Melody J. Eckardt

Human trafficking: review of educational resources for health professionals

CONTEXT Human trafficking is an increasingly well-recognized human rights violation that is estimated to involve more than 2 million victims worldwide each year. The health consequences of this issue bring victims into contact with health systems and healthcare providers, thus providing the potential for identification and intervention. A robust healthcare response, however, requires a healthcare workforce that is aware of the health impact of this issue; educated about how to identify and treat affected individuals in a compassionate, culturally aware, and trauma-informed manner; and trained about how to collaborate efficiently with law enforcement, case management, and advocacy partners. This article describes existing educational offerings about human trafficking designed for a healthcare audience and makes recommendations for further curriculum development. EVIDENCE ACQUISITION A keyword search and structured analysis of peer-reviewed and gray literature, conducted in 2011 and 2012, yielded 27 items that provide basic guidance to health professionals on human trafficking. EVIDENCE SYNTHESIS The 27 resources differed substantially in format, length, scope, and intended audience. Topic areas covered by these resources included trafficking definitions and scope, health consequences, victim identification, appropriate treatment, referral to services, legal issues, and security. None of the educational resources has been rigorously evaluated. CONCLUSIONS There is a clear need to develop, implement, and evaluate high-quality education and training programs that focus on human trafficking for healthcare providers.

Uterine balloon tamponade for the treatment of postpartum haemorrhage in resource-poor settings: a systematic review

Background  Effective interventions addressing postpartum haemorrhage (PPH) are critically needed to reduce maternal mortality worldwide. Uterine balloon tamponade (UBT) has been shown to be an effective technique to treat PPH in developed countries, but has not been examined in resource‐poor settings.

A postpartum haemorrhage package with condom uterine balloon tamponade: a prospective multi‐centre case series in Kenya, Sierra Leone, Senegal, and Nepal

To evaluate the effectiveness and safety of an ultra‐low‐cost uterine balloon tamponade package (ESM‐UBT™) for facility‐based management of uncontrolled postpartum haemorrhage (PPH) in Kenya, Sierra Leone, Senegal, and Nepal.

Evaluation of a novel training package among frontline maternal, newborn, and child health workers in South Sudan

To develop, implement, and evaluate an evidence‐based Maternal, Newborn, and Child Survival (MNCS) package for frontline health workers (FHWs) in South Sudan.

Use of uterine balloon tamponade for control of postpartum hemorrhage by community-based health providers in South Sudan

To determine whether use of uterine balloon tamponade (UBT) for management of uncontrolled postpartum hemorrhage (PPH) by community‐based providers in a resource‐limited setting could be feasible, effective, and safe.

A qualitative assessment of the impact of a uterine balloon tamponade package on decisions regarding the role of emergency hysterectomy in women with uncontrolled postpartum haemorrhage in Kenya and Senegal.

Objectives To assess the impact of a every second matters for mothers and babies uterine balloon tamponade package (ESM-UBT) on provider decisions regarding emergency hysterectomy in cases of uncontrolled postpartum haemorrhage (PPH). Design Qualitative assessment and analysis of a subgroup extracted from a larger database that contains all UBT device uses among ESM-UBT trained health providers. Setting Health facilities in Kenya and Senegal with ESM-UBT training and capable of performing emergency hysterectomies. Participants All medical doctors who had placed a UBT for uncontrolled PPH subsequent to implementation of ESM-UBT at their facility, and who also had the capabilities of performing emergency hysterectomies. Primary outcome measures The impact of ESM-UBT on decisions regarding emergency hysterectomy in cases of uncontrolled PPH. Results 30 of the 31 medical doctors (97%) who fulfilled the inclusion criteria were independently interviewed. Collectively the interviewed medical doctors had placed over 80 UBT devices for uncontrolled PPH since ESM-UBT implementation. All 30 responded that UBT devices immediately controlled haemorrhage and prevented women from being taken to emergency hysterectomy. All 30 would continue to use UBT devices in future cases of uncontrolled PPH. Conclusions These preliminary data suggest that following ESM-UBT implementation, emergency hysterectomy for uncontrolled PPH may be averted by use of uterine balloon tamponade.

Provider experiences with improvised uterine balloon tamponade for the management of uncontrolled postpartum hemorrhage in Kenya

To understand healthcare providers’ experiences with improvised uterine balloon tamponade (UBT) for the management of uncontrolled postpartum hemorrhage (PPH).

Emergency hysterectomy for uncontrolled postpartum hemorrhage may be averted through uterine balloon tamponade in Kenya and Senegal.

