Please use this identifier to cite or link to this item: https://doi.org/10.1371/journal.pgph.0001670
Title: Quality of care for postpartum hemorrhage: A direct observation study in referral hospitals in Kenya
Authors: Clarke-Deelder, Emma
Opondo, Kennedy
Achieng, Emmaculate
Garg, Lorraine
Han, Dan 
Henry, Junita
Guha, Moytrayee
Lightbourne, Alicia
Makin, Jennifer
Miller, Nora
Otieno, Brenda
Borovac-Pinheiro, Anderson
Suarez-Rebling, Daniela
Menzies, Nicolas A
Burke, Thomas
Oguttu, Monica
McConnell, Margaret
Cohen, Jessica
Issue Date: 2023
Publisher: Public Library of Science (PLoS)
Citation: Clarke-Deelder, Emma, Opondo, Kennedy, Achieng, Emmaculate, Garg, Lorraine, Han, Dan, Henry, Junita, Guha, Moytrayee, Lightbourne, Alicia, Makin, Jennifer, Miller, Nora, Otieno, Brenda, Borovac-Pinheiro, Anderson, Suarez-Rebling, Daniela, Menzies, Nicolas A, Burke, Thomas, Oguttu, Monica, McConnell, Margaret, Cohen, Jessica (2023). Quality of care for postpartum hemorrhage: A direct observation study in referral hospitals in Kenya. PLOS Global Public Health 3 (3) : e0001670-e0001670. ScholarBank@NUS Repository. https://doi.org/10.1371/journal.pgph.0001670
Abstract: Postpartum hemorrhage (PPH) is the leading cause of maternal mortality in Kenya. The aim of this study was to measure quality and timeliness of care for PPH in a sample of deliveries in referral hospitals in Kenya. We conducted direct observations of 907 vaginal deliveries in three Kenyan hospitals from October 2018 through February 2019, observing the care women received from admission for labor and delivery through hospital discharge. We identified cases of “suspected PPH”, defined as cases in which providers indicated suspicion of and/or took an action to manage abnormal bleeding. We measured adherence to World Health Organization and Kenyan guidelines for PPH risk assessment, prevention, identification, and management and the timeliness of care in each domain. The rate of suspected PPH among the observed vaginal deliveries was 9% (95% Confidence Interval: 7% - 11%). Health care providers followed all guidelines for PPH risk assessment in 7% (5% - 10%) of observed deliveries and all guidelines for PPH prevention in 4% (3% - 6%) of observed deliveries. Lowest adherence was observed for taking vital signs and for timely administration of a prophylactic uterotonic. Providers did not follow guidelines for postpartum monitoring in any of the observed deliveries. When suspected PPH occurred, providers performed all recommended actions in 23% (6% - 40%) of cases. Many of the critical actions for suspected PPH were performed in a timely manner, but, in some cases, substantial delays were observed. In conclusion, we found significant gaps in the quality of risk assessment, prevention, identification, and management of PPH after vaginal deliveries in referral hospitals in Kenya. Efforts to reduce maternal morbidity and mortality from PPH should emphasize improvements in the quality of care, with a particular focus on postpartum monitoring and timely emergency response.
Source Title: PLOS Global Public Health
URI: https://scholarbank.nus.edu.sg/handle/10635/243419
ISSN: 2767-3375
DOI: 10.1371/journal.pgph.0001670
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