Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Nov 18:3:1020163.
doi: 10.3389/fgwh.2022.1020163. eCollection 2022.

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

Shahinoor Akter  1 , Gillian Forbes  2 , Suellen Miller  3 , Hadiza Galadanci  4 , Zahida Qureshi  5 , Sue Fawcus  6 , G Justus Hofmeyr  7   8 , Neil Moran  9 , Mandisa Singata-Madliki  8 , Taiwo Gboluwaga Amole  10 , George Gwako  5 , Alfred Osoti  5   11 , Eleanor Thomas  12 , Ioannis Gallos  12 , Kristie-Marie Mammoliti  12 , Arri Coomarasamy  12 , Fernando Althabe  13 , Fabiana Lorencatto  2 , Meghan A Bohren  1
Affiliations

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

Shahinoor Akter et al. Front Glob Womens Health. .

Abstract

Background: Postpartum 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.

Methods: Between 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.

Results: Four 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.

Conclusion: There 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).

Keywords: clinical care bundles; formative research; maternal health; maternal mortality; postpartum haemorrhage; qualitative research.

PubMed Disclaimer

Conflict of interest statement

Professor Suellen Miller's University (University of California San Francisco) holds the license for the Trademark name “LifeWrap.” The LifeWrap is the name of one first-aid device used in refractory postpartum haemorrhage, the Nonpneumatic Anti-Shock Garment (NASG). The manufacturer of the LifeWrap NASG pays the University of California a royalty for the use of the name. Professor Justus Hofmeyr has conceived a re-usable device for postpartum blood loss monitoring, the “Safe Birth Tray”, which is under development by Equalize Health, a non-profit global health organization who hold the intellectual property. JH may in future benefit from sales of the device. The remaining authors declare that they have no competing interests.

Figures

Figure 1
Figure 1
Current practices and key challenges about detection and primary PPH response in nine hospitals in Kenya, Nigeria, and South Africa, based on the findings from 45 interviews.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Kassebaum NJ, Bertozzi-Villa A, Coggeshall MS, Shackelford KA, Steiner C, Heuton KR, et al. Global, regional, and national levels and causes of maternal mortality during 1990–2013: a systematic analysis for the global burden of disease study 2013. Lancet. (2014) 384(9947):980–1004. 10.1016/S0140-6736(14)60696-6 - DOI - PMC - PubMed
    1. UNICEF. Maternal mortality (2019). Available at: https://data.unicef.org/topic/maternal-health/maternal-mortality/ (updated September 2019).
    1. Althabe F, Therrien MN, Pingray V, Hermida J, Gülmezoglu AM, Armbruster D, et al. Postpartum hemorrhage care bundles to improve adherence to guidelines: a WHO technical consultation. Int J Gynecol Obstet. (2020) 148(3):290–9. 10.1002/ijgo.13028 - DOI - PMC - PubMed
    1. Goffman D, Nathan L, Chazotte C, editors. Obstetric hemorrhage: a global review. Semin. Perinatol. (2016) 40:96–8. 10.1053/j.semperi.2015.11.014 - DOI - PubMed
    1. Borovac-Pinheiro A, Pacagnella R, Cecatti J, Miller S, El Ayadi A, Souza J, et al. Postpartum hemorrhage: new insights for definition and diagnosis. Am J Obstet Gynecol. (2018) 219(2):162–8. 10.1016/j.ajog.2018.04.013 - DOI - PubMed

Associated data