Ibrahim Mohedas

Discrepancies between clinicians and rural healthcare workers regarding referral procedures based on blood pressure measurements

Hypertensive disorders of pregnancy are the third most common cause of maternal mortality worldwide, and the proportion of deaths resulting from these disorders is increasing [1,2]. Proper management begins with correct diagnosis and appropriate referral decisions. Within maternity referral networks in low-resource countries, rural healthcare workers are the first to identify hypertension, which requires accurate equipment and proper measurement technique. The aim of the present study was to assess whether referral procedures based on blood pressuremeasurementswere consistent throughout a maternity referral network. Seventy-five semi-structured interviews were performed at healthcare centers—teaching hospital (n = 1), district hospitals (n = 10), health clinics (n = 11), and community health posts (n = 8)—within a convenience sample of 9 districts in Ghana. Participants were asked to define the blood pressure measurement that would be considered high and warrant treatment and/or referral. Participant groups included obstetricians and physicians, midwives/nurses, and community health workers (CHWs). The

Assistive Device for the Insertion of Subcutaneous Contraceptive Implants

Providing access to family planning services in lowand middle-income countries (LMICs) is a major focus of the global health community [1]. The World Bank estimates that only 45% of the demand for contraceptive services in subSaharan Africa is satisfied [2]. The availability of long-term contraceptive methods is particularly important for women who prefer to space pregnancies by two or more years. Intrauterine and subcutaneous implant contraceptive methods are the most effective reversible contraception methods available [3]. Subcutaneous implants are single (or double) rods that contain etonogestrel and are inserted subdermally on the inner side of a womans non-dominant arm [4]. Single-rod devices (e.g., Implanon, Nexplanon) can prevent pregnancy for up to three years while two-rod devices (e.g., Jadelle, Sino-implant) can prevent pregnancy for up to five years. In addition, implants do not require maintenance or effort on the part of the user, allow women to return to fertility quickly, and have very low failure rates [5]. While the benefits of implantable contraceptives are significant, major barriers exist that prevent wider usage; namely, the training and skill required for performing insertion/removal procedures. This barrier is exacerbated in rural areas where access to health clinics, medical devices, and trained clinicians is more limited. This paper details the design of an innovative task shifting device that enables community healthcare workers to insert subcutaneous contraceptive implants. The ultimate goal of this work is to lower the barrier to adoption of long-term contraceptive implants for rural women in LMICs.