Zambia’s large-scale evaluation of a device that prevents postpartum hemorrhage lays blueprint for wider regional adoption – Clinton Health Access Initiative

CHAI and the Zambia Ministry of Health have published a groundbreaking study in BMC Health Services Research. The study in Northern Zambia marks the first large-scale evaluation of the introduction of the non-pneumatic anti-shock garment (NASG) globally.

The NASG is a lifesaving compression device that helps women manage heavy blood loss resulting from childbirth (postpartum hemorrhage). In places where health facilities are remote, it can buy new mothers time before they can get the help they need.

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“I arrived at the clinic bleeding profusely; it was not easy,” said Anne. “I thought I was going to die. The nurse attended to me promptly, and I watched skeptically as she applied this garment, wondering if she realized the severity of my condition.”

Global postpartum hemorrhage deaths

Post-partum hemorrhage (PPH) stands as a major cause of maternal mortality globally. It contributes to over 20 percent of childbirth-related deaths worldwide. These deaths are largely preventable, as many high-income countries (HICs) have nearly eliminated them. Low- and middle-income countries (LMICS), particularly those in sub-Saharan Africa and South Asia, remain disproportionately affected by PPH-related deaths.

It takes less than four hours from the onset of hemorrhage, on average, to die. Worse, the condition can only be treated in a hospital. This is a significant challenge across many LMICs. For many women, it can take hours, sometimes days before reaching and receiving emergency care at a hospital.

Buying women more time

“If a woman starts hemorrhaging after giving birth, she could die within two hours, so buying time to reach effective treatment is key,” says Dr. Yirgu Gebrehiwot, Former President of the Ethiopian Society of Obstetricians & Gynecologists and the African Federation of Obstetrics and Gynaecology. “The NASG can be highly valuable in affording this additional time, especially in rural or resource-limited settings.”

The NASG effectively compresses the abdomen and lower body, countering hypovolemic shock resulting from obstetric hemorrhage. Its ease of use makes it ideal for use at all levels of the health system.

Nearly all facilities use NASGs

This study marks the first large-scale implementation of NASGs, covering 143 public health facilities. The results are remarkable. Just after 16 months of introducing the device, nearly all (99%) facilities have maintained their supply of NASGs. About 88 percent of the facilities have used the device at least once. Of the 68 recorded applications, 66 were clinically justified. Healthcare professionals’ feedback was overwhelmingly positive. Roughly 97 percent endorsed the decision to introduce NASGs, and 92 percent reported confidence in applying the NASG after receiving training.

Reducing maternal mortality

The introduction of NASG is part of a broader strategy, aligned with the World Health Organization’s PPH prevention and care roadmap, to combat PPH. The roadmap, stretching from 2023 to 2030, addresses PPH priorities and fast-tracks achieving global maternal health targets.

This study adds to the growing body of evidence supporting the NASG’s addition as part of a package for the treatment of PPH. This research has enabled the Zambian Ministry of Health and CHAI to formulate an operational blueprint for other countries.

As countries with a high burden of PPH continue to seek effective solutions, Zambia’s experiences from its implementation, offers invaluable insights and direction.

Download the paper