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

Abstract

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).

An exploratory study to unveil the behavioral aspects and practical approaches of healthcare providers to detect and manage the post-partum hemorrhage: Insights from the COM-B model

“…Lack of training of the HCPs, risk factor screening, timely diagnosis, volume administration, blood transfusion and hospital infrastructure were some barriers in PPH detection and management reported in this study. Although the WHO recommends the appointment of well trained staff to prevent and manage the PPH (31), the shortage of well-trained healthcare staff is global challenge but it is intensi ed in LMICs including Pakistan (13,20,21,31). Only one respondent of this study attended an awareness session conducted by an institution.…”

“…The reason could be the unfamiliarity of modern trends due to unavailability of technology, no access to research, no compulsion of updating practices by hospital management, unavailability of training and awareness sessions. These trends are very common in other LMICs (12,19,31). Even when there is a global consent about the importance of establishing management protocols for PPH, there are no universal practice guidelines (32).…”

“…The interview schema was designed after a comprehensive literature review and was developed to best answer the research problems and identify gaps in the existing literature (19)(20)(21). Interview schema was pilot tested by conducting two interviews from target participants to con rm the validity of study protocol (20).…”

“…This study was conducted in southern area of Punjab province, Pakistan. Southern Punjab has 3 divisions (Bahawalpur, Dera Ghazi Khan and Multan) which encompasses 11 districts comprising approximately 32% of Punjab's population (34.7 million people) and 45% of Punjab's land area (19).…”

Global Emergency Medicine: A Scoping Review of the Literature from 2022

“…found that by task shifting point‐of‐care ultrasound to health workers without prior ultrasound training, it can be implemented in a variety of low‐resource contexts with short‐term training. Akter et al 41 . provided formative qualitative data on a critical care bundle that showed that early detection and management of postpartum hemorrhage could be improved through in‐service and multidisciplinary trainings and simulations as well as through objective means of assessing blood loss.…”