Postpartum hemorrhage (PPH) is responsible for more than one in three maternal deaths in Sub-Saharan Africa [1,2]. The authors previously designed, and have been implementing (since August 2012), a uterine balloon tamponade (UBT) package for uncontrolled PPH called Every Second Matters for Mothers and Babies–UBT (ESMUBT; Massachusetts General Hospital, Boston, USA) through local partners and ministries of health [3,4]. Multicountry preliminary analysis demonstrated a 98% survival ofwomenwith severe uncontrolled PPH if delivery occurred at an ESM-UBT on-line facility [4]. The aim of the present study was to understand the impact of the ESM-UBT package on decisions regarding emergency hysterectomy for severe uncontrolled PPH. The participants in the study were all medical doctors, identified from the authors’ Kenya and Senegal ESM-UBT database, who met the following criteria: (1) the provider had received ESM-UBT training and their facility was “on-line” (checklist wall charts and UBT devices in place); (2) the provider had implemented UBT in a case of uncontrolled PPH since training; and (3) theprovider had the capability of performing emergency hysterectomy for PPH at the facility at which he or she inserted a UBT device. Interviews were conducted between January 19, 2015 and February 5, 2015. Ethical approval was obtained from the Partners Healthcare Human Research Committee (Boston, MA, USA) and the Maseno University Ethics Review Committee (Maseno, Kenya) and informed consent from the participants was obtained. Semistructured interviews were voice-recorded, transcribed, and independently analyzed and coded by two independent researchers usingNVivo10 software (QSR International, Doncaster, Victoria, Australia). Researchers used an iterative process of code identification and revision to develop domains and themes. Thirty of the 31 medical doctors who fulfilled the inclusion criteria in the two-country database were interviewed. Twenty-eight of the 30 interviewed providers reported having witnessed at least one (15 had cared for more than five each) PPH-related maternal death in their careers. Twenty-one of the 30 had inserted multiple UBT devices (range, 2–60) since being trained on ESM-UBT. Twenty-six of the 30 responded that if they had not received ESM-UBT training they would have performed emergency hysterectomies in the cases of uncontrolled PPH that they instead successfully managed with UBT devices. All interviewed providers described that UBT prevented women from undergoing emergency hysterectomy and that they would continue to use UBT devices in future cases of uncontrolled PPH. This preliminary study suggests that emergency hysterectomy for uncontrolled PPH may be averted by uterine balloon tamponade.

Provider experiences with uterine balloon tamponade for uncontrolled postpartum hemorrhage in health facilities in Kenya

To understand provider perceptions and experiences following training in the use of a condom‐catheter uterine balloon tamponade (UBT) as second‐line treatment for uncontrolled postpartum hemorrhage (PPH) in health facilities in Kenya.

Use of prophylactic uterotonics during the third stage of labor: a survey of provider practices in community health facilities in Sierra Leone

BackgroundPostpartum hemorrhage remains the leading cause of maternal mortality worldwide. Administration of uterotonics during the third stage of labor is a simple and well established intervention that can significantly decrease the development of postpartum hemorrhage. Little is known about the use of prophylactic uterotonics in peripheral health centers, where the majority of normal deliveries occur. The purpose of this study is to assess health provider current practices and determinants to the use of prophylactic uterotonics in Sierra Leone, a country with one of the highest maternal mortality ratios worldwide.MethodsThis is a mixed methods study using descriptive cross-sectional survey and qualitative interviews in community health facilities in Freetown, Sierra Leone following a comprehensive training on postpartum hemorrhage. Facilities and providers were surveyed between May and June 2014. Qualitative methods were used to identify barriers and facilitators to the use of prophylactic uterotonics.ResultsA total of 134 providers were surveyed at 39 periphreal health facilities. Thirteen facilities (39 %) reported an inconsistent supply of oxytocin. The majority of facilities (64 %) stored oxytocin at room temperature. Provider level, in-service training, and leadership role were significantly associated with prophylactic uterotonic use. Overall, 62 % of providers reported routine use. Midwives were most likely to routinely administer uterotonics (93 %), followed by community health officers/assistants (78 %), maternal and child health aides (56 %), and state-enrolled community health nurses (52 %). Of the providers who received in-service training, 67 % reported routine use; of those with no in-service training, 42 % reported routine use. Qualitative analysis revealed that facility protocols, widespread availability, and provider perception of utility facilitated routine use. Common barriers reported included inconsistent supply of uterotonics, lack of knowledge regarding timely administration, and provider attitude regarding utility of uterotonics following normal deliveries.ConclusionThere is considerable room for improvement in availability and administration of prophylactic uterotonics. Understanding barriers to routine use may aid in developing multifaceted pre-service and in-service training interventions designed to improve routine intrapartum care.