Control of Postpartum Haemorrhage with Uterine Balloon Tamponade Using Foley Catheter in a Rural Mission Hospital in Ebonyi State, Southeast Nigeria

Background: Postpartum haemorrhage is the leading cause of maternal deaths worldwide, the majority of which occur in low resource settings. Uterine atony is the commonest cause of postpartum haemorrhage. Uterine balloon tamponade (UBT) is an effective method of treating refractory postpartum haemorrhage. Aim: Commercial UBT devices are often not affordable and not readily available in rural settings. The aim of this paper is to report on three cases of postpartum haemorrhage successfully managed with uterine balloon tamponade using Foley catheters. Case Reports: We report on three patients with major obstetric haemorrhage from uterine atony who were successfully managed with uterine balloon tamponade using Foley’s urethral catheter. The first two patients had primary postpartum haemorrhage while the third patient had significant bleeding during the surgical evacuation of the uterus for a molar pregnancy. In each case, uterine bleeding was refractory to pharmacologic uterotonics. They all had uterine tamponade with a Foley catheter with the dramatic resolution of their bleeding. Conclusion: In well-selected patients, uterine balloon tamponade with Foley catheter is cheap, arrests bleeding and prevents clinical deterioration among women with refractory postpartum haemorrhage, especially in low resource settings where commercial balloon tamponade may not be available or affordable.

Quality of Health Care in Resource Limited Settings-Patients’ Satisfaction Survey at a Mission Hospital in South East, Nigeria

Introduction: Quality healthcare is a major contributor to health disparities and inequalities in resource limited settings. Patient satisfaction remains an important and valuable method of assessing the quality of care. Aim: This study assessed patients’ satisfaction with quality of inpatient clinical care in a mission hospital in a semi urban setting. Methods: The study was a cross-sectional study carried out on 140 inpatients at a mission hospital in Afikpo, South East Nigeria. Data was collected using pretested structured questionnaires designed on a five-point likert scale with 1 indicating the lowest and 5 indicating the highest scale. Knowledge of factors contributing to quality of care and satisfaction in the following domains: patient-staff relationship, patient-staff (doctors/nurses) communication, facility convenience, technical aspect of care (availability of equipment, drugs and adequacy of staff) and overall general satisfaction were measured. Operationally, patients who rated 3 points and above were considered satisfied while ratings less than 3 points were considered dissatisfied. Results: Knowledge of factors contributing to quality of care was 4.65 ± 0.48. General satisfaction rated 4.22 ± 0.52. Specifically, the different domains had the following scores: inter personal relationship 4.28 ± 0.81, technical aspect of care (availability of drugs, equipment and medical personnel) 4.29 ± 0.57 and facility convenience 4.21 ± 0.51. Conclusions: Knowledge of factors contributing to quality of care and overall patients’ satisfaction with inpatient care were good and comparable with patients’ satisfaction with tertiary health institutions in Nigeria. Mission hospitals may serve as excellent alternatives to government hospitals in resource limited settings to promote health equity across populations.