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Table 1 ESM-UBT training curriculum

From: A condom uterine balloon device among referral facilities in Dar Es Salaam: an assessment of perceptions, barriers and facilitators one year after implementation

• Contents of device: syringe with a Luer lock valve, condom, Foley catheter with cotton string

• Training and curriculum materials: PPH-UBT job aid checklist, a wall poster, PPH clinical pathway guide, a trainer’s flipchart, and a learner’s booklet

• Trainees were instructed to use the UBT within the context of the established national protocol for PPH, which first included active management of the third stage of labor:

• uterine massage

• emptying the bladder

• breastfeeding (if feasible)

• identifying and treating perineal or cervical tears

• administering prophylactic oxytocin and/or misoprostol (or other uterotonics if available)

• manual removal of the placenta and blood clots

• placement of the uterine balloon should occur if these interventions fail

• Training-of-trainers model: the training program was a participatory, skills-based training that used hands-on PPH scenarios and simple maternal uterine models made of local components (e.g. a pillow surrounding a plastic water bottle, which represented a uterus within an abdomen)

• Trainees were representative maternal health providers from each facility and were brought to a regional location for initial training.

• These providers then returned to their facilities and trained staff with the target of ensuring that at least 85% of maternity providers in each facility achieved competence in UBT placement (defined as ‘online’ status).

• All facilities received one wall chart checklist per delivery room, two manuals for PPH management and UBT use, and an adequate number of pre-deviced ESM-UBT kits (i.e. device and checklist).