ABSTRACT
BACKGROUND: Postpartum hemorrhage (PPH) is the leading cause of maternal death in Tanzania. The Every Second Matters for Mothers and Babies- Uterine Balloon Tamponade (ESM-UBT) device was developed to address this problem in women with atonic uterus. The objective of this study was to understand the barriers and facilitators to optimal use of the device, in Dar es Salaam Tanzania 1 year after implementation. METHODS: Semi-structured interviews of skilled-birth attendants were conducted between May and July 2017. Interviews were recorded, coded and analyzed for emergent themes. RESULTS: Among the participants, overall there was a positive perception of the ESM-UBT device. More than half of participants reported the device was readily available and more than 1/3 described ease and success with initial use. Barriers included fear and lack of refresher training. Finally, participants expressed a need for training and device availability at peripheral hospitals. CONCLUSION: The implementation and progression to optimal use of the ESM-UBT device in Tanzania is quite complex. Ease of use and the prospect of saving a life/preserving fertility strongly promoted use while fear and lack of high-level buy-in hindered utilization of the device. A thorough understanding and investigation of these facilitators and barriers are required to increase uptake of the ESM-UBT device.
Subject(s)
Condoms, Female , Maternal Health Services/statistics & numerical data , Postpartum Hemorrhage/therapy , Uterine Balloon Tamponade/instrumentation , Uterine Inertia/therapy , Adult , Female , Health Plan Implementation , Health Services Accessibility , Humans , Maternal Mortality/trends , Postpartum Hemorrhage/mortality , Pregnancy , Referral and Consultation , Tanzania/epidemiology , Uterine Balloon Tamponade/mortality , Uterine Inertia/mortalityABSTRACT
Background:Vitamin D is partly responsible formaintainingcalcium and phosphatehomeostasisbut has been shown to have immune modulatory functions.Objective:To measure serumlevels of vitamin D, and plasma levels of calcium and phosphatein children with pneumonia and compare with those of apparentlyhealthy controls.Methods:A cross-sectional study involving seventy-six childrenwith pneumonia, matched with 76 apparently healthy controls.Results:There was no statistically significant difference in the mean serum vitamin D levels between the cases and the controls (t = 1.190, p = 0.236). The mean serum vitamin D level was significantly higher in childrenwith non-severe pneumonia than in those with severe pneumonia (t = 3.299, p =.002). Themean serum vitamin D level was higher among the controls than those with severe pneumonia (t = 2.674, p = 0.009).The mean plasmacalcium and phosphate levels in the controls were significantly higher than in the cases (t = 2.528, p = .013 and t = 4.594, p < .001 respectively). Plasmacalcium and phosphate levels did not vary with the severity of pneumonia. Pneumonia was independently associated with the occurrence of hypocalcaemia and hypophosphataemia (OR= 4.366, 95% CI = 1.851-10.295, p= 0.001; OR= 7.355, 95% CI = 1.545-35.027, p= 0.01 respectively). Conclusion:Children with severe pneumonia hadlower levels of vitamin D than those with the non-severe disease.Derangements in plasma levels of calcium and phosphateare common in children with pneumonia, and these abnormalities occur independently of low vitamin D levels
