Utilization, associated factors and health workers' perceptions of non-pneumatic anti-shock garment in managing obstetric hemorrhage at Kawempe National Referral Hospital

Abstract

INTRODUCTION: Obstetric hemorrhage stands as the foremost contributor to global maternal mortality accounting for 27% of the deaths. Particularly postpartum hemorrhage accounts for 70,000 deaths annually. The highest number of deaths occurring in sub-Saharan Africa with most attributed to delay in receiving definitive care. When applied correctly, the non-pneumatic antishock garment is a valuable and efficacious interim intervention available at Kawempe National Referral Hospital (KNRH) for management of obstetric hemorrhage and hypovolemic shock as the patient awaits definitive care. AIM: The purpose of this study was to assess the use of NASG in managing obstetric hemorrhage at KNRH. This encompassed determining the level of utilization of the NASG, associated factors and health workers perceptions to its use in managing postpartum hemorrhage. METHODS: This was a mixed method convergent parallel study; The Quantitative study was a facility based cross sectional survey conducted using structured interviewer administered questionnaire to assess the level of NASG utilization and associated factors among 191 obstetric care providers including midwives and doctors who were recruited using consecutive sampling. Qualitative study was an exploratory study which applied the Unified Theory of Acceptance and Use of Technology to explore health workers perceptions about the use of NASG in management of obstetric hemorrhage. Data was collected through in-depth interviews with the obstetric care providers. The quantitative data was analyzed using SPSS, and analysis relied on descriptive and inferential statistics. Bivariate and multivariate analysis were used to evaluate the relationship between associated factors. Qualitative data analysis relied on both inductive and deductive thematic analysis. Results were merged to draw conclusions. RESULTS: The level of utilization of the NASG was 52.6%, with only 6% of the participants having used it more than 5 times. Only 41.9% of the participants were knowledgeable about use of the NASG and majority of the respondents (62.3%) had a positive attitude. Higher levels of knowledge (aOR=1.294, p value <0.001,95%CI:( 1.128-1.484)), positive attitudes (aOR=1.22, p value 0.037, 95% CI:(1.012-1.468)) and presence of experienced staff to train on NASG use (aOR=4.137 p value 0.001), were significantly associated with the use of NASG in management of obstetric hemorrhage as they reported it to improve their work efficiency “When a patient comes with low blood pressure, the antishock garment helps you to buy time as you look for blood to give the patient and correct the cause of the bleeding”. CONCLUSION: The level of utilization of the NASG was fairly average at 52.6%. Being knowledgeable, having a positive attitude and presence of experienced staff to train on use of the garment is associated with increased utilization of the garment in managing obstetric hemorrhage.