A review of postpartum hemorrhage in low‐income countries and implications for strengthening health systems

2021 ◽  
Author(s):  
Anderson Borovac‐Pinheiro ◽  
Preeti Priyadarshani ◽  
Thomas F. Burke
Keyword(s):  
Health Systems ◽  
Low Income ◽  
Postpartum Hemorrhage ◽  
Low Income Countries

scholarly journals Factors that influence the scale up of new interventions in low-income settings: a qualitative case study of the introduction of chlorhexidine cleansing of the umbilical cord in Bangladesh

2020 ◽  
Vol 35 (4) ◽  
pp. 440-451
Author(s):  
Jennifer A Callaghan-Koru ◽  
Munia Islam ◽  
Marufa Khan ◽  
Ardy Sowe ◽  
Jahrul Islam ◽  
...  
Keyword(s):  
Public Health ◽  
Health Systems ◽  
Umbilical Cord ◽  
Low Income ◽  
Qualitative Case Study ◽  
National Level ◽  
Scale Up ◽  
New Drugs ◽  
Low Income Countries

Abstract There is a well-recognized need for empirical study of processes and factors that influence scale up of evidence-based interventions in low-income countries to address the ‘know-do’ gap. We undertook a qualitative case study of the scale up of chlorhexidine cleansing of the umbilical cord (CHX) in Bangladesh to identify and compare facilitators and barriers for the institutionalization and expansion stages of scale up. Data collection and analysis for this case study were informed by the Consolidated Framework for Implementation Research (CFIR) and the WHO/ExpandNet model of scale up. At the national level, we interviewed 20 stakeholders involved in CHX policy or implementation. At the district level, we conducted interviews with 31 facility-based healthcare providers in five districts and focus group discussions (FGDs) with eight community-based providers and eight programme managers. At the community level, we conducted 7 FGDs with 53 mothers who had a baby within the past year. Expanded interview notes were thematically coded and analysed following an adapted Framework approach. National stakeholders identified external policy and incentives, and the engagement of stakeholders in policy development through the National Technical Working Committee for Newborn Health, as key facilitators for policy and health systems changes. Stakeholders, providers and families perceived the intervention to be simple, safe and effective, and more consistent with family preferences than the prior policy of dry cord care. The major barriers that delayed or decreased the public health impact of the scale up of CHX in Bangladesh’s public health system related to commodity production, procurement and distribution. Bangladesh’s experience scaling up CHX suggests that scale up should involve early needs assessments and planning for institutionalizing new drugs and commodities into the supply chain. While the five CFIR domains were useful for categorizing barriers and facilitators, additional constructs are needed for common health systems barriers in low-income settings.

scholarly journals Health systems performance assessment in low-income countries: learning from international experiences

2014 ◽  
Vol 10 (1) ◽  
pp. 5 ◽  
Author(s):  
Christine Tashobya ◽  
Valéria da Silveira ◽  
Freddie Ssengooba ◽  
Juliet Nabyonga-Orem ◽  
Jean Macq ◽  
...  
Keyword(s):  
Performance Assessment ◽  
Health Systems ◽  
Low Income ◽  
Low Income Countries ◽  
International Experiences ◽  
Health Systems Performance

Next Generation Medical Management of Postpartum Hemorrhage

2019 ◽  
Vol 25 (5) ◽  
pp. 549-555 ◽  
Author(s):  
Jaclyn M. Phillips ◽  
John N. van den Anker ◽  
Homa K. Ahmadzia
Keyword(s):  
Low Income ◽  
Postpartum Hemorrhage ◽  
Medical Management ◽  
Low Income Countries ◽  
Fibrinogen Concentrate ◽  
Childbearing Age ◽  
New Approach ◽  
Patients At Risk ◽  
Target Prevention ◽  
New Generation

