Leone over the subsequent four years. Further donor partners include the HIF (UK + DFID) and Izumi Foundation.
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