{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,27]],"date-time":"2026-06-27T02:21:07Z","timestamp":1782526867448,"version":"3.54.5"},"reference-count":21,"publisher":"Public Library of Science (PLoS)","issue":"5","license":[{"start":{"date-parts":[[2021,5,20]],"date-time":"2021-05-20T00:00:00Z","timestamp":1621468800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Embassy of Ireland with complementary contribution from the Zimbabwe Ministry of Health and Child Care"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:p>The Non-Pneumatic Anti-Shock Garment (NASG) is a first aid tool that can halt and reverse hypovolemic shock secondary to obstetric hemorrhage. The World Health Organization recommended the NASG for use as a temporizing measure in 2012, but uptake of the recommendation has been slow, partially because operational experience is limited. The study is a process evaluation of the introduction of NASG in a public sector health facility network in rural Zimbabwe utilizing an adapted RE-AIM, categorizing observations into the domains of: reach, effectiveness, adoption, implementation and maintenance. The location of the study was Hurungwe district, where staff members of 34 health facilities at primary (31), secondary (2) and tertiary (1) levels of care participated. We found that all facilities became skilled in using the NASG, and that the NASG was used in 10 of 11 instances of severe hemorrhage. In the cases of hypovolemic shock where the NASG was used, there were no maternal deaths and no extreme adverse outcomes related to obstetric hemorrhage in the study period. Among the 10 NASG uses, the garment was used correctly in each case. Fidelity to processes was high, especially in regard to training and cascading skills, but revisions of the NASG rotation and replacement operating procedures were required to keep clean garments stocked. Clinical documentation was also a key challenge. NASG introduction dovetailed very well with pre-existing systems for obstetric emergency response, and improved clinical outcomes. Scale-up of the NASG in the Zimbabwean public health system can be undertaken with careful attention to mentorship, drills, documentation and logistics.<\/jats:p>","DOI":"10.1371\/journal.pone.0251908","type":"journal-article","created":{"date-parts":[[2021,5,20]],"date-time":"2021-05-20T17:44:34Z","timestamp":1621532674000},"page":"e0251908","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":4,"title":["Applying the RE-AIM framework in a process evaluation of the introduction of the Non-Pneumatic Anti-Shock Garment in a rural district of Zimbabwe"],"prefix":"10.1371","volume":"16","author":[{"given":"Thulani Leslie","family":"Magwali","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abaden","family":"Svisva","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tarryn","family":"Bowers","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fishiwe","family":"Chiyaka","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jenna-Dawn","family":"Conway","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernard","family":"Madzima","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Violet","family":"Mambo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexio","family":"Mangwiro","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6455-6206","authenticated-orcid":true,"given":"Andy Elizabeth","family":"Carmone","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2021,5,20]]},"reference":[{"key":"pone.0251908.ref001","author":"World Health Organization","year":"2019"},{"key":"pone.0251908.ref002","volume-title":"Zimbabwe Demographic and Health Survey 2015: Final Report","author":"Zimbabwe National Statistics Agency and ICF International","year":"2019"},{"key":"pone.0251908.ref003","volume-title":"Maternal and Perinatal Death Surveillance and Response 2018 Annual Report","author":"Zimbabwe Ministry of Health and Child Care","year":"2019"},{"issue":"8","key":"pone.0251908.ref004","doi-asserted-by":"crossref","first-page":"e0160170","DOI":"10.1371\/journal.pone.0160170","article-title":"Praying until Death: Apostolicism, Delays and Maternal Mortality in Zimbabwe","volume":"11","author":"D Munyaradzi Kenneth","year":"2016","journal-title":"PLoS 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maternal mortality from obstetric hemorrhage: a cluster randomized trial","volume":"8","author":"S Miller","year":"2013","journal-title":"PLoS One"},{"key":"pone.0251908.ref011","volume-title":"WHO recommendations for the prevention and treatment of postpartum haemorrhage","author":"World Health Organization","year":"2012"},{"key":"pone.0251908.ref012","author":"Clinton Health Access Initiative","year":"2013"},{"key":"pone.0251908.ref013","article-title":"Evaluation of Accelerating progress to achieve health related MDGs in Nigeria","author":"KPMG","year":"2016","journal-title":"Abuja"},{"key":"pone.0251908.ref014","doi-asserted-by":"crossref","first-page":"986","DOI":"10.1007\/s10995-018-2476-3","article-title":"Advancing survival in Nigeria: a pre-post evaluation of an integrated maternal and neonatal health program","volume":"22","author":"NL Sloan","year":"2018","journal-title":"Maternal Child Health Journal"},{"key":"pone.0251908.ref015","author":"Clinton Health Access Initiative","year":"2015","journal-title":"Deploying the non-pneumatic anti-shock garments to reduce maternal mortality"},{"key":"pone.0251908.ref016","unstructured":"UNFPA Procurement Services [Internet]. New York (US): UNFPA Product Catalog. Available from: https:\/\/www.unfpaprocurement.org\/products"},{"key":"pone.0251908.ref017","author":"Intertek Testing Services Hong Kong Ltd","year":"2014","journal-title":"Blue Fuzion Group NASG washing test, Number: HKGT03862055-S1"},{"key":"pone.0251908.ref018","unstructured":"United Nations Commission on Life Saving Commodities. UN Commission on Life Saving Commodities 2014 Progress Report. Geneva; 2015. 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