Background: Postpartum hemorrhage remains a significant contributor to morbidity and mortality of women of childbearing age worldwide. Trends in both incidence and severity of postpartum hemorrhage are increasing which makes it imperative to identify drugs that could target prevention and/or treatment of these postpartum hemorrhages for women living in high, middle and low-income countries. Methods: We have reviewed current advances in the medical management of postpartum hemorrhage focusing on non-uterotonic therapy. We specifically describe the use and mechanism of action of tranexamic acid (TXA) and fibrinogen concentrate. Furthermore, we address the existing data for using these medications in postpartum hemorrhage, highlighting both strengths and limitations. Results: This review describes a new generation of medications that are promising for the prevention and/or treatment of postpartum hemorrhage. For patients at risk for significant hemorrhage, TXA has been shown to reduce intraoperative blood loss and can be given as a prophylactic agent. For the treatment of postpartum hemorrhage, early use of TXA has the potential to reduce mortality. In addition, some data exists supporting the use of fibrinogen concentrate, though more studies are required to help formulate guidelines for its use. Conclusion: A promising new approach for the management of severe postpartum hemorrhage is using medications that alter coagulation. More data are needed to describe ideal patient populations, dosing, the time of administration, and infusion rate.

scholarly journals Exploring health systems research and its influence on policy processes in low income countries

2007 ◽  
Vol 7 (1) ◽  
Author(s):  
Adnan A Hyder ◽  
◽  
Gerald Bloom ◽  
Melissa Leach ◽  
Shamsuzzoha B Syed ◽  
...  
Keyword(s):  
Health Systems ◽  
Low Income ◽  
Health Systems Research ◽  
Low Income Countries ◽  
Systems Research

scholarly journals Barriers inhibiting effective detection and management of postpartum hemorrhage during facility-based births in Madagascar: findings from a qualitative study using a behavioral science lens

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Sara V. Flanagan ◽  
Tina Razafinamanana ◽  
Charlotte Warren ◽  
Jana Smith
Keyword(s):  
Decision Making ◽  
Best Practices ◽  
Low Income ◽  
Postpartum Hemorrhage ◽  
Clinical Decision Making ◽  
Behavioral Science ◽  
Low Risk ◽  
Low Income Countries ◽  
Care Providers ◽  
Clinical Practices

Abstract Background Postpartum hemorrhage (PPH) is the leading cause of maternal mortality in low-income countries, and is the most common direct cause of maternal deaths in Madagascar. Studies in Madagascar and other low-income countries observe low provider adherence to recommended practices for PPH prevention and treatment. Our study addresses gaps in the literature by applying a behavioral science lens to identify barriers inhibiting facility-based providers’ consistent following of PPH best practices in Madagascar. Methods In June 2019, we undertook a cross-sectional qualitative research study in peri-urban and rural areas of the Vatovavy-Fitovinany region of Madagascar. We conducted 47 in-depth interviews in 19 facilities and five communities, with facility-based healthcare providers, postpartum women, medical supervisors, community health volunteers, and traditional birth attendants, and conducted thematic analysis of the transcripts. Results We identified seven key behavioral insights representing a range of factors that may contribute to delays in appropriate PPH management in these settings. Findings suggest providers’ perceived low risk of PPH may influence their compliance with best practices, subconsciously or explicitly, and lead them to undervalue the importance of PPH prevention and monitoring measures. Providers lack clear feedback on specific components of their performance, which ultimately inhibits continuous improvement of compliance with best practices. Providers demonstrate great resourcefulness while operating in a challenging context with limited equipment, supplies, and support; however, overcoming these challenges remains their foremost concern. This response to chronic scarcity is cognitively taxing and may ultimately affect clinical decision-making. Conclusions Our study reveals how perception of low risk of PPH, limited feedback on compliance with best practices and consequences of current practices, and a context of scarcity may negatively affect provider decision-making and clinical practices. Behaviorally informed interventions, designed for specific contexts that care providers operate in, can help improve quality of care and health outcomes for women in labor and childbirth.

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