1. POPPHI 2009 UPDATE NON-PNEUMATIC ANTI- SHOCK GARMENT (NASG) POPPHI 2009 UPDATE SUELLEN MILLER, CNM, PHD DIRECTOR, SAFE MOTHERHOOD PROGRAMS, BIXBY CENTER FOR GLOBAL REPRODUCTIVE HEALTH, UCSF Presented by Carinne Meyer, MA, MPH

2. The NASG: Low-cost, Low Tech Life Saving Device

3. Update on Research  Nigeria: Pre-Post Study (Completed)  Egypt: Pre-Post Study (Completed)  Zambia/Zimbabwe: Cluster Randomized Trial (In Progress)

4. Nigeria Study (Mar. 04 – Nov. 08)  Pre-intervention/intervention study design  12 referral hospitals in Northern and Southern Nigeria  Entry criteria were OH of any etiology (> = 750 ml) and one clinical sign of shock.  Outcomes: mean measured blood loss and mortality. PhaseN=756 Pre-intervention /Standard Treatment 182 Intervention / NASG574

5. Ongoing Collaboration

6. Egypt Study (June 06 – May 08)  Pre-intervention/intervention study design  2 referral facilities in Egypt  Entry criteria were OH of any etiology (> = 750 ml) and one clinical sign of shock.  Outcomes: mean measured blood loss, mortality, severe morbidities and extreme adverse outcomes. PhaseN=990 Pre-intervention /Standard Treatment 432 Intervention / NASG558

7. Zambia/Zimbabwe RCT Design: Cluster Randomized Trial Funding: NIH and Gates Foundation Data Coordination: WHO, RHRU Data Management: Centro Rosario Estudios Perinatales (CREP) (Argentina) OpenClinica Research Collaboration: University Teaching Hospital in Lusaka, Zambia and the University of Zimbabwe (UZ-UCSF RH Collaborative)

8. Why a RCT? The RCT is designed to early application determine if early application at the primary care level by midwives will IMPROVE MATERNAL OUTCOMES.

9. Randomized Cluster Trial Clinics Referral Hospital SiteClusters Harare12 Lusaka12 Copperbelt13

10. Study Design – Example Lusaka

11. Study Timeline October 2007October 2008 June 2008 October 2009May 2009 Feb 2009 July 2009 LUSAKA – Phase 1 HARARE – Phase 1 LUSAKA – Phase 3 LUSAKA – Phase 2 HARARE – Phase 3 HARARE – Phase 2 COPPERBELT– Phase 3 COPPERBELT– Phase 2 COPPERBELT– Phase 1

12. Thank You.