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

AbstractObjectiveTo understand healthcare providers’ experiences with improvised uterine balloon tamponade (UBT) for the management of uncontrolled postpartum hemorrhage (PPH).MethodsIn a qualitative descriptive study, in-depth semi-structured interviews were conducted between November 2014 and June 2015 among Kenyan healthcare providers who had previous experience with improvising a UBT device. Interviews were conducted, audio-recorded, and transcribed.ResultsOverall, 29 healthcare providers (14 nurse-midwifes, 7 medical officers, 7 obstetricians, and 1 clinical officer) were interviewed. Providers perceived improvised UBT as valuable for managing uncontrolled PPH. Reported benefits included effectiveness in arresting hemorrhage and averting hysterectomy, and ease of use by providers of all levels of training. Providers used various materials to construct an improvised UBT. Challenges to improvising UBT—e.g. searching for materials during an emergency, procuring male condoms, and inserting fluid via a small syringe—were reported to lead to delays in care. Providers described their introduction to improvised UBT through both formal and informal sources. There was universal enthusiasm for widespread standardized training.ConclusionImprovised UBT seems to be a valuable second-line treatment for uncontrolled PPH that can be used by providers of all levels. UBT might be optimized by integrating a standard package across the health system

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

Background Postpartum 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. Methods This 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. Results A 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. Conclusion There 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

Detoxification of Toxic Organic Dye by Heteroatom-Doped Fluorescent Carbon Dots Prepared by Green Hydrothermal Method Using <i>Garcinia mangostana</i> Extract

In this work, nitrogen- and oxygen-doped fluorescent carbon dots (NOFCDs) were prepared using a simple green hydrothermal carbonization technique. Aqueous ammonia and the plant extract of Garcinia mangostana were used as a source of nitrogen and carbon, respectively. The prepared NOFCDs were examined using a variety of microscopic and spectroscopic techniques for physicochemical characterization. Fluorescence and UV–visible spectroscopy measurements were used to analyze the NOFCDs’ excitation-dependent fluorescent emission and absorption nature. It is observed that fluorescence intensity was excited at 320 nm and the strongest emission peak absorbed at 405 nm. The HRTEM imaging revealed NOFCDs to be spherical in shape with particle size at 3.58 nm. Moreover, the amorphous nature of NOFCDs was verified by X-ray diffraction, Raman spectroscopy, and SAED pattern techniques. Through FTIR, XPS, and EDS investigations, the doping of nitrogen and oxygen over the surface of the NOFCDs was evaluated and validated. The presence of carboxylic, amine, hydroxyl, and carbonyl functional groups on NOFCDs’ surface was shown by XPS and FTIR investigations. By using NaBH4, the obtained NOFCDs were demonstrated to possess excellent catalytic activity in the detoxification of methylene blue. Overall, this study revealed that the NOFCDs synthesized from green sources could be a promising material for catalytic and environmental remediation applications

Synthesis, Characterization and Application of SnO₂@rGO Nanocomposite for Selective Catalytic Reduction of Exhaust Emission in Internal Combustion Engines

In this experimental investigation, a procreation approach was used to produce a catalyst based on SnO2@rGO nanocomposite for use in a selective catalytic reduction (SCR) system. Plastic waste oil is one such alternative that helps to ensure the survival of fossil fuels and also lessens the negative impacts of improper waste disposal. The SnO2@rGO nanocomposite was prepared by fine dispersion of SnO2 nanoparticles on monolayer-dispersed reduced graphene oxide (rGO) and carefully investigated for its potential in adsorbing CO, CO2, NOX, and hydrocarbon (HC). The as-synthesized SnO2@rGO nanocomposite was characterized by Fourier transform infrared spectroscopy, high-resolution transmission electron microscopy, scanning electron microscopy, X-ray diffraction spectroscopy, thermogravimetry, and surface area analyses. Then, the impact of catalysts inside the exhaust engine system was evaluated in a realistic setting with a single-cylinder, direct-injection diesel engine. As a result, the catalysts reduced harmful pollution emissions while marginally increasing brake-specific fuel consumption. The nanocomposite was shown to exhibit higher NOX adsorption efficiencies when working with different toxic gases. Maximum reductions in the emission of NOX, hydrocarbons, and CO were achieved at a rate of 78%, 62%, and 15%, respectively. These harmful pollutants were adsorbed on the active sites of catalyst and are converted to useful fuel gases through catalytic reduction thereby hindering the trajectory of global warming

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: Table 1

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

Barriers to Timely Surgery for Breast Cancer in Rwanda

Ensuring timely and high-quality surgery must be a key element of breast cancer control efforts in sub-Saharan Africa. We investigated delays in preoperative care and the impact of on-site versus off-site operation on time to operative treatment of patients with breast cancer at Butaro Cancer Center of Excellence in Rwanda. We used a standardized data abstraction form to collect demographic data, clinical characteristics, treatments received, and disease status as of November 2017 for all patients diagnosed with breast cancer at Butaro Cancer Center of Excellence in 2014 to 2015. From 2014 to 2015, 89 patients were diagnosed with stage I to III breast cancer and treated with curative intent. Of those, 68 (76%) underwent curative breast operations, 12 (14%) were lost to follow-up, 7 (8%) progressed, and 2 declined the recommended operation. Only 32% of patients who underwent operative treatment had the operation within 60 days from diagnosis or last neoadjuvant chemotherapy. Median time to operation was 122 days from biopsy if no neoadjuvant treatments were given and 51 days from last cycle of neoadjuvant chemotherapy. Patients who received no neoadjuvant chemotherapy experienced greater median times to operation at Butaro Cancer Center of Excellence (180 days) than at a referral hospital in Kigali (93 days, P = .04). Most patients (60%) experienced a disruption in preoperative care, frequently at the point of surgical referral. Documented reasons for disruptions and delays included patient factors, clinically indicated treatment modifications, and system factors. We observed frequent delays to operative treatment, disruptions in preoperative care, and loss to follow-up, particularly at the point of surgical referral. There are opportunities to improve breast cancer survival in Rwanda and other low- and middle-income countries through interventions that facilitate more timely surgical care