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Ameh, Charles 
ORCID: https://orcid.org/0000-0002-2341-7605, Meka, Ramya Jyothi, West, Florence, Dickinson, Fiona ORCID: https://orcid.org/0000-0002-5298-9127, Allott, Helen and Godia, Pamela
(2022)
'A synthesis of clinical and health system bottlenecks to implementing new WHO postpartum hemorrhage recommendations: Secondary data analysis of the Kenya. Confidential Enquiry into Maternal Deaths 2014–2017'. International Journal of Gynecology & Obstetrics, Vol 158, Issue S1, pp. 14-22.
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Intl J Gynecology Obste - 2022 - Ameh - A synthesis of clinical and health system bottlenecks to implementing new WHO.pdf - Published Version Available under License Creative Commons Attribution Non-commercial No Derivatives. Download (880kB) | Preview |
Abstract
Objective
To describe maternal deaths from postpartum hemorrhage (PPH) in Kenya by secondary analysis of the Kenya Confidential Enquiry into Maternal Deaths (CEMD) database and clinical audit of a sample of those deaths, and to identify the perceived challenges to implementing country-specific PPH guidelines.
Methods
A retrospective descriptive study using the Kenyan CEMD database and anonymized maternal death records from 2014–2017. Eight standards from the Kenya National Guidelines for Quality Obstetric and Perinatal Care were selected to perform clinical audit. The process of supporting eight Sub-Saharan African countries to develop country-specific PPH guidelines was described and perceived challenges implementing these were identified.
Results
In total, 725 women died from PPH. Most women attended at least one antenatal care visit (67.2%) and most did not receive iron and folate supplementation (35.7%). Only 39.0% of women received prophylactic uterotonics in the third stage of labor. Factors significantly associated with receiving prophylactic uterotonics were place of delivery (χ2 = 43.666, df = 4; P < 0.001), being reviewed by a medical doctor (χ2 = 16.905, df = 1; P < 0.001), and being reviewed by a specialist (χ2 = 49.244, df = 1; P < 0.001). Only three of eight standards had a greater percentage of met cases in comparison to unmet cases. Key concerns about implementation of the new WHO PPH guidance included use of misoprostol by unskilled health personnel, availability of misoprostol and tranexamic acid (TXA) at primary healthcare level, lack of availability of heat-stable carbetocin (HSC) due to cost, lack of awareness and education about HSC and TXA, and lack of systems to ensure quality oxytocin is available at point of care.
Conclusion
There is a need for improved quality of care for women to minimize the risk of mortality from PPH, by implementing updated clinical guidelines combined with focused health system interventions.
| Item Type: | Article |
|---|---|
| Additional Information: | Special Issue: Improving access to essential medicines to reduce postpartum hemorrhage morbidity and mortality |
| Subjects: | WA Public Health > WA 30 Socioeconomic factors in public health (General) WA Public Health > Health Problems of Special Population Groups > WA 310 Maternal welfare WA Public Health > Health Administration and Organization > WA 530 International health administration WQ Obstetrics > Pregnancy Complications > WQ 252 Hematologic complications WQ Obstetrics > Labor > WQ 330 Complications of labor |
| Faculty: Department: | Clinical Sciences & International Health > International Public Health Department |
| Digital Object Identifer (DOI): | https://doi.org/10.1002/ijgo.14270 |
| Depositing User: | Mary Creegan |
| Date Deposited: | 25 Aug 2022 09:57 |
| Last Modified: | 06 Jun 2023 14:15 |
| URI: | https://archive.lstmed.ac.uk/id/eprint/20472 |
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