Healthcare providers' knowledge and practices associated with postpartum hemorrhage during facility delivery in Dar es Salaam, Tanzania

Abstract

Objective: To investigate healthcare providers' knowledge and practices associated with prevention and management of postpartum hemorrhage (PPH) to improve care in urban settings and reduce maternal morbidity and mortality.

Methods: As part of a cross-sectional, survey-based study, providers from 14 government health facilities providing maternal delivery services in the Ilala Municipality, Dar es Salaam, Tanzania, were surveyed about PPH-related practices and knowledge in April 2015. The data were analyzed descriptively, and χ² tests of independence were used to examine relationships between experience, facility type, and knowledge.

Results: Among 115 respondents, 7 (6.1%) answered all PPH knowledge questions correctly. The mean knowledge score was 63.9%±21.1%. Non-calibrated methods for estimating postpartum blood loss were common; only 62 (53.9%) respondents reported direct collection. Referral of patients for PPH-related transfer was reported by 49 (42.6%) respondents; transportation and finances were barriers to transfer. Respondents requested continued training and additional supplies to address emergencies.

Conclusion: Healthcare providers had suboptimal knowledge of PPH risk factors, diagnosis, and causes. Strategies that provide ongoing education and equip lower-level facilities with adequate supplies might minimize PPH-related transfers. Providing prenatal women with basic delivery items (e.g. a blood collection device) and misoprostol is a viable option to ensure that essential PPH-prevention tools are available at delivery.

Keywords: Facility delivery; Healthcare providers; Knowledge; Maternal morbidity; Maternal mortality; Midwives; Postpartum hemorrhage; Tanzania.