A low-cost simulator for learning to manage postpartum hemorrhage in rural Africa

  • Simulation in Healthcare, Volume 6, No. 1, Year 2011

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Study Justification:
– Postpartum hemorrhage (PPH) is the leading cause of maternal mortality in Africa and Asia.
– Women in rural communities with poor access to care are at a higher risk of PPH.
– Traditional birth attendants (TBAs) lack training and equipment to manage PPH.
– The study aims to design and evaluate a low-cost simulator to train TBAs and nurse midwives in managing PPH.
Highlights:
– The study developed a low-cost, portable simulator for training TBAs and nurse midwives.
– Engineering specifications were developed in consultation with clinicians in the USA and Ghana.
– The simulator was evaluated by obstetricians, nurse midwives, midwifery students, and TBAs.
– The simulator was found to be effective, with excellent fidelity and valid feedback mechanisms.
– It was demonstrated to be feasible for training illiterate TBAs in performing bimanual compression.
Recommendations:
– Implement the use of the low-cost simulator in training programs for TBAs and nurse midwives.
– Expand the evaluation of the simulator to include a larger sample size and diverse settings.
– Conduct further research to assess the impact of the simulator on reducing maternal mortality from PPH.
Key Role Players:
– Clinicians (obstetricians, nurse midwives) for providing expertise and guidance.
– Engineers for designing and developing the low-cost simulator.
– Researchers for evaluating the simulator and conducting further studies.
– Training institutions and organizations for implementing the simulator in training programs.
Cost Items for Planning Recommendations:
– Development and production of the low-cost simulator.
– Training programs and materials for TBAs and nurse midwives.
– Research and evaluation costs.
– Implementation costs for integrating the simulator into existing healthcare systems and training programs.

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INTRODUCTION: Postpartum hemorrhage (PPH) is the leading cause of maternal mortality in Africa and Asia. Despite an UN Millennium Development Goal to reduce maternal mortality rates, no significant effect has resulted to date, in large part because women in these areas give birth in rural communities with poor access to definitive care. Traditional birth attendants (TBAs) provide care for delivering mothers; however, they are neither trained nor equipped to recognize or manage PPH as a life-threatening emergent condition. The purpose of this study was to design and evaluate a low-cost, portable simulator for training TBAs and nurse midwives in the use of bimanual compression to manage PPH. METHODS: Clinicians in USA and Ghana were consulted to develop the engineering specifications, including low cost, long lifetime, easy to use, portable, and high anatomic and procedural fidelity. Pugh charts were used to finalize the design from multiple concepts. The simulator was built and evaluated for validity by American and Ghanaian obstetricians, nurse midwives, midwifery students, and TBAs. The feasibility of the simulator for training illiterate learners was also assessed. RESULTS: The simulator was evaluated to be an effective training platform with excellent fidelity and valid feedback mechanisms. It was demonstrated to be a feasible platform for training illiterate TBAs to perform bimanual compression. CONCLUSIONS: The low cost, portable simulator developed for this project has the potential to reduce maternal mortality from PPH in the developing world. Research is ongoing in this application. © 2011 Lippincott Williams & Wilkins, Inc.

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The innovation described in the recommendation is the development of a low-cost simulator for learning to manage postpartum hemorrhage (PPH) in rural Africa. This simulator is designed to train traditional birth attendants (TBAs) and nurse midwives in the use of bimanual compression to manage PPH, which is the leading cause of maternal mortality in Africa and Asia.

The simulator was developed based on engineering specifications that include low cost, long lifetime, easy to use, portability, and high anatomical and procedural fidelity. It has been evaluated by obstetricians, nurse midwives, midwifery students, and TBAs in the United States and Ghana, and has been found to be an effective training platform with excellent fidelity and valid feedback mechanisms.

One of the key advantages of this simulator is its feasibility for training illiterate learners, such as TBAs. By providing training on how to manage PPH, this low-cost simulator has the potential to reduce maternal mortality in rural communities with poor access to definitive care.

Further research is ongoing in this application to continue improving access to maternal health and reducing maternal mortality rates.
AI Innovations Description
The recommendation to improve access to maternal health is the development of a low-cost simulator for learning to manage postpartum hemorrhage (PPH) in rural Africa. This simulator is designed to train traditional birth attendants (TBAs) and nurse midwives in the use of bimanual compression to manage PPH, which is the leading cause of maternal mortality in Africa and Asia.

The simulator was developed based on engineering specifications that include low cost, long lifetime, easy to use, portability, and high anatomical and procedural fidelity. It has been evaluated by obstetricians, nurse midwives, midwifery students, and TBAs in the United States and Ghana, and has been found to be an effective training platform with excellent fidelity and valid feedback mechanisms.

One of the key advantages of this simulator is its feasibility for training illiterate learners, such as TBAs. By providing training on how to manage PPH, this low-cost simulator has the potential to reduce maternal mortality in rural communities with poor access to definitive care.

Further research is ongoing in this application to continue improving access to maternal health and reducing maternal mortality rates.
AI Innovations Methodology
To simulate the impact of the recommendations mentioned in the abstract on improving access to maternal health, the following methodology can be used:

1. Identify the target population: Determine the specific rural communities in Africa where access to maternal health is poor and where the implementation of the low-cost simulator for managing PPH would be beneficial.

2. Baseline data collection: Gather data on the current maternal mortality rates in the identified communities, as well as information on the availability and accessibility of maternal health services.

3. Intervention implementation: Introduce the low-cost simulator for training TBAs and nurse midwives in the identified communities. Provide training sessions on how to use the simulator effectively for managing PPH.

4. Monitoring and evaluation: Regularly monitor the usage of the simulator by TBAs and nurse midwives in the communities. Collect data on the number of individuals trained, their proficiency in using the simulator, and their confidence in managing PPH.

5. Post-intervention data collection: After a specified period of time, collect data on the maternal mortality rates in the communities where the simulator was implemented. Compare these rates to the baseline data collected in step 2 to assess the impact of the intervention.

6. Feedback and improvement: Gather feedback from the trained TBAs and nurse midwives regarding their experience with the simulator. Use this feedback to make any necessary improvements to the simulator or the training program.

7. Dissemination of findings: Share the results of the simulation study, including the impact on maternal mortality rates, with relevant stakeholders, such as healthcare providers, policymakers, and organizations working in maternal health. This will help raise awareness and potentially lead to the scaling up of the intervention in other similar communities.

By following this methodology, researchers can simulate the impact of the low-cost simulator on improving access to maternal health in rural Africa and assess its effectiveness in reducing maternal mortality rates caused by PPH.


Statistics:
Citations: 16
Identifiers:
DOI: 10.1097/SIH.0b013e3181ebbcfd
ISSN: 15592332
Research Areas:
Health System and Policy, Maternal and Child Health, Workforce
Study Countries:
Ghana
Participants Gender:
Female
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