Detection and management of postpartum haemorrhage: Qualitative evidence on healthcare providers' knowledge and practices in Kenya, Nigeria, and South Africa

• DOI: 10.3389/fgwh.2022.1020163
• Publication Date: 2022-11-18T05:29:50Z
• Authors: Shahinoor Akter; Gillian Forbes; Suellen Miller; Hadiza Galadanci; Zahida Qureshi; Sue Fawcus; G. Justus Hofmeyr; Neil Moran; Mandisa Singata-M...; Taiwo Gboluwaga A...; George Gwako; Alfred Osoti; Eleanor Thomas; Ioannis Gallos; Kristie-Marie Mam...; Arri Coomarasamy; Fernando Althabe; Fabiana Lorencatto; Meghan A. Bohren
• Keywords: Biomedical and clinical sciences; Developing country; Economics; FOS: Political science; 8.1 Organisation and delivery of services; CLINICAL CARE BUNDLES; FOS: Health sciences; maternal health; Context (archaeology); 0302 clinical medicine; Sociology; https://purl.org/becyt/ford/3.3; Maternal Morbidity Associated with Pregnancy and Childbirth; Psychology; Government (linguistics); Business; Political science; Economic shortage; Marketing; Geography; Obstetrics and Gynecology; Health Services; Social science; clinical care bundles; FOS: Philosophy, ethics and religion; FOS: Sociology; 3. Good health; Service provider; Archaeology; postpartum haemorrhage; Emergency Medicine; Medicine; Public Health; Health and social care services research; Maternal and Neonatal Outcomes of Cesarean Section; Women. Feminism; Medical emergency; 610; FOS: Law; Nursing; Midwifery; 618; POSTPARTUM HAEMORRHAGE; Global Women's Health; FOS: Economics and business; 03 medical and health sciences; formative research; /dk/atira/pure/subjectarea/asjc/2700/2700; Clinical Research; Qualitative research; Service (business); Health Sciences; https://purl.org/becyt/ford/3; name=General Medicine; Economic growth; FORMATIVE RESEARCH; Biomedical and Clinical Sciences; maternal mortality; Prevention; Postpartum Hemorrhage; Health care; Health sciences; HQ1101-2030.7; Linguistics; Gynecology and obstetrics; QUALITATIVE RESEARCH; MATERNAL HEALTH; Thematic analysis; Philosophy; Good Health and Well Being; Emergency Department Crowding; Reproductive Medicine; MATERNAL MORTALITY; Pediatrics, Perinatology and Child Health; RG1-991; FOS: Languages and literature; Law; qualitative research

BackgroundPostpartum haemorrhage (PPH) is the leading cause of maternal death globally. Most PPH deaths can be avoided with timely detection and management; however, critical challenges persist. A multi-country cluster-randomised trial (E-MOTIVE) will introduce a clinical care bundle for early detection and first-response PPH management in hospital settings. This formative qualitative study aimed to explore healthcare providers' knowledge and practices of PPH detection and management after vaginal birth, to inform design and implementation of E-MOTIVE.MethodsBetween July 2020–June 2021, semi-structured qualitative interviews were conducted with 45 maternity healthcare providers (midwives, nurses, doctors, managers) of nine hospitals in Kenya, Nigeria, and South Africa. A thematic analysis approach was used.ResultsFour key themes were identified, which varied across contexts: in-service training on emergency obstetric care; limited knowledge about PPH; current approaches to PPH detection; and current PPH management and associated challenges. PPH was recognised as an emergency but understanding of PPH varied. Early PPH detection was limited by the subjective nature of visual estimation of blood loss. Lack of expertise on PPH detection and using visual estimation can result in delays in initiation of PPH management. Shortages of trained staff and essential resources, and late inter-hospital referrals were common barriers to PPH management.ConclusionThere are critical needs to address context-specific barriers to early and timely detection and management of PPH in hospital settings. These findings will be used to develop evidence-informed implementation strategies, such as improved in-service training, and objective measurement of blood loss, which are key components of the E-MOTIVE trial (Trial registration: ClinicalTrials.gov: NCT04341